Cultural Safety is a Journey: Reflections from the Cultural Safety Design Collaborative

Healthcare Excellence Canada (HEC) identifies cultural safety and equity as one of five foundations of healthcare excellence in its refreshed strategy — alongside patient and community perspectives, workforce experience, First Nations, Inuit and Métis priorities, and the appropriate use of technology.

This reflects a growing recognition that care cannot be considered high-quality or safe if people experience racism, discrimination or exclusion.

The Cultural Safety Design Collaborative is one way this work is being advanced across the country. Supported by HEC, the collaborative brought together teams from across the country to address systemic racism and improve culturally safe care for First Nations, Inuit and Métis. A collection of stories, lessons and lived experiences emerged from this work, reminding us that meaningful change begins with listening, humility and relationship.

Why cultural safety is essential to quality and safety

Racism experienced by First Nations, Inuit and Métis in the healthcare system is a significant patient safety and quality issue. It can contribute to mistrust, delays in care and preventable harm. As healthcare organizations work to improve outcomes, there is growing recognition that cultural safety and equity are foundational to delivering effective care.

The Cultural Safety Design Collaborative brought together twelve teams committed to doing this work, supporting them with coaching, resources and a shared space to learn and reflect. While improving cultural safety is an ongoing journey, this work offers important insights into what is helping drive meaningful change.

What system supports are required for cultural safety improvement?

Across their diverse settings and projects, similar themes began to emerge in what helped move their work forward.

Partnerships and community engagement

Teams worked alongside First Nations, Inuit and Métis leaders, Elders, health authorities, governments, friendship centres, families and traditional practitioners. These partnerships increased trust, strengthened community engagement and led to shared decision-making. Teams emphasize a non-extractive approach – listening first, asking what communities need and then co-creating solutions together – was essential.

As one participant shared, “you cannot operate alone in this journey. Partnerships keep the fire alive.”

Readiness for change and leadership at every level

Meaningful change requires readiness within organizations and across communities. Many acknowledged past harms and recognized the urgent need to do better. Leadership at all levels mattered. From system leaders to point-of-care providers, champions and advocates helped sustain momentum and navigate challenges. Teams also highlighted the importance of having the right people at the table – leaders who were committed, present and willing to act.

A wholistic and Indigenous-led approach

Health, culture, ceremony, environment and community are inseparable – and First Nations, Inuit and Métis leadership is essential in addressing power imbalances and ensuring the work remains community-driven.

As one team shared, “true reconciliation takes place when Nations are leading.”

Funding and capacity

Many teams noted that cultural safety work is often done 'off the side of the desk.' Sustainable, dedicated investment is necessary to support lasting change, build capacity and honour the scope of this work.

Wise practices from the Cultural Safety Design Collaborative

The Cultural Safety Design Collaborative was rooted in the understanding that racism continues to shape healthcare experiences. Teams identified wise practices that help address this reality – not as checklists, but as ways of working towards meaningful change.

Honour First Nations, Inuit and Métis culture and teachings

Teams integrated ceremonies, traditional medicines, language revitalization, country foods and culturally welcoming spaces into healthcare settings. Providing Elder support and engaging in traditional practices like smudging or lighting a Qulliq can help patients feel safe, seen and connected to home.

As one team shared, “culture is a protective factor. Culture is healing.”

Go into community

Visiting communities – being invited in, listening deeply and building friendships – can transform relationships. Seeing firsthand the realities of people’s lives helps healthcare providers move beyond assumptions and toward empathy and collaboration.

Employ patient advocates and navigators

Many teams included Indigenous patient advocates, navigators or liaison workers. These individuals play an important role in supporting patients and families, navigating complex systems, providing translation and ensuring voices are heard, often reducing fear and misunderstanding.

Centre patient and Elder voices

Patient input, Elder circles and advisory committees were central to project design and decision-making for many teams. Centering these voices helps ensure changes reflect lived experience rather than institutional assumptions.

What changed and why it matters

While the work to improve cultural safety in healthcare settings continues, the Cultural Safety Design Collaborative contributed to many meaningful impacts, including:

• Reduced patient complaints and conflict

• Increased trust and comfort within healthcare spaces

• Greater understanding of power imbalances

• Improved communication and feedback

• Stronger connections between communities and healthcare settings

• Patients feeling respected, valued and safe

This work highlights a broader shift: cultural safety and equity are not add-ons, but foundational to delivering safe, high-quality care.

What’s next

The Cultural Safety Design Collaborative demonstrated that when First Nations, Inuit and Métis voices lead, when relationships come first and when systems are willing to change, healthcare can become safer and more equitable for everyone. It’s not about quick fixes, but about lasting change. As one teaching reminds us, “we do this work for seven generations – not just for today.”

Healthcare leaders, providers and partners all have a role to play. The reflections from this work offer a starting point — grounded in listening, partnership and sustained commitment.

In June, HEC is launching a new, two-year learning collaborative to support organizations to address systemic racism and advance culturally safe care – leading to safer experiences, stronger trust and improved outcomes for First Nations, Inuit and Métis patients and communities. Sign up to be the first to learn about the opportunity to join this collaborative when it launches.