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Applying Cultural Safety Applying Cultural Safety in Australiain Australia

Gregory PhillipsGregory PhillipsMonash UniversityMonash University

The LIME Connection III The LIME Connection III Melbourne December 2009Melbourne December 2009

22

AustraliaAustralia

Waanyi

country

Jaru country

33

44

OutlineOutline

Case studies of cultural safety in actionCase studies of cultural safety in action

Elements of cultural safetyElements of cultural safety

Organisational reformOrganisational reform

A model of applied cultural safetyA model of applied cultural safety

55

Case Study 1: Medical SchoolsCase Study 1: Medical Schools

Key subject areas and outcomes

Pedagogical principles

Assessment guidelines

Processes for development over time

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Lessons LearnedLessons Learned

The ‘why’ is as important as the ‘how’The ‘why’ is as important as the ‘how’

‘‘Context’ is more important than the Context’ is more important than the ‘content’‘content’

A new curriculum required capacity building A new curriculum required capacity building of staffof staff

- can’t rely on individual champions- can’t rely on individual champions- The LIME Network and accreditation- The LIME Network and accreditation

‘‘Indigenous leadership; faculty responsibility’Indigenous leadership; faculty responsibility’

Concepts of cultural awareness, cultural Concepts of cultural awareness, cultural safety, Indigenous health and Indigenous safety, Indigenous health and Indigenous knowledge were used interchangeably, and knowledge were used interchangeably, and with confusion!with confusion!

77

Case Study 2: A mainstream Case Study 2: A mainstream mental health organisationmental health organisation

Organisation with significant resources; multi-site operations; keen CEO and Board; 1 Aboriginal Board member

Operating for 3 years with no Indigenous strategy; contract consultant to develop one

Specific discussions about decision-making & governance structures so as not to form just another advisory committee

Indigenous strategy group formed; spends significant time and resources developing trust

Strategy recommends Indigenous staff and internal commitment to restructuring existing operations as a baseline, as well as external big ticket item of healing/wellbeing centres

CEO goes to government for $20m in specific funds for healing centres without speaking to Board member, consultant or Strategy committee

CEO Cannot understand why Board member and consultant are not supportive

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Lessons LearnedLessons Learned

Governance and power relationships as Governance and power relationships as critical as ‘the business’critical as ‘the business’

Internal baseline work must be achieved:Internal baseline work must be achieved:– Staff development and cross-cultural learningStaff development and cross-cultural learning– Hiring Indigenous staffHiring Indigenous staff– Partnership arrangement with community at largePartnership arrangement with community at large– Governance and decision-making strategiesGovernance and decision-making strategies– Communications with communities and access Communications with communities and access

issuesissues External ‘the business’ – must have the right External ‘the business’ – must have the right

internal baseline supportsinternal baseline supports The application of cultural safety didn’t The application of cultural safety didn’t

match the intentionmatch the intention

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Case Study 3: AotearoaCase Study 3: Aotearoa

Irihapeti Ramsden and others in Aotearoa/NZ Irihapeti Ramsden and others in Aotearoa/NZ lobbied for curriculum reform in nursing schools lobbied for curriculum reform in nursing schools

(1990)(1990)

Over time, health and public health institutions Over time, health and public health institutions include cultural safety in key legislation, policies include cultural safety in key legislation, policies and strategiesand strategies

An argument begins to be made about cultural An argument begins to be made about cultural safety for all meaning no need for Maori healthsafety for all meaning no need for Maori health

Maori health advocates forced to defend Maori Maori health advocates forced to defend Maori health specific strategieshealth specific strategies

(Pitama, 2006)(Pitama, 2006)

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Lessons LearnedLessons Learned

Must be more specific about the relationship Must be more specific about the relationship between cultural safety and Indigenous between cultural safety and Indigenous healthhealth

Cultural safety and Indigenous health are Cultural safety and Indigenous health are related, but not the samerelated, but not the same

Must guard against mainstreamingMust guard against mainstreaming

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Elements of Cultural SafetyElements of Cultural Safety

Moving from ‘cultural awareness’ to ‘cultural Moving from ‘cultural awareness’ to ‘cultural safety’safety’

Moving from ‘othering’ Moving from ‘othering’ (Moreton-Robinson, 2000)(Moreton-Robinson, 2000) to to reflexivity reflexivity (Elston, 2003; Phillips, 2005)(Elston, 2003; Phillips, 2005)

Cultural safety includes:Cultural safety includes:– information and individual change (cultural information and individual change (cultural

awareness)awareness)– institutional change and organisational responsibility institutional change and organisational responsibility

(organisational reform)(organisational reform)– effective decision-making and governance (power effective decision-making and governance (power

relations)relations)– internal and external focusinternal and external focus– the right motivationsthe right motivations– Is strengths-based not deficit-ladenIs strengths-based not deficit-laden

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A Model of Applied Cultural A Model of Applied Cultural Safety Safety

in Australiain Australia

CulturalCultural

SafetySafety

‘‘levelling the levelling the playing field’playing field’

Indigenous Indigenous

HealthHealth

‘‘the business’the business’Indigenous Knowledge

‘Indigenous Knowledge’ is about Intellectual Property - and depends on PLACE, history, social phenomena, languages, customs, cultures, spiritualities and religions

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Organisational Reform: InternalOrganisational Reform: Internal

Decision-making and governance – Decision-making and governance – ‘Indigenous leadership, organisational ‘Indigenous leadership, organisational responsibility’responsibility’

Partnerships (not advisory but design, Partnerships (not advisory but design, decision-making and evaluation)decision-making and evaluation)

Funds committedFunds committed Employing Indigenous staff at senior, mid Employing Indigenous staff at senior, mid

and junior levelsand junior levels Career development for Indigenous staffCareer development for Indigenous staff Cultural safety training for all staffCultural safety training for all staff

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Indigenous health: ExternalIndigenous health: External

Strengths-basedStrengths-based

Community-focussedCommunity-focussed

Community developmentCommunity development

A new paradigm of health – people and A new paradigm of health – people and communities are their own healers, health communities are their own healers, health care workers are the facilitators and care workers are the facilitators and technical helperstechnical helpers

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Whose responsibility is Whose responsibility is change?change?

Internal ‘levelling the playing field’ cultural Internal ‘levelling the playing field’ cultural safety is the responsibility of non-Indigenous safety is the responsibility of non-Indigenous people and institutionspeople and institutions

External ‘the business’ of Indigenous health is External ‘the business’ of Indigenous health is the responsibility of Indigenous people and the responsibility of Indigenous people and communitiescommunities

To apply cultural safety well, individuals and To apply cultural safety well, individuals and institutions must be:institutions must be:– ReflexiveReflexive– Cognisant of place and Indigenous history and Cognisant of place and Indigenous history and

knowledgeknowledge– Have the right motivationsHave the right motivations– Have undertaken internal organisation reform and Have undertaken internal organisation reform and

redressed power imbalancesredressed power imbalances

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ReferencesReferences

Australian Medical Council. 2007. Australian Medical Council. 2007. Assessment and Accreditation of Assessment and Accreditation of Medical Schools: Standards and Procedures.Medical Schools: Standards and Procedures. Canberra: AMC Canberra: AMC

Elston, Jacinta. 2003. Personal Communications.Elston, Jacinta. 2003. Personal Communications.Hendricks, Aunty Joan. 2005. Personal communication: Indigenous Hendricks, Aunty Joan. 2005. Personal communication: Indigenous

Health Education Workshop, Faculty of Health Sciences, The Health Education Workshop, Faculty of Health Sciences, The University of Queensland, 6 April.University of Queensland, 6 April.

Moreton-Robinson, A. 2000. Moreton-Robinson, A. 2000. Talkin' up to the white woman: Aboriginal Talkin' up to the white woman: Aboriginal women and feminism.women and feminism. St Lucia: University Of Queensland Press. St Lucia: University Of Queensland Press.

Phillips, G. 2004. Phillips, G. 2004. CDAMS Indigenous Health Curriculum Framework.CDAMS Indigenous Health Curriculum Framework. Melbourne: VicHealth Koori Health Research and Community Melbourne: VicHealth Koori Health Research and Community Development Unit, The University of Melbourne.Development Unit, The University of Melbourne.

Phillips, G. 2005. “Relationships, Respect and Responsibility”: Cultural Phillips, G. 2005. “Relationships, Respect and Responsibility”: Cultural Safety and Ensuring Quality Curriculum for Indigenous Health in Safety and Ensuring Quality Curriculum for Indigenous Health in Medical Education. In Australian Universities Quality Forum Medical Education. In Australian Universities Quality Forum Proceedings. Sydney: AUQA Occasional Paper Number 5. Pp131-Proceedings. Sydney: AUQA Occasional Paper Number 5. Pp131-135.135.

Pitama, Suzanne. 2006. Personal Communications.Pitama, Suzanne. 2006. Personal Communications.Ramsden, I. 1990. Ramsden, I. 1990. Whakarururhau: Cultural Safety in Nursing Whakarururhau: Cultural Safety in Nursing

Education in AotearoaEducation in Aotearoa. A Report for the Maori Health and Nursing . A Report for the Maori Health and Nursing Committee. Wellington: New Zealand Ministry of Education.Committee. Wellington: New Zealand Ministry of Education.