Cultural Safety

Overview

Cultural safety is defined by the Australian Health Practitioner Regulation Agency and National Health Leadership Forum of Aboriginal and Torres Strait Islander health peak organisations (in consultation with the MBA and AMC) as follows:

‘Cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities. Culturally safe practice is the ongoing critical reflection of health practitioner knowledge, skills, attitudes, practicing behaviours and power differentials in delivering safe, accessible and responsive healthcare free of racism.’ 

‘Patient safety for Aboriginal and Torres Strait Islander Peoples is the norm. We recognise that patient safety includes the inextricably linked elements of clinical and cultural safety, and that this link must be defined by Aboriginal and Torres Strait Islander Peoples.’ (AHPRA, 2020)

Cultural safety is defined in the New Zealand context as: 

'The need for doctors to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery.

The commitment by individual doctors to acknowledge and address any of their own biases, attitudes, assumptions, stereotypes, prejudices, structures and characteristics that may affect the quality of care provided.

The awareness that cultural safety encompasses a critical consciousness where healthcare professionals and healthcare organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care, as defined by the patient and their communities'. (MCNZ, 2019)

The following general resources have been collated to support clinical radiologists and radiation oncologists to enhance cultural competency and promote cultural safety. 

The following are links to websites for news, information and resources about Aboriginal and Torres Strait Islander people and Maori people in relation to health.

  

Health Promotion Forum of New Zealand – Maori Health

  

Healing Foundation

The Healing Foundation is a national Aboriginal and Torres Strait Islander organisation that partners with communities to address the ongoing trauma caused by actions like the forced removal of children from their families.

Specific pages:

 

Australian Institute of Health and Welfare (AIHW) – Snapshots on Indigenous health

These short fact sheets provide useful overview of demographics and social determinants.

  

Common ground

Short articles (400-500 words) and accompanying YouTube videos on specific topics such as ‘What is country and the stolen generation.

Some articles might help clinicians understand the perspectives of First Nations people. For example, Death and Sorry Business and protocols of bereavement.

 

Lowitja Institute

An Aboriginal and Torres Strait Islander organisation working for the health and wellbeing of Australia’s First Peoples through high impact quality research, knowledge translation, and by supporting Aboriginal and Torres Strait Islander health researchers.

 

Australian Indigenous HealthInfoNet – Cultural Safety for Health Professionals

The portal aims to support teaching health professionals to critically reflect on the concept of cultural safety and to deliver safe, accessible and responsive healthcare that is free from racism. Links are provided here to Aboriginal and Torres Strait Islander health and cultural safety resources with links for specific medical disciplines.

 

The LIME Network 

Leaders in Indigenous Medical Education resources hub  was developed to enhance information sharing and develop deliver initiatives in Indigenous medical and health education and encourage the development of Indigenous health as a discipline.

  

Other sites

 

Stop Institutional Racism

STIR is a nationwide network of public health professionals and activist scholars committed to ending institutional racism within the administration of the public health sector.

The site contains links to current news and includes a page of resources.

 

Getting Better – A year in the Life of a Maori Medical Student

A trainee doctor and award-winning writer Emma Espiner (Ngāti Tukorehe, Ngāti Porou) travels to the front lines of healthcare in New Zealand, where life and death decisions are made every day and where the statistics clearly show Māori are suffering: Māori die younger, get chronic illnesses earlier and receive less care than non-Māori. The episodes include hearing from whānau whose experiences are the real-life stories behind the statistics and doctors who see first-hand the racism that has led to our acceptance of “unequal outcomes”- in the real world, “unequal outcomes” means sickness and death.

   

Katherine Hospital: Back from the brink

Just five years ago this Northern Territory hospital was facing closure, its doctors were out of their depth and indigenous patients were leaving the wards in droves. This is the remarkable story of how Katherine Hospital turned its fortunes around. It now ranks among Australia's best for its relationship with its indigenous patients. How did the hospital do it and what lessons does this have for the rest of the nation?

  

Indigenous Health MeDTalk

Indigenous Health MedTalk covers topics related to women's and men's health, family health and wellness, mental health, sexual health and community innovations related to and affecting Aboriginal and Torres Strait Islander people.

  

Ask the Specialist

Ask the Specialist is a podcast for health professionals who work with Aboriginal patients. Created in the Northern Territory of Australia, doctors from Royal Darwin Hospital ask Larrakia, Tiwi and Yolngu leaders (the ‘Specialists’) to answer their questions which span clinical to philosophical issues.

 

The Journey of Health and Wellbeing

You Tube resource developed by the Western Australia Department of Health, which explains some of the history of Aboriginal and Torres Strait Islander people and the effects of colonisation and oppression on health and wellbeing.

   

Health Navigator - Maori health videos

This video series includes stories about engaging with healthcare services from a Maori perspective.

   

Understanding Conscious Bias

Presentation by Professor David Tipene Leach on why understanding bias contributes to anti-racism and promotes equity. The presentation was sponsored by Choosing Wisely and Eastern Institute of Technology Te Whare Takiura o Kahungunu, Hawke’s Bay.

 

The following online modules are available for completion. Some modules requirement payment of a fee.

 

RACP Australian Aboriginal, Torres Strait Islander and Maori Cultural Competence and Cultural Safety resource

The Royal Australasian College of Physicians (RACP) have granted permission for RANZCR trainees to complete the RACP Australian Aboriginal, Torres Strait Islander and Maori Cultural Competence and Cultural Safety resource. This resource includes in-depth content, video scenarios, reflection and discussion activities and recommended further resources. This module is a Phase 2 requirement for Clinical Radiology trainees. 

   

Understanding bias in health care

Three learning and education videos/modules developed by the Health Quality and Safety Commission, New Zealand.

  1. Understanding and addressing implicit bias
  2. Te Tiritio Waitangi, colonisation and racism
  3. Experiences of bias

   

Mauriora

Mauriora provides two courses:

  • Cultural Competency (Maori) - developed specifically for the registered New Zealand workforce and provides a basic understanding of cultural competency in the New Zealand Health context. 3 modules.
  • Te Tiritu o Waitangi and Maori Health – Four modules, takes 1-3 hours to complete.

   

University of Sydney – Kinship Module

Online learning module which covers the systems of social organisation that traditionally govern Aboriginal societies and explains this significant cultural difference. Presented as a series of videos.

See also ‘Community Narratives’ – interviews with Aboriginal people who provide examples from their lives of times when cultural difference was not understood and created conflict or trauma in their lives.

 

Communicating Effectively with Aboriginal and Torres Strait Islander people

General guide developed by Queensland Health.

  

Aboriginal and Torres Strait Islander Patient Care Guideline

Reference tool to support healthcare staff in delivering safe, clinically and culturally responsive inpatient care to Aboriginal and Torres Strait Islander patients, developed by Queensland Health. Includes information on:

  • Factors influencing access to healthcare
  • Providing culturally capable patient care
  • Aspects of clinical care, such as medical examinations, pain management and end-of-life care

   

Sad News, Sorry Business

Guidelines for caring for Aboriginal and Torres Strait Islander people through death and dying. This document aims to provide some insight into appropriate cultural practices and identify tools that will assist in providing culturally and clinically responsive care for Aboriginal and Torres Strait Islander patients and their families.

   

Aboriginal and Torres Strait Islander – Cultural Safety Framework and Continuum of Cultural Safety Reflective Tool

The framework provides a continuous quality improvement model to strengthen the cultural safety of individuals and organisations, developed by the Victorian Department of Health. 

 

Guidelines for Research

 

Health Research Council of New Zealand - Māori Health Research

If your study involves Māori participants or research on issues relevant to Māori health, you should undertake appropriate and relevant consultation with Māori communities that will be involved in the design, development and implementation of the research. This webpage provides links to guidelines for researchers.

 

National Health and Medical Research Council

Guidelines on ethical conduct of research with Aboriginal and Torres Strait Islander peoples and communities.

Sharing the true stories: improving communication between Aboriginal patients and healthcare workers

Cass A, Lowell A, Christie M, Snelling PL, Flack M, Marrnganyin B, Brown I. Sharing the true stories: improving communication between Aboriginal patients and healthcare workers. Medical Journal of Australia. 2002 May;176(10):466-70.

  

Transforming institutional racism at an Australian hospital

Bourke CJ, Marrie H, Marrie A. Transforming institutional racism at an Australian hospital. Australian Health Review. 2018 Nov 21;43(6):611-8.

The deleterious effects of institutional racism occur regardless of practitioner capability. The role for practitioners in ameliorating institutional racism is to recognise the key indicator of poorer health outcomes, and to then seek change within their hospital or healthcare organisation.

 

The power of talk and power in talk: a systematic review of Indigenous narratives of culturally safe healthcare communication

Jennings W, Bond C, Hill PS. The power of talk and power in talk: a systematic review of Indigenous narratives of culturally safe healthcare communication. Australian Journal of Primary Health. 2018 May 8;24(2):109-15.

By mediating the power differentials between health professionals and Indigenous clients, talk could either reinforce powerlessness, through judgmental down-talk, medical jargon or withholding of talk, or empower patients with good talk, delivered on the client’s level. Good talk is a critical ingredient to improving Indigenous accessibility and engagement with healthcare services, having the ability to minimise the power differentials between Indigenous clients and the healthcare system.

 

Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition

Curtis E, Jones R, Tipene-Leach D, Walker C, Loring B, Paine SJ, Reid P. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. International journal for equity in health. 2019 Dec;18(1):1-7.

A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important.

 

Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia.

Nolan-Isles D, Macniven R, Hunter K, Gwynn J, Lincoln M, Moir R, Dimitropoulos Y, Taylor D, Agius T, Finlayson H, Martin R. Enablers and barriers to accessing healthcare services for Aboriginal people in New South Wales, Australia. International Journal of Environmental Research and Public Health. 2021 Jan;18(6):3014.

This study aimed to investigate barriers and enablers to accessing healthcare services for Aboriginal people living in regional and remote Australia. Six themes were identified: (1) Improved coordination of healthcare services; (2) Better communication between services and patients; (3) Trust in services and cultural safety; (4) Importance of prioritizing health services by Aboriginal people; (5) Importance of reliable, affordable and sustainable services; (6) Distance and transport availability. This study describes a pathway to better healthcare outcomes for Aboriginal Australians by providing insights into ways to improve access.

 

Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander peoples healthcare experiences

Jones B, Heslop D, Harrison R. Seldom heard voices: a meta-narrative systematic review of Aboriginal and Torres Strait Islander peoples healthcare experiences. International journal for equity in health. 2020 Dec;19(1):1-1.

It is well established that Aboriginal and Torres Strait Islander populations face considerable health inequities, exacerbated by poorer healthcare quality. Patient experience is recognised as a major contributing factor to healthcare quality and outcomes, therefore, enriched knowledge of the patient experiences of Aboriginal and Torres Strait Islander populations is critical to redress health inequities. This review synthesises evidence of the healthcare experiences amongst Aboriginal and Torres Strait Islander patients through a metanarrative synthesis of qualitative literature.

 

To search for articles specific to medical specialties …

 

Lowitja Institute

Search tool which provides easy access to Aboriginal and Torres Strait Islander health literature on the PubMed database.

 

Overview of Aboriginal and Torres Strait Islander Health Status 2021

Australian Indigenous HealthInfoNet (2022). Overview of Aboriginal and Torres Strait Islander health status 2021. Perth: Australian Indigenous HealthInfoNet.

The Overview aims to provide a comprehensive outline of the most recent indicators of the health and current health status of Australia's Aboriginal and Torres Strait Islander people.

  

Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice.

Dudgeon P, Milroy H, Walker R. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice. Telethon Kids Institute, Kulunga Aboriginal Research Development Unit, Department of the Prime Minister and Cabinet (Australia); 2014 May 1.

 
Culture, Diversity and Health in Australia: Towards Culturally Safe Health Care

Dune T, McLeod K, Williams R, editors. Culture, Diversity and Health in Australia: Towards Culturally Safe Health Care. Routledge; 2021 May 30.

 

  

Indigenous Australian health and cultures: an introduction for health professionals.

Scott K. Indigenous Australian health and cultures: an introduction for health professionals. Pearson; 2010.

 

Individuals can complete the following courses. Check the websites for registration and fee information.

University of Otago
MIHI 501 Health Professionals Course: Application of the Hui Process / Meihana Model to Clinical Practice

This course comprises on-line learning modules, one on-site training seminar and an assessment module. The objective of the course is to support health practitioners to feel informed and confident in the development of Hauora Māori competencies, with a special focus on the application of the Hui Process and Meihana Model.

 

Understanding bias in health care (a certificate of completion can be issued)

Three learning and education videos/modules developed by the Health Quality and Safety Commission, New Zealand.

  1. Understanding and addressing implicit bias
  2. Te Tiritio Waitangi, colonisation and racism
  3. Experiences of bias

  

RACGP - Introduction to Aboriginal and Torres Strait Islander cultural awareness in general practice

It aims to improve the health of Aboriginal and Torres Strait Islander people by enhancing the cultural awareness of GPs, general practice staff, primary healthcare staff and other healthcare providers. This 6 hour activity aims to help participants to:

  • extend their knowledge about Aboriginal and Torres Strait Islander history and culture
  • explore how attitudes and values can influence perceptions, assumptions and behaviours in a clinical setting
  • discuss key issues facing the practice team and Aboriginal and Torres Strait Islander people
  • consider ways to address these issues.
 
RACS - Aboriginal and Torres Strait Islander Health and Cultural Safety eLearning program

Two courses, which take around 10 hours each, designed to be completed over 12 months.

Small individual modules of 30 minutes each

 
Introduction to providing Culturally Safe Care for Aboriginal and Torres Strait Islander Peoples

Victoria University – Future Learn

4 weeks, 3 hours per week, available at selected times.

 

Not specifically health related

 
SBS Cultural Competence Program

Not specific to health care – designed more for relationships in the workplace

 
University of Sydney – National Centre for Cultural Competence

Cultural Competence Online Modules

4 hours, with a maximum of 90 days to complete.

 

Baseline Data Capture: Cultural Safety, Partnership and Health Equity Initiatives. Final Report.

Allen + Clarke 2020, Baseline Data Capture:  Medical Council of New Zealand and Te Ohu Rata o Aotearoa, Wellington. ISBN 978-0-473-54688-5 (Epub)

 

Medical Council of New Zealand – Statement on Cultural Safety

October 2019.

This statement outlines what cultural safety means, why it is important and how doctors need to reflect on their own biases and attitudes to understand how these can impact on how patients receive their care.

  

Medical Council of New Zealand - He Ara Hauora Māori: A Pathway to Māori Health Equity

October 2019

This document outlines the Medical Council of New Zealand’s position on how doctors can support the achievement of best health outcomes for Māori. It also provides guidance for healthcare organisations to support achieving cultural safety and Māori health equity1. It has been developed in partnership with Te Ohu Rata O Aotearoa, the Māori Medical Practitioners Association (Te ORA).

 

Partnership for Justice in Health: Scoping paper on Race, Racism and the Australian Health System

Watego, C., Singh, D. & Macoun, A. 2021, Partnership for Justice in Health: Scoping Paper on Race, Racism and the Australian Health System, Discussion Paper, The Lowitja Institute, Melbourne, DOI: 10.48455/sdrt-sb97

 

The College is committed to supporting the professions of Clinical Radiology and Radiation Oncology to contribute to equitable health outcomes for Māori, Aboriginal and Torres Strait Islander Peoples. This work is central to the strategic objectives of the College and is reflected in the College’s Strategic Plan.

This is supported by the Māori, Aboriginal and Torres Strait Islander Executive Committee (MATEC). MATEC is a bi-national peak committee to provide authoritative advice to the Board, the Faculty of Radiation Oncology, the Faculty of Clinical Radiology, and other key committees, on how to significantly reduce disparities in health outcomes for Māori, Aboriginal and Torres Strait Islander Peoples.

To view the RANZCR Statement of Intent in its entirety, click here

Radiation Oncology Specific Resources

The following resources are specific to Radiation Oncology.

National Indigenous Cancer Network (NiCAN) is a partnership between the Menzies School of Health Research, the Australian Indigenous HealthInfoNet, the Lowitja Institute and Cancer Council Australia.

NICaN was established in 2013 and aims to improve health services for Indigenous people with cancer. NICaN brings together Indigenous audiences, consumers, service providers, researchers and health professionals from a broad range of disciplines, as well as private sector and government organisations.

The NiCaN online portal is now accessed via the HealthInfoNet site, it was originally on the Menzies School of Health Research website.

Key documents:

Review of cancer among Aboriginal and Torres Strait Islander people (2020)

The purpose of this review is to provide a comprehensive synthesis of key information on cancer among Aboriginal and Torres Strait Islander people in Australia to: (1) inform those involved or interested in Aboriginal and Torres Strait Islander health; and (2) provide the evidence for those involved in policy, strategy and program development and delivery.

The review provides general information on factors that contribute to cancer among Aboriginal and Torres Strait Islander people. It provides detailed information on the extent of cancer among Aboriginal and Torres Strait Islander people, including: incidence, prevalence and survival data; mortality and burden of disease and health service utilisation. This review discusses the issues of prevention and management of cancer, and provides information on relevant programs, services, policies and strategies that address cancer among Aboriginal and Torres Strait Islander people. It concludes by discussing possible future directions for combatting cancer in Australia.

 

Guide to Implementing the Optimal Care Pathway for Aboriginal and Torres Strait Islander People With Cancer

Each Optimal Care Pathway is underpinned by principles such as multidisciplinary care and care coordination. The Optimal Care Pathway for Aboriginal and Torres Strait Islander people with cancer (OCP) incorporates additional concepts to support the delivery of culturally appropriate and responsive cancer care. It is the responsibility of the healthcare system and all people within its employment to address the needs of Aboriginal and Torres Strait Islander people in a culturally appropriate and responsive way.

Cancer Australia – For Aboriginal and Torres Strait Islander people

The site includes Aboriginal and Torres Strait Islander cancer statistics, Breast Cancer Awareness, Resources for Health Professionals and Resources for people with cancer.

 

Culturally safe communication skills for non-Indigenous health professionals

The resource comprises a series of short videos and a key messages tip sheet providing practical advice for cancer care specialists to optimise culturally safe and responsive communication with Aboriginal and Torres Strait Islander patients, their families and carers.

The videos feature medical oncologists, cancer care co-ordinators, Aboriginal and Torres Strait Islander Liaison Officers and Health Workers, as well as Aboriginal and Torres Strait Islander people with cancer. The videos include delivering a diagnosis, staging and treatment, care after treatment and recover, and managing recurrent, residual and metastatic.

There is also a summary Tip Sheet.

Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers.

Shahid S, Durey A, Bessarab D, Aoun SM, Thompson SC. Identifying barriers and improving communication between cancer service providers and Aboriginal patients and their families: the perspective of service providers. BMC Health Services Research. 2013 Dec;13(1):1-3.

A qualitative study involving in-depth interviews with 62 Aboriginal and non-Aboriginal Cancer Service Providers (CSPs) from across WA and CSPs were asked to share their experiences with Aboriginal patients and families experiencing cancer. 

Individual CSPs identified challenges in cross-cultural communication and their willingness to accommodate culture-specific needs within the wider health care system including better communication with Aboriginal patients. However, participants’ comments indicated a lack of concerted effort at the system level to address Aboriginal disadvantage in cancer outcomes.

 

The support has been brilliant: experiences of Aboriginal and Torres Strait Islander patients attending two high performing cancer services.

Taylor EV, Lyford M, Holloway M, Parsons L, Mason T, Sabesan S, Thompson SC. “The support has been brilliant”: experiences of Aboriginal and Torres Strait Islander patients attending two high performing cancer services. BMC health services research. 2021 Dec;21(1):1-5.

Services were identified as part of a national study designed to identify and assess innovative services for Indigenous cancer patients and their families. Case studies were conducted with a small number of identified services. In-depth interviews were conducted with Indigenous people affected by cancer and hospital staff. The interviews from two services, which stood out as particularly high performing, were analysed through the lens of the patient experience.

This article is significant because it demonstrates that with a culturally appropriate and person-centred approach, involving patients, family members, Indigenous and non-Indigenous staff, it is possible for Indigenous people to have positive experiences of cancer care in mainstream, tertiary health services. If we are to improve health outcomes for Indigenous people it is vital more cancer services and hospitals follow the lead of these two services and make a sustained and ongoing commitment to strengthening the cultural safety of their service.

 

Cancer care disparities among Australian and Aotearoa New Zealand Indigenous peoples.

Davies A, Gurney J, Garvey G, Diaz A, Segelov E. Cancer care disparities among Australian and Aotearoa New Zealand Indigenous peoples. Current opinion in supportive and palliative care. 2021 Sep 1;15(3):162-8.

Cancer-specific outcomes in Indigenous people of Australia and New Zealand remain poor with many widening disparities compared to non-indigenous populations. A growing body of epidemiological, health service and clinical research is documenting both the problems and potential solutions. Further work is needed in both broad health policies and the workforce, in building cultural competence to optimize individual care encounters.