Introduction by Croakey: Cultural safety must be at the heart of health systems, but so much more than lip service is required to ensure its delivery.
AHPRA, the regulatory body for Australia’s health practitioners, is currently running public consultations about what cultural safety means, with a view to embedding an agreed definition as part of national registration and accreditation requirements.
Announcing the inquiry process earlier this month, AHPRA’s Gregory Phillips described it as an important step towards health equity for Aboriginal and Torres Strait Islander Australians:
Patient safety for Aboriginal and Torres Strait Islander Peoples is inextricably linked with cultural safety. We need a baseline definition of ‘cultural safety’ that can be used across the National Scheme so that we can help registered health practitioners understand what cultural safety is and how it can help achieve health equity for all Australians.”
Some 44 organisations are participating in the six-week consultation process, which is being led by the National Health Leadership Forum in partnership with AHPRA’s Aboriginal and Torres Strait Islander Health Strategy Group, of which Phillips is co-chair.
For Australia’s First Peoples to have the best possible healthcare, providers and professions must embrace the concept of cultural safety where everyone feels valued & respected. See public consultation details here: https://t.co/f4Fyoojjdy pic.twitter.com/SZ0whmMUnV
— AHCRA (@AusHealthReform) April 5, 2019
In this timely and important piece, cross-posted here with permission, Ngiyampaa academic Dr Mark J Lock argues that Australian institutions have a serious credibility gap when it comes to cultural safety and the development policies intended to safeguard it.
Mark J Lock writes:
Australia’s raft of cultural policies is adrift in a stormy cultural sea because they are untethered to culturally rigorous development processes.
The eleven cultural policies, below, were analysed to assess their cultural credibility based on their development process. The RACGP’s ‘National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people‘ (The National Guide) was used as a benchmark for comparison.
- Cultural Respect Framework 2016–2026 for Aboriginal and Torres Strait Islander Health (Australian Health Ministers’ Advisory Council, 2016)
- Aboriginal Cultural Security Framework 2016–2026 (Northern Territory, 2016)
- Aboriginal and Torres Strait Islander Cultural Capability: A Framework for Commonwealth Agencies (Australian Public Service Commission, 2015)
- Towards Culturally Appropriate and Inclusive Services 2014–2018 (Australian Capital Territory, 2014)
- WA Health Aboriginal Cultural Learning Framework 2012–2016 (Western Australia, 2012)
- Respecting the Difference – An Aboriginal Cultural Training Framework for NSW Health (NSW Health, 2011)
- Queensland Health Aboriginal and Torres Strait Islander Cultural Capability Framework 2010–2033 (Queensland Health, 2010)
- Aboriginal Cultural Competence Framework, and Matrix (Victoria, 2008)
- Victorian Government Aboriginal Inclusion Framework (2009)
- Aboriginal Cultural Respect Framework 2007–2012 (South Australia, 2007)
- Tasmanian Multicultural Policy (2014)
Audit Guide for Cultural Credibility
The RACGP’s National Guide demonstrates an outstanding developmental process.
As I wrote in the Cultural Safety and Security FB Group, it has several culturally safe governance points:
- NACCHO – the peak body for Aboriginal community controlled health services – is a lead author.
- Culturally safe criterion: redress power imbalance so that Aboriginal people decide what is culturally safe.
- RACGP – a mainstream organisation – is a co-author.
- Culturally safe criterion: Shared learning, shared knowledge, shared experience, and working together (See Williams, 1999)
- Foreword by the Chair of NACCHO.
- Culturally safe criterion: Endorsed by community elected leader.
- Acknowledgements: Every person involved in the knowledge production process, for example: editor, editorial committee, advisor, authors, reviewers, expert reviewers, organisational reviewers, reference group, endorsements, publishing team, and sponsors.
- Culturally safe criterion: transparency and accountability of knowledge production.
- Methodology is clearly explained in detail.
- Culturally safe criterion: Transparency in the knowledge gathering process.
- Advocates for a culturally supportive and culturally safe environment that needs to be established and continuously demonstrated.
- Culturally safe criterion: Advocates for the respect of the cultural perspectives of Australia’s First Peoples.
What I like about the National Guide is the transparency and accountability. I can see who was involved, who did the writing and reviewing. This means, as an Aboriginal citizen, I can trust the knowledge production process.
In contrast, the eleven cultural strategies above show none of these characteristics. Why should Australian healthcare stewards and leaders pay heed to them?
Cultural Concept Soup
Together, the eleven frameworks exemplify the cultural concept soup phenomenon with ‘cultural’ — respect, security, capability, appropriate, learning, difference, capability, competence, inclusion — ‘safety’ and ‘security’ sprinkled throughout as key words to spice up the soup.
However, like any soup with too many ingredients, the unpleasant taste and smell means that it’s left to go cold in the policy bain-marie.
In the article ‘Doing the culture mash: would you like some respect with your security?’ I noted three fundamental flaws in those cultural policies that undermine their validity and credibility for healthcare governance.
The three flaws are:
- transparency — who developed them and how?
- accountability — who is responsible for their governance?
- performance — where is the measurement, monitoring, and evaluation of their implementation?
Furthermore, in First Nations communities, none of the these ‘frameworks’ are endorsed by Aboriginal community organisations (compared to, for example, the NACCHO Cultural Safety Training Standards).
In research, they are ignored by academics who study cultural concepts. And there is certainly no funding to incentivise their use. Would you let them through your organisation’s governance door?
The Cultural Provenance Principle
Ultimately, these policies create confusion for healthcare leaders seeking clarity about how best to improve the cultural safety of their organisations.
Therefore, I advocate that all Australian jurisdictions dismiss their cultural policies, and reset them with each First Nations community with regard to the cultural provenance principle.
This envisages the development of ‘cultural’ frameworks with local communities, organisations, networks and groups, to truly reflect the distinct and unique history of each First Nation.
The hundreds of Australian First Nations communities are their own politically sovereign entities, and should be accorded due respect through local definitions of cultural safety.
As it stands, the cultural provenance of Australia’s First Peoples is made invisible in the eleven frameworks, developed by invisible bureaucrats in capital cities.
I recommend the use of cultural safety criterion to inform the developmental processes of cultural policies about Australia’s First Peoples.
Mark J Lock is a Ngiyampaa academic and founder and director of Committix Pty Ltd, a governance concept analysis group.
This piece first appeared on the Committix site, and appears here with permission