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Applying Cultural Safety in Australia. Gregory Phillips Monash University The LIME Connection III Melbourne December 2009. Australia. Waanyi country. Jaru country. Outline. Case studies of cultural safety in action Elements of cultural safety Organisational reform
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Applying Cultural Safety in Australia Gregory Phillips Monash University The LIME Connection III Melbourne December 2009
Australia Waanyi country Jarucountry
Outline • Case studies of cultural safety in action • Elements of cultural safety • Organisational reform • A model of applied cultural safety
Case Study 1: Medical Schools • Key subject areas and outcomes • Pedagogical principles • Assessment guidelines • Processes for development over time
Lessons Learned • The ‘why’ is as important as the ‘how’ • ‘Context’ is more important than the ‘content’ • A new curriculum required capacity building of staff - can’t rely on individual champions - The LIME Network and accreditation • ‘Indigenous leadership; faculty responsibility’ • Concepts of cultural awareness, cultural safety, Indigenous health and Indigenous knowledge were used interchangeably, and with confusion!
Case Study 2: A mainstream mental 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
Lessons Learned • Governance and power relationships as critical as ‘the business’ • Internal baseline work must be achieved: • Staff development and cross-cultural learning • Hiring Indigenous staff • Partnership arrangement with community at large • Governance and decision-making strategies • Communications with communities and access issues • External ‘the business’ – must have the right internal baseline supports • The application of cultural safety didn’t match the intention
Case Study 3: Aotearoa • Irihapeti Ramsden and others in Aotearoa/NZ lobbied for curriculum reform in nursing schools (1990) • Over time, health and public health institutions include cultural safety in key legislation, policies and strategies • An argument begins to be made about cultural safety for all meaning no need for Maori health • Maori health advocates forced to defend Maori health specific strategies (Pitama, 2006)
Lessons Learned • Must be more specific about the relationship between cultural safety and Indigenous health • Cultural safety and Indigenous health are related, but not the same • Must guard against mainstreaming
Elements of Cultural Safety • Moving from ‘cultural awareness’ to ‘cultural safety’ • Moving from ‘othering’ (Moreton-Robinson, 2000) to reflexivity (Elston, 2003; Phillips, 2005) • Cultural safety includes: • information and individual change (cultural awareness) • institutional change and organisational responsibility (organisational reform) • effective decision-making and governance (power relations) • internal and external focus • the right motivations • Is strengths-based not deficit-laden
A Model of Applied Cultural Safety in Australia Cultural Safety ‘levelling the playing field’ Indigenous Health ‘the business’ Indigenous Knowledge ‘Indigenous Knowledge’ is about Intellectual Property - and depends on PLACE, history, social phenomena, languages, customs, cultures, spiritualities and religions
Organisational Reform: Internal • Decision-making and governance – ‘Indigenous leadership, organisational responsibility’ • Partnerships (not advisory but design, decision-making and evaluation) • Funds committed • Employing Indigenous staff at senior, mid and junior levels • Career development for Indigenous staff • Cultural safety training for all staff
Indigenous health: External • Strengths-based • Community-focussed • Community development • A new paradigm of health – people and communities are their own healers, health care workers are the facilitators and technical helpers
Whose responsibility is change? • Internal ‘levelling the playing field’ cultural safety is the responsibility of non-Indigenous people and institutions • External ‘the business’ of Indigenous health is the responsibility of Indigenous people and communities • To apply cultural safety well, individuals and institutions must be: • Reflexive • Cognisant of place and Indigenous history and knowledge • Have the right motivations • Have undertaken internal organisation reform and redressed power imbalances
References Australian Medical Council. 2007. Assessment and Accreditation of Medical Schools: Standards and Procedures. Canberra: AMC Elston, Jacinta. 2003. Personal Communications. Hendricks, Aunty Joan. 2005. Personal communication: Indigenous Health Education Workshop, Faculty of Health Sciences, The University of Queensland, 6 April. Moreton-Robinson, A. 2000. Talkin' up to the white woman: Aboriginal women and feminism. St Lucia: University Of Queensland Press. Phillips, G. 2004. CDAMS Indigenous Health Curriculum Framework. Melbourne: VicHealth Koori Health Research and Community Development Unit, The University of Melbourne. Phillips, G. 2005. “Relationships, Respect and Responsibility”: Cultural Safety and Ensuring Quality Curriculum for Indigenous Health in Medical Education. In Australian Universities Quality Forum Proceedings. Sydney: AUQA Occasional Paper Number 5. Pp131-135. Pitama, Suzanne. 2006. Personal Communications. Ramsden, I. 1990. Whakarururhau: Cultural Safety in Nursing Education in Aotearoa. A Report for the Maori Health and Nursing Committee. Wellington: New Zealand Ministry of Education.