Applying Cultural Safety in Australia

1. Applying Cultural Safety in Australia Gregory Phillips Monash University The LIME Connection III Melbourne December 2009

2. Australia Waanyi country Jarucountry

4. Outline • Case studies of cultural safety in action • Elements of cultural safety • Organisational reform • A model of applied cultural safety

5. Case Study 1: Medical Schools • Key subject areas and outcomes • Pedagogical principles • Assessment guidelines • Processes for development over time

6. 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!

7. 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

8. 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

9. 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)

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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.