Progress on advancing cultural safety for Indigenous patients and families

Embracing a “safety culture” has become a cornerstone of the modern health-care facility, in which organizations openly investigate clinical care errors and near misses with the objective of developing strategies that improve care as part of a commitment to safety and efforts to minimize patient harm. But what about cultural safety?

Indigenous cultural safety involves making our spaces, services and care safer and more equitable for Indigenous people by considering current and historical colonial impact and seeking to eliminate structural racism and discrimination. On National Indigenous Peoples Day, it’s critical to reflect on the hospital’s progress in advancing culturally safe care with a focus on supporting Indigenous patients, families and staff. 

Truth telling and accountable transparency are pivotal to this process. In 2018 SickKids made a statement regarding the hospital’s historical involvement of conducting research on Indigenous children, a starting point for SickKids’ reconciliation journey. Guided by the calls to action through the Truth and Reconciliation Commission of Canada report and informed by the findings of extensive consultation with Indigenous leaders and communities, the Indigenous Health Strategy is steered by an Indigenous Health Council which meets on a monthly basis and includes both Indigenous and non-Indigenous representation.

Six priorities within the strategy aim to create tangible systemic and specific changes to advance culturally safe care. Some initiatives to date include:

• A policy that facilitates open-flame Smudging ceremonies in patient rooms was recently approved and additional polices are planned for other Indigenous medicines and ceremonies.
• Recruitment for an Indigenous Health Navigator and Patient Experience Specialist is underway. This individual will provide culturally appropriate support to Indigenous patients and families.
• Indigenous Days of Significance including the National Day for Truth and Reconciliation are commemorated annually and educational events are held for staff and patients on these days.
• More than 550 staff have registered for the San’yas Indigenous Cultural Safety online training, and a plan to provide broad cultural safety training for staff and volunteers through the Equity, Diversity and Inclusion (EDI) Strategy is being developed.
• An Indigenous centre is being planned for the new patient care tower to provide a gathering, ceremonial and healing space. A spiritual space during the interim construction phase of Project Horizon, our campus redevelopment project, will be available.
• Indigenous artwork is being commissioned for the hospital and Emily Kewageshig, an Ojibwe Woodland artist, was commissioned to paint land acknowledgement plaques that are up across the SickKids campus in honour of our commitment toward reconciliation.
• Deepening relationships with Indigenous communities to better support the health-care needs of local and remote communities is also underway. A Community Advisory Circle is being developed that will have a tri-chair model, led by an Indigenous Elder, African Elder and SickKids EDI Executive Lead. This entity will sit with a dotted line of accountability to and from the Board of Trustees, with seats for board trustees and the President & CEO.

There’s much more work to be done. Reforming care, research and education at SickKids to respect Indigenous traditions and medicines is a priority of the EDI Strategy, launched earlier this year. In it, we note a quote that guides our efforts: “It’s truth and then reconciliation. You can’t get to the ‘R’ without bringing the ‘T’ into the light.”

Earning the trust of Indigenous patients, families and communities will take time. Ultimately, through this work we strive to help staff increase their confidence in their clinical capacity to integrate Indigenous ways of knowing into the care they provide. Simultaneously, we will work towards our obligation of increasing Indigenous representation of staff and faculty in health care.

Though it cannot be the work of Indigenous people to undo the work of years of colonization, we must begin redressing the years of systematic and systemic oppression. The work to examine and decolonize hospital practices is ongoing and we remain committed to creating culturally safer services for children and families as part of our reconciliation journey.