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

2 Australia Waanyi country Jaru country

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4 Outline Case studies of cultural safety in action Case studies of cultural safety in action Elements of cultural safety Elements of cultural safety Organisational reform Organisational reform A model of applied cultural safety 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’ The ‘why’ is as important as the ‘how’ ‘Context’ is more important than the ‘content’ ‘Context’ is more important than the ‘content’ A new curriculum required capacity building of staff A new curriculum required capacity building of staff - can’t rely on individual champions - The LIME Network and accreditation ‘Indigenous leadership; faculty responsibility’ ‘Indigenous leadership; faculty responsibility’ Concepts of cultural awareness, cultural safety, Indigenous health and Indigenous knowledge were used interchangeably, and with confusion! 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’ Governance and power relationships as critical as ‘the business’ Internal baseline work must be achieved: 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 External ‘the business’ – must have the right internal baseline supports The application of cultural safety didn’t match the intention 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) 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 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 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 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 Must be more specific about the relationship between cultural safety and Indigenous health Cultural safety and Indigenous health are related, but not the same Cultural safety and Indigenous health are related, but not the same Must guard against mainstreaming Must guard against mainstreaming

11 Elements of Cultural Safety Moving from ‘cultural awareness’ to ‘cultural safety’ Moving from ‘cultural awareness’ to ‘cultural safety’ Moving from ‘othering’ (Moreton-Robinson, 2000) to reflexivity (Elston, 2003; Phillips, 2005) Moving from ‘othering’ (Moreton-Robinson, 2000) to reflexivity (Elston, 2003; Phillips, 2005) Cultural safety includes: 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 CulturalSafety ‘levelling the playing field’ IndigenousHealth ‘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’ Decision-making and governance – ‘Indigenous leadership, organisational responsibility’ Partnerships (not advisory but design, decision- making and evaluation) Partnerships (not advisory but design, decision- making and evaluation) Funds committed Funds committed Employing Indigenous staff at senior, mid and junior levels Employing Indigenous staff at senior, mid and junior levels Career development for Indigenous staff Career development for Indigenous staff Cultural safety training for all staff Cultural safety training for all staff

14 Indigenous health: External Strengths-based Strengths-based Community-focussed Community-focussed Community development Community development A new paradigm of health – people and communities are their own healers, health care workers are the facilitators and technical helpers 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 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 External ‘the business’ of Indigenous health is the responsibility of Indigenous people and communities To apply cultural safety well, individuals and institutions must be: 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 Assessment and Accreditation of Medical Schools: Standards and Procedures. Canberra: AMC Elston, Jacinta Personal Communications. Hendricks, Aunty Joan Personal communication: Indigenous Health Education Workshop, Faculty of Health Sciences, The University of Queensland, 6 April. Moreton-Robinson, A Talkin' up to the white woman: Aboriginal women and feminism. St Lucia: University Of Queensland Press. Phillips, G CDAMS Indigenous Health Curriculum Framework. Melbourne: VicHealth Koori Health Research and Community Development Unit, The University of Melbourne. Phillips, G “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. Pp Pitama, Suzanne Personal Communications. Ramsden, I Whakarururhau: Cultural Safety in Nursing Education in Aotearoa. A Report for the Maori Health and Nursing Committee. Wellington: New Zealand Ministry of Education.