C1 – Operationalizing Quality: Creating an Organizational Cultural Safety Framework
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Transcript of C1 – Operationalizing Quality: Creating an Organizational Cultural Safety Framework
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Operationalizing Quality: Creating an Organizational Cultural
Safety Framework
Brad AndersonCorporate Director, Aboriginal Health
Interior Health
Quality Forum: Best of Both WorldsVancouver, BCMarch 1, 2017
Cheryl WardInterim Director, Indigenous HealthProvincial Health Services Authority
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Disclosure
• Faculty: Cheryl Ward & Brad Anderson
• Relationships with commercial interests:
– Grants/Research Support: n/a
– Speakers Bureau/Honoraria: n/a
– Consulting Fees: n/a
– Other: n/a
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Managing Potential Bias
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All meetings are transformations, what brings you here?
Kwakwaka’wakw
4
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Intentions
• Context
• HR at Interior Health
• Assessment Tool
• Service Delivery at PHSA
• Racism Interventions
• Activity
• Q & A/Reflections
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2015 2016
Truth and Reconciliation
Recommendations
Declaration of Commitment: Cultural Safety and Humility
1996
Royal
Commission
on
Aboriginal
Peoples
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Declaration of Commitment
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Cultural Awareness
Cultural Humility
Cultural
Cultural Sensitivity
Cultural Competency
Cultural Safety goes beyond…
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Cultural Safety is:
An ongoing process
There is an historical, socioeconomic, political context
An outcome
PHSA Indigenous Health (2016)
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An Organizational Self-Assessment Tool for Indigenous Cultural Competency at IH
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Domains
A Culturally Safe
Organization
Domain 1: Administrat-
ion & Governance
Domain 2: Human
Resources, Training &
Staff Developm’t
Domain 3: Equitable Access & Service Delivery
Domain 4: Policy,
Procedures, Risk & Legal
Domain 5: Communica
-tions & Community Relations
Domain 6: Planning,
Monitoring, Evaluation &
Research
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Human Resource Training and Staff Development Domain
• Process
– 15 staff volunteered to self-assess
– Ability to provide notes, evidence of scoring and recommendations
– Survey on validation
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Human Resources Training and Staff Development: Categories
• HR: Recruitment Strategy - 2.5 score
• HR: Orientation (New worker and Reorientation) –1.63 score
• SD: Training Course – 1.96 score
• SD: Volunteers - 1.30 score
• HR: Performance Reviews – 1.3 score
• HR: Retention – 1.96 score
• HR: Aboriginal Staff Support System –
1.86 score
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Lessons Learned
• Allowed for foundational internal evidence to begin conversation
• Showed commitment to IH’s Aboriginal partners to work towards cultural safety
• Increased Awareness amongst staff
• OPPORTUNITIES to move the organization forward
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Action Plan
• Examples
– Move towards Represented Aboriginal Workforce
– Focus recruitment on Aboriginal populations
– Emphasize CS training on new employees
– Embed CS in performance reviews
– Support volunteers with education and awareness
– Interview current Aboriginal employees for suggestions and recommendation
– Build Traditional supports for employees (elders)
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Next Steps for IH
• Human Resource Aboriginal Recruitment Lead
• Attention paid by Senior Executive Team
• Administration and Governance
• Planning, Monitoring, Evaluation and Research
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Rate Your Organization
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PHSA Indigenous Cultural Safety Framework
Focus Area
1
Non-
Existent
2
Developing
3
Meeting
4
Leading
Score
(Out of 4)
Provincial,
Regional
and Federal
Partnerships
No evidence
of
partnerships.
Identify
cultural
safety
leaders
Articulate
mutual goals
Awareness
of protocols
Meets
criteria 2
Organization
al coalition
Joint
meetings
Protocols
followed
Alignment
with FNHA
Framework
Information
sharing
Meets
criteria 3
PHSA at
the table
in ICS
initiatives
Joint
planning
aligned w/
partner-
ships
Province-
wide ICS
advisory
committee
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19
What we are trying to address: RACISM
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Stereotype
(beliefs)
Prejudice
(attitudes)
Discrimination
(behaviours)
Colonial Ideology
(worldview)
“They are inferior
to us”“They are slow
learners”
“Just another one
of those kids
looking for free
stuff”
“They’re all
drunks”
“They are just
biologically
different”
Avoidance
Denial of Care
Misdiagnosis
Violence
Aggression
Maltreatment
Patronizing
Pity
Disgust
Contempt
Anger
Resentment
Hostility
“They benefit
from colonization”
Invisible/Ignored
Labelling
Pathway to Harm
Adapted from Jackson (2012). The Psychology of Prejudice.
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Activity
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1. What assumptions or stereotypes are being made?
2. What attitudes are surfacing here? How is prejudice shaping the doctor’s behaviour?
3. What are the potential impacts on the patient? On the family?
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1. What needs to change to make sure this never happens again?
2. What next steps can we take as an organization to make those changes?
3. What actions can we take as individuals to shift the workplace culture?
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Reflect Back
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Now What? Interventions on Racism
•BCCDC
•Women’s and Children’s Hospital
•Labour/Delivery, Emergency, NICUPilot Sites
•Organized by Six Domains
•Non-Existent, Developing, Meeting, Leading
•Rating each element across Domains Assessment Tool
•Site specific
•Developed in collaboration
•1-2 year scope Planning Tool
•Building on existing tools
•Working with UBC School of Nursing
• Interventions for policy and practiceIntervention Tools
•Literature Review
•Best Practice Models
• In Collaboration with Indigenous Health Leads
Framework for Responding to
Harmful Practices
•Rigorous methodology
•Measuring impact
•Measuring implementationEvaluationE
xis
tin
g S
tru
ctu
res
BC Women’s and Children’s ICS Task Force
Workplace Culture / Patient Experience Councils
Accreditation
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Health Equity
Pocket Cards
Small changes in the way you
speak to a patient can make a
big difference!
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INSTEAD OF…
“How much do you drink?”
TRY THIS:
“In order to provide the best care possible, it’s
helpful for me to know about people’s alcohol
use. Could you tell me if you drink alcohol?”
If yes, “OK, and can you tell me how often
do you drink? For example, most days?, once
a week?, once a month?”
(Start with most days)
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What’s Your Commitment?
• How to motivate and move?• Who needs to engaged?• How to build champions?• Where can you start?• Why is this important to you?
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Questions? Reflections?
Gilakas’la