Working to make the system safer for Indigenous patients
Patient safety is a fundamental right, but for many Indigenous Peoples (First Nations, Métis and Inuit), it continues to fall short of acceptable standards. During this year's Canadian Patient Safety Week, the First Nations Health Authority (FNHA) is releasing a new research report that highlights the urgent need to improve cultural safety in the health care system for Indigenous Peoples.
Our report, called “A System that Works for Us: Upholding Indigenous Perspectives for Decolonizing Patient-Centred Measurement,1" shares insights from 11 Indigenous participants, including First Nations and Métis patients, Knowledge Keepers, youth, and health professionals about what matters most in gathering and learning from Indigenous people's health care experiences. As one First Nations/Métis healthcare quality professional said:
“I really believe that if Indigenous people can share their experiences – and if we are able to have people listen for the greater good for future generations – we will be able to make a difference."
Our report highlights how Indigenous wellness practices have sustained communities for generations. However, ongoing colonialism and widespread Indigenous-specific racism continue to impact both the accessibility and safety of the health care system, something made clear in the 2020 In Plain Sight report.
Our report also emphasizes that colonial practices and belief systems often fail to capture what truly matters to Indigenous patients in ways that feel safe and genuine. As one Ojibwe/Saulteaux/Métis/Ukrainian patient participant said:
“Is it really inclusive to say, 'We've got this; we want you to give us some feedback and information and include you in this process, but… this health care system is already out there and you're going to just have to fit into it, and that's a fact, Jack?' [But] If you're actually doing research around cultural safety, and we're actually setting standards, [then] what we're doing is facilitating change and bringing new knowledge and expanding the body of knowledge around Indigenous health and Indigeneity and the methodologies in research as well as bringing the standards forward."
Participants pointed out that there is so much more power to transform the system when the people who design patient-centred measurements co-develop the table with Indigenous Peoples. They can then determine together what to measure and how to ask about experiences of care, including having Indigenous Peoples set the priorities for gathering and using patient experiences to shape the health care system.
Wise practices for improving patient safety
Our report provides some wise practices drawn from the study on how to improve Indigenous patient engagement and experiences within the health care system:
- Embed Indigenous worldviews and perspectives of health and wellness into the health care system.
- Foster a culture of accountability and eliminate conditions that allow and perpetuate Indigenous-specific racism.
- Move forward on existing recommendations developed and informed by Indigenous Peoples to hardwire cultural safety in the health care system.
- Redress power imbalances in health care decision-making to uphold Indigenous health innovation and health sovereignty.
We invite you to read our report and share these findings as part of an ongoing conversation about how we can ensure the voices of Indigenous Peoples guide transformative change in the cultural safety of the health care system.
The FNHA Quality Care and Safety Office provides a safe space for First Nations people to share feedback and raise concerns, without fear of retribution or an impact on their health services and care.
For more information / resources:
Please reach out to us at RKE@fnha.ca to learn more about the project.
[1] Patient-centred measurement (PCM), such as patient-reported experience measures (PREMs), are a tool to monitor, learn from, and improve patient safety and experiences in health care.
