How cultural safety in healthcare and human services can make a difference
By Pauline Thompson, co-author of A Cultural Safety Approach to Health Psychology
It is more important than ever that we find all the ways that we can be part of the solution and not the problem when it comes to mental health and social and emotional wellbeing. Every day, in our families, in our jobs, and in every interaction in our communities, we have opportunities to promote good mental health and wellbeing. Healthcare and human services professionals are at the forefront of delicate interactions with clients. Importantly, these professionals themselves are also often struggling with their own mental health and wellbeing concerns. That mental health and wellbeing are infused across most of the Sustainable Development Goals, but specifically part of Goal 3: Good Health and Wellbeing (United Nations Development Program, 2022) further highlights their importance. Cultural safety is one way that we can all contribute to improving mental health and wellbeing.
Cultural safety is an Indigenous-derived approach to healthcare and human services developed in New Zealand that is attracting interest and attention globally because of its unique implications and transformative potential. Culture, in the cultural safety model, is broadly defined with implications across many populations and groups and is not limited to ‘culture’ in an ethnicity or racial sense. Culturally safe professional practice is determined by the recipient of care, not the provider, and requires professionals to be reflective of what they do and who they are and to be mindful of issues of power and privilege when engaging with clients. Perhaps most importantly, cultural safety requires practitioners to ‘de-colonise’ their practice. Culturally unsafe practice—that which ‘diminishes, demeans or disempowers the cultural identity and well-being of an individual’—can contribute to mental ill health and compromised wellbeing. Conversely, culturally safe practice can enhance mental health and wellbeing and other health outcomes more broadly.
Curtis, Jones, Tipene-Leach, et al. (2019, p. 14) overtly link health equity in the following definition:
Cultural safety requires healthcare professionals and their associated healthcare organisations to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery. This requires individual healthcare professionals and healthcare organisations to acknowledge and address their own biases, attitudes, assumptions, stereotypes, prejudices, structures, and characteristics that may affect the quality of care provided. In doing so, cultural safety encompasses a critical consciousness where healthcare professionals and healthcare organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care, as defined by the patient and their communities, and as measured through progress towards achieving health equity. Cultural safety requires healthcare professionals and their associated healthcare organisations to influence healthcare to reduce bias and achieve equity within the workforce and working environment.
Practicing cultural safety at every opportunity can make a big difference to a client’s experience, from initial phone conversations, interactions at the reception desk, when picking up medications, or scheduling appointments. Structurally, cultural safety applied throughout an organization also means creating culturally safe workspaces for employees. When employees feel culturally safe in their work environment, they can do their jobs better and provide culturally safe services for clients.
In our book (Thompson & Taylor, 2021), we use scenarios to help learn and understand the ways to practice cultural safety. Here is one example:
A new client has come to the mental health clinic. The receptionist asks them their name and the person responds: ‘Amy’. When Amy provides the receptionist with their health insurance card, the receptionist says, ‘This card says ‘David’ and David is a male name; what is your name?’ Amy responds that the card has her legal name, but she prefers to be called Amy and her pronouns are she/her. The receptionist says, ‘So are you a male or a female’? And proceeds to refer to Amy as ‘he’ and ‘him’.
- How do you feel this engagement might have been experienced by Amy? By the receptionist?
- What assumptions has the receptionist made about gender identities and legal names? After Amy has explained that she is transgender, the receptionist responds, “Oh I don’t care about any of that, ‘to each his own’; everyone can live their own life the way they want!”
- How might this interaction impact on Amy’s healthcare-seeking in the future?
- What might the impact be on Amy to always have to explain her identity? In what ways can the emotional impact be reduced for everyone involved?
- What might be impacting or influencing the way the receptionist interacts with Amy?
- In what ways could the service support the receptionist to provide culturally safe care?
Health and human services professionals rarely see themselves as contributing to poor health outcomes and are are usually viewed as part of the solution. But professionals hold a great deal of power when interacting with clients who are often in vulnerable positions. Acknowledging these power relationships are a key element of culturally safe care. The Nightingale Oath and current narratives advocate for ‘treating everyone the same’. However, in culturally safe care, professionals are encouraged to be regardful of other’s culture, while simultaneously being aware of the possibilities of stereotyping and discriminating. Every interaction counts.
Pauline Thompson, PhD, is Professor of Psychology, Pennsylvania State University, Brandywine Campus, Media, PA.
- Curtis, E., Jones, R., Tipene-Leach, D. et al. (2019). Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. International Journal of Equity and Health 18, 174. https://doi.org/10.1186/s12939-019-1082-3
- Thompson, P. B. & Taylor, K. (2021). A Cultural Safety Approach to Health Psychology. Palgrave-Macmillan, USA.
- United Nations Development Program (2022). Sustainable Development Goals. Goal 3: Good Health and Wellbeing. https://www.undp.org/sustainable-development-goals?utm_source=EN&utm_medium=GSR&utm_content=US_UNDP_PaidSearch_Brand_English&utm_campaign=CENTRAL&c_src=CENTRAL&c_src2=GSR&gclid=Cj0KCQjwpeaYBhDXARIsAEzItbGMZyjeFPZ35sCJIxDGWQy4Ey1TGcFSIHvVu3kjwWRgjgFqFs0jyC0aAj_iEALw_wcB#good-health