Using community-to-care provider dialogue to promote anti-racism and culturally safe health care

Culturally safe approaches to health care are fundamental to addressing Indigenous-specific racism and improving health care experiences and health outcomes for Indigenous peoples. However, historical and structural barriers in British Columbia, Canada mean that health care and services are not consistently or predictably provided in a culturally safe manner as people cross from Indigenous-led health services to mainstream health care providers who serve Indigenous communities. The Nuu-chah-nulth Patient Voices Project was a participatory research-to-action project which aimed to facilitate dialogue between health care providers and Nuu-chah-nulth community members about the impact of culturally unsafe care delivery on health outcomes. The Nuu-chah-nulth Voices project was conducted in partnership with the Nuu-chah-nulth Tribal Council, Tseshaht First Nation and Mowachaht/Muchalaht First Nation. The research team utilized a storywork and brokered dialogue methodology facilitated between members of the participating First Nations and mainstream health care providers serving Nuu-chah-nulth communities, including family practice and emergency department physicians and nurse practitioners. The findings demonstrate that cultural safety requires a multi-pronged approach – including education, changes in standard care practices, policy and procedure changes in patient advocates and complaint processes, increasing access to primary care in Indigenous communities, and instigating workplace culture change in hospitals and clinics. Importantly, these strategies will be most effective when they are rooted in the perspectives of Indigenous patients and developed in collaboration with health care providers, bridging the divide between care provider and patient experiences.