How cultural safety is conceptualized, operationalized & evaluated in health services systems: A scoping review

Cultural safety is a system-level concept that is essential to realizing the transformation of health services systems needed to correct persistent health inequities in colonial contexts. A sizeable proportion of research over the past two decades has conflated cultural safety with the complementary concept of cultural competence, and conceptualized it as an individual-level phenomenon, to the detriment of advancing our understanding and realization of culturally safe health systems. In this scoping review, we summarize the ways in which cultural safety has been conceptualized and operationalized in health human services systems. We conclude with a set of system-level cultural safety attributes suggested by our review that will inform the development of indicators in future.