c3 a bc first nations lens on cultural safety & quality in health care - j. gallagher

QUALITY FORUM 2012Applying a BC First Nations lens to quality in

health care

Presented by:Joe Gallagher, CEO

March 8th , 2012: Four Seasons Hotel, Vancouver

British Columbia First Nations

26 Cultural Groups32 Aboriginal Languages203 Bands (or First Nations)3 Provincial First Nations Organizations

BC Assembly of First Nations First Nations Summit Union of BC Indian Chiefs

OUR POPULATION

• First Nations population suffered a major collapse in the late 19th century.

• PHO report estimates that the FN population of 250,000 in mid 1700’s was reduced to 23,000 by 1929.

OUR POPULATION

• Aboriginal Population in BC is 197, 070

• Registered status First Nations population is 127, 675

• 60, 505 (47%) registered status First Nations people live on reserve

OUR POPULATION

Fraser Interior Northern Vancouver Coastal Vancouver Island

On Reserve and on Crown Land 4489 14720 18464 8962 13870

Off Reserve 3873 13678 28169 6254 15169

2,500

7,500

12,500

17,500

22,500

27,500

32,500

37,500

42,500

47,500

On and Off-Reserve Status Population by HA Region

203 BC First Nations communities

Regional Health Authorities (Provincial)

137 Community Health Centres (Federal / FNs)

CURRENT FIRST NATIONS HEALTH SERVICE DELIVERY

A BRIEF HISTORY OF FIRST NATION HEALTH DEVELOPMENTS IN BC

• 2005: Leadership Accord & New Relationship & Transformative Change Accord (TCA)

• 2006: TCA: First Nations Health Plan

• 2007: Tripartite First Nations Health Plan. FNHC established

A BRIEF HISTORY OF FIRST NATION HEALTH DEVELOPMENTS IN BC

• 2008 - 2011: Gathering Wisdom for a Shared Journey

• 2012: FN Health Society becomes interim First Nations Health Authority.

• Transition phase to become the new FNHA 2013-2015

The health and wellbeing of my people depends on how well I work with each and every one of you in this room.

Gathering Wisdom 2011

1- Community Driven, Nation Based

2- Increase First Nations Decision-

Making and Control

3- Improve Services

4- Foster Meaningful Collaboration and Partnership

5- Develop Human & Economic Capacity

6- Be Without Prejudice to First Nations Interests

7- Function at a High Operational Standard

What does this all mean for `quality and safety` in First Nations patient care in BC?

• Definitions must come from First Nations themselves…

• We can and should create space for this dialogue to happen

• Dialogue needs to occur between PROVIDERS of care and RECEIVERS of care on what quality and safety means

Example of Model of Care: South Central Foundation, Anchorage, Alaska

NUKA MODEL of CARE:• Relationships are key to health care• Patient care should be integrated• Same day access for primary care• CUSTOMER-OWNERS are partners in their own health

care• Customers must have ample opportunity to offer

advice and feedback

How SCF implements the Nuka Model

• Create a culture where training and re-training is valued• Create a comprehensive induction process around the

Nuka model• Have primary care teams that are without hierarchy –

everyone on the team is equal• Have `talking rooms`- not consulting rooms• Customer-owners choose their team – and make

changes if unhappy• Leaders share and constantly LIVE the vision

Creating the Space to talk about Quality

• iFNHA / FNIH, BC Patient Safety and Quality Council and Province working together

• Utilizing Regional Tables who partner with Regional Health Authorities

• Working with First Nations Health Directors and their patients, clients and communities

PATIENT SAFETY & QUALITY COUNCILQUALITY MATRIX

Acceptability Appropriateness Accessibility Safety Effectiveness

PREVENTION Culturally acceptable

services, respectful

of FN values,

traditions, teachings

and cultural practices

Cultural appropriateness

of health professionals

and organizations

and the services they provide for

FNs

Geographic factors (rural, remote, on & off reserve)

FN Health Literacy (across

jurisdictions)

Cultural safety for FN clients

Cultural safety for workers & practition-

ers

Equity of outcome for FN patients who have

higher rates of most

illnesses and conditions

The outcomes

are not the same if

access and experience is not the same

TREATMENT

LIVING WITH ILLNESS OR DISABILITY

COPING WITH END OF LIFE

Cultural Competency Factors‘Cultural Competency’ in health may been defined in two main forms:

– An individual focus on the COMPETENCY of PEOPLE:• Health professionals and practitioners, Nurses,

Managers, Governors, Health Workers

– An institutional focus on the COMPETENCY of ORGANIZATIONS including:• Policies, practices, strategies, plans, service delivery

mechanisms, systems, processes, forms, partnerships and relationships, communications etc

Cultural Competency FactorsA Culturally responsive health system

Is a combination of

Culturally competent staff / workforce

+

Culturally safe clients

+

Culturally appropriate systems & processes operated by institutions within the system

Cultural Competency at South Central Foundation

• RAISE PROGRAM - opportunities for native youth 14 – 19 to get on-the-job work experience in the context of Alaska Native cultural values

• TRADITIONAL HEALING CLINIC ON SITE – provide service and teach other health workers

• FAMILY WELLNESS WARRIORS – promote wellness through cultural and traditional methods

• ORIENTATION OF NEW STAFF – incorporates Nuka model, values, traditions and ongoing learning

TAKING RESPONSIBILITY / RECIPROCAL ACCOUNTABILITY

Embed cultural competency programs and initiatives within organizations

Individual workers, employees and practitioners take responsibility for their own learning

First Nations take responsibility for helping others to understand their perspectives in health

Tripartite Partners can create the space for these dialogues to happen at all levels

In conclusion…

The environment is right for partnership and collaboration at all levels

First Nations have been clear that they must define and govern their own health

First Nations health leaders are committed to service improvement; to better health experiences for their community members and to better health outcomes

THANK YOU