Our engagement leader for the Interior region, Jacquelyne Foidart, has been directly involved in our efforts to follow the lead of Indigenous Advisors to increase the participation of Indigenous patient partners in health care improvement. In this post, she shares a few approaches we’ve tried and the results so far:
One of the things I value most about my role as a PVN Engagement Leader is how fortunate I am to learn from amazing people across British Columbia. I travel primarily within the Thompson Cariboo Shuswap areas of the Interior to share opportunities where patients, family members and caregivers can help impact change in health care. Along the way, I’ve been honoured with some incredible relationships and important teachings from Indigenous Advisors.
The advisors know that patient experiences in accessing care are unique. Every patient brings their own medical, family and cultural history to each touch point of care. They know positive change happens when patients and providers are able to speak with openness and trust. Buzz Morissette, for example, is an Elder and a PVN Patient Partner who has impacted many lives. He feels it is now his responsibility to help others understand the need to share their voice:
“We have to encourage and bring our Aboriginal people to start participating in health system processes. That’s a difficult thing, as there’s been a history of barriers that have barred our people from participating in society and, unfortunately, in health programs,” says Buzz. “Now we have to try and get them interested and involved. We’ve been working at it for some time! But that’s okay, that’s the way. We have to continue to bring people together, and invite them to share their ideas, concerns, and knowledge. Because they are the ones that have knowledge of their issues, their health matters, their health concerns. And they have to share them with us and the system, or their issues are not going to be known. We just have to continue to educate and to work with other groups and agencies to develop those initiatives.”
The importance of cultural awareness
While recently participating in a round table discussion on cultural awareness and the patient experience, a message resounded in the thoughts of diverse participants in the circle: to be culturally aware is to listen with kindness, curiosity and lack of judgment to understand the needs of the individual you are caring for.
With this in mind, health care providers recognize that the experience of a young Indigenous mother from a remote community will be entirely different than that of a young Indigenous mother’s access to care in an urban setting. They recognize that experiences from various cultures, ages, communities and genders must be part of the discussion when seeking to provide a positive experience for the diverse patients of British Columbia. PVN is exploring how to support this movement.
In January 2016, there were seven self-identified Indigenous patient partners in the Network. As engagement leaders, we witnessed hundreds of incredible improvement projects and initiatives, each hoping to hear from diverse patient experiences. It was clear that we needed to help bring these opportunities to Indigenous communities to ensure future service changes would reflect their needs. Two years later, in January 2018, the number of Indigenous patient partners has increased to 81, amounting to 9.5% of the total Network! From this growth in interest, we learned that rigid processes do not suit the needs or comfort level of diverse patient partners. With this in mind, we continue to reach out to Indigenous community members and learn from their ideas for change.
Some of the ways we’ve been advised to approach Indigenous community members:
Having a presence
We’ve been reaching out in person at Indigenous celebrations, Regional Caucus meetings, All Native Basketball Tournament, Provincial Elder’s Gathering, Friendship Centres, Band Health Centres, Metis support organizations and more! Our intent has been to take interest, be curious, learn as much as possible and hear from community members how we could adjust our program to better meet their interests in participating.
Building relationships at community level
Trusting relationships are essential. Knowing that true relationship building takes time, we must commit time and resources to connect in-person with transparent purpose and open minds to how the community or individual want to work together. Solid trusting relationships can take years to form, however, we’ve been taught that working with a trusted member of a community can enhance relationship building with others in the same community. Focusing primarily in Northern, Interior and Vancouver Island Regions of BC, we have been putting the advice into action:
- Connecting with community health directors, engagement coordinators, health representatives and urban Indigenous health centre staff to learn of trusted community members who may be able to assist with relationship building;
- Learning as much as possible about the cultural norms of the community, acknowledging that we are guests within the territory and acknowledging what we don’t know;
- Being willing to laugh at ourselves on our journey to understanding. Being open about our journeys and intent to learn;
- Working with trusted community members as a main contact for sharing information with the entire community (often information would be shared by personal invitation or a pre-existing communication process); and
- Requesting permission to join existing community gatherings around food to be introduced and where appropriate, share information.
Spreading the word
We learned that local health centres and social media are widely used for sharing news and events in Indigenous communities. We’ve responded to advice by:
- Creating Engagement Leader Facebook pages to share information on Indigenous community Facebook pages;
- Working with Indigenous patient partners to develop culturally safe workshops and appropriate posters;
- Working within First Nation Health Authority communication pathways as well as local community communication pathways to share information; and
- Highlighting stories of Indigenous patient partner engagements through our outlets (Twitter, Facebook, newsletters)
As an extension of the Cultural Safety & Humility partnership formed between the BC Patient Safety & Quality Council, which supports PVN, and First Nations Health Authority (FNHA), we are excited to share that FNHA is supportive of PVN. FNHA has offered to use their existing engagement pathway for sharing opportunities that align with their strategic priorities for improved care. This partnership is invaluable to engaging Indigenous voices, as we have been advised that information shared in this manner is considered with greater weight and authenticity than information provided directly at a community level. In addition, FNHA will share opportunities through their social media channels, reaching over 4,000 Indigenous community members.
Supporting health care partners explore flexible engagement formats
We’ve heard that some engagement formats may have less cultural safety than others, so we’re working with health care partners to provide a number of options and formats to meet the patient partners’ needs for each opportunity.
As health care partners strive to engage diverse voices in their work, they must consider the various need individual patient partners may have. Some considerations will be:
- Adequate pre-planning to allow time for spreading the word about the request through existing relationships
- Travel needs: consider what would be easiest for the patient partners: Arranging travel to an engagement site or bringing the engagement site to their community? What plans are in place to support any necessary travel?
- Format of engagement: we’ve learned from our Indigenous Advisors that information dropping (presentation style) is not well received by community members. A preferred approach may be a sharing circle, discussion with an Elders or community group, or a community activity where discussions take place while working to create (beading, basket weaving, medicine pouches – many ideas were suggested by Advisors)
Listening and learning from Indigenous Advisors is making a difference and creating interest among Indigenous community members. Our greatest takeaway is understanding that an Ally is an individual or organization who takes an interest, is willing to continuously learn and adjust their approach to help and support. Thank you to our Indigenous partners who continue to share their knowledge as we move forward!