Creating meaningful engagement with First Nations, Métis and Inuit peoples is an ongoing practice that requires repeated commitment, said Kimberly Fairman, Executive Director of the Institute for Circumpolar Health Research (ICHR).

Fairman was speaking during Part III of Health Standards Organization (HSO)’s Indigenous-focused webinar series Meet me where I am: Applying people-centred care to engaging with First Nations, Métis and Inuit peoples. Also speaking was Marilee A. Nowgesic, CEO of the Canadian Indigenous Nurses Association (CINA) with moderator, Heather Thiessen, patient leader with the Patient Partnership Office at HSO.

During the 60-minute webinar, participants were invited to reflect upon the analogy of running uphill, which can be challenging but eventually, rewarding. Participants were encouraged to take this analogy towards implementing people-centred care and creating meaningful engagement with First Nations, Métis and Inuit peoples in Canada.

Building authentic relationships
Fairman noted that a good place to start is by building relationships in which you can have discussions about challenges and obtain feedback. “If you build relationships where you can get feedback, you can start to move into places of discomfort and begin to address challenges and issues,” she said. Fairman added that as an Indigenous person, she relies heavily on meaningful relationships. “It’s about the type of support that you have around you. It’s how safe people feel to talk about the struggles and challenges they are experiencing,” she said. “It’s finding those partners where you’ve had success in the relationship before and relying on those people for support when you move into that engagement space.”

Thiessen noted during the webinar that people-centred care is about building meaningful relationships. “It’s about relationship building and meeting people in their communities,” she said. “It’s about shifting conversations from ‘what’s the matter with you?’ to ‘what matters to you?’.” She added that this shift in perspective doesn’t happen overnight. “If we’re going to build authentic relationships with people, we need to get to know them first and know all that’s involved, so that we can create a safe space for them to come into.”

Thiessen said much work has been done to change the perspective towards patients and families, but due diligence needs to be done when it comes to First Nations, Métis and Inuit patients and families. “We need to ensure they are being respected as well,” she said. “It’s not just about going through the motions. It’s about taking responsibility and looking at how to practice [care] in a culturally safe and humble environment.”

On June 23rd, HSO launched a public review on its new British Columbia (B.C.) First Nations, Métis and Inuit Cultural Safety and Humility standard. The draft standard, which is the first of its kind in Canada, was developed by a First Nations-led Technical Committee in B.C., with additional input from Métis Nation B.C. It aims to create a culturally safe environment for Indigenous people in the health system, encourage health care providers to provide care with humility and end Indigenous-specific racism. The public review is open until August 23rd.

Following on Thiessen’s points, Nowgesic noted that creating meaningful engagement with First Nations, Métis and Inuit people can be challenging for both the provider and the Indigenous patient themselves.

She said that a provider may be uncomfortable and unsure about how to move into that culturally appropriate space and at the same time, the patient may be hesitant to communicate their cultural needs. “Being able to identify what is uncomfortable and being able to bring that forward in the conversation is tricky,” Nowgesic said. “So, it’s a matter of looking at that specific person. It’s creating a safe space and an environment that is free of judgment.”

Educate yourself on Indigenous cultures and customs
During the webinar, Nowgesic also noted that when moving to engage with Indigenous people, organizations and providers should take the time to educate themselves on Indigenous cultures and customs. She said that for example, some hospitals in Canada have considered adding or have added a sweat lodge to their facilities. “But it’s looking at, do you know why you’re doing this, and do you know how to do it properly? Are you following the protocols, and have you looked at the traditional approaches?” Nowgesic said.

She added that reconciliation and meaningful engagement is to be taken upon by the non-Indigenous. “This is part of your discomfort. Take responsibility and learn that exercise of humility,” Nowgesic said. “I sit at the table with my non-Indigenous allies, partners and stakeholders to ensure that you’re following the protocols, the values of respect, the Seven Sacred Grandfather Teachings and many other traditional approaches that are necessary to engage with Indigenous people.”

Share your learnings with others
Fairman added that reconciliation and meaningful engagement takes time. It is also not something that can be taken on by a single person. “I believe reconciliation has to happen on an individual level, through relationship first, then we have to let it seep into all the organizations that we work in,” she said.

Fairman also encouraged people to share their learnings with others as this often opens the door to change. “It’s about sharing what that learning was like for you and encouraging others to take those first steps and then, continuing to bring others along with you,” she said. “It becomes a practice and a commitment to that practice as opposed to just one effort, one time.”

Thiessen noted that she’s been working on moving patient and family engagement forward for 13 years. “And we haven’t even scratched the surface yet about how to authentically engage with users of the health system,” she said. She added that organizations need to establish guiding principles to ensure that Indigenous people feel safe and that they are receiving culturally appropriate care. “It’s building this work into guiding principles so that everyone can feel safe and participate.”

This was the last Indigenous-focused webinar in a series of three, which were presented in partnership with the Canadian College of Health Leaders (CCHL). If you missed it, you can watch the full recording here.