PP3 – Respectful, culturally appropriate and culturally safe care

All patients have the right to receive respectful and person-centred care that is accessible and considers and respects their identity, body diversity, religion and cultural beliefs. Respect for a patient means that care is available to them without bias or the influence of the team member’s personal beliefs.

Similarly, patients have a responsibility to be respectful and considerate towards their practitioners and other practice team members.

When referring to the experiences of Aboriginal and Torres Strait Islander peoples, culturally safe practice is defined as the:

ongoing critical reflection of health practitioner knowledge, skills, attitudes, practising behaviours and power differentials in delivering safe, accessible, and responsive healthcare free of racism⁽³²⁾.

For Aboriginal and Torres Strait Islander peoples, clinical and cultural safety are inextricably linked. This means cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities as recipients of healthcare.

Culturally safe policies aim to create:

an environment that is safe for people: where there is no assault, challenge or denial of their identity, of who they are and what they need, where there is shared respect, shared meaning, shared knowledge and experience, of learning, living and working together with dignity and truly listening⁽³³⁾.

Members of the practice team who are Ahpra registered have an obligation as a registered professional to promote culturally safe care that is free from bias and racism. To support them to do so, the practice could:

• acknowledge the factors that impact individual and community health, including colonisation, systemic racism, as well as social, cultural, behavioural and economic factors
• encourage the practice team to acknowledge and address their own racism and biases, assumptions, stereotypes and prejudices
• recognise the importance of shared decision-making, partnership and collaboration in healthcare that is self-determined by individuals, families and communities
• foster a safe working environment by providing leadership that supports the rights and dignity of Aboriginal and Torres Strait Islander people and colleagues⁽³²⁾.

To provide the most appropriate care that is culturally safe, the practice team needs to understand the demographics and cultural backgrounds of the practice’s patient population. This could be achieved by using a digital data extraction tool or census data to identify cultural groups in the patient population.

For the practice to provide culturally safe care for Aboriginal and Torres Strait Islander patients, the practice could:

• provide the practice team with access to cultural awareness and cultural safety training, and keep records of the training in the practice’s training register
• maintain a cultural safety policy so the practice team knows they are required to provide care that is respectful of a person’s culture and beliefs, and that is free from discrimination
• regularly seek feedback from the practice’s Aboriginal and Torres Strait Islander patients
• seek feedback from Elders in the local Aboriginal and Torres Strait Islander community
• collaborate with Aboriginal and Torres Strait Islander patients to co-design service at the practice
• have an Elders Council at the practice
• have members of the local Aboriginal and Torres Strait Islander Community as cultural mentors to practice staff
• have an employment policy to employ Aboriginal and Torres Strait Islander staff
• make the practice’s public areas welcoming to Aboriginal and Torres Strait Islander patients
• have culturally appropriate information that is available and accessible to Aboriginal and Torres Strait Islander patients
• allow practice staff to acknowledge and participate in significant events in the local Aboriginal and Torres Strait Islander calendar
• display signs acknowledging the traditional custodians of the land
• display Aboriginal and/or Torres Strait Islander art and flags.

The practice team could support safe and respectful communication by:

• using culturally safe, non‑judgemental and trauma‑informed communication practices, recognising that experiences of family, domestic and sexual violence (FDSV) may be shaped by cultural identity, intergenerational trauma, disability, gender diversity or migration experiences
• recognising that some patients may face cultural, linguistic, disability‑related or historical barriers to raising safety concerns, and fostering communication environments that feel safe
• recognising that trauma can influence how some patients express distress, and that trauma‑informed training can help members of the practice team to understand these responses and communicate in ways that support safety for patients and the practice team
• respecting a patient’s choice not to proceed.

To provide care that is respectful and recognises diversity and individuality, the practice could:

• have a policy clearly setting out patients’ rights and responsibilities
• educate the practice team about how to deliver care that is compassionate, person-centred and respects patients’ rights
• have an anti-discrimination policy that complies with relevant discrimination laws
• have a process where members of the clinical team respectfully ask patients about their cultural identity and beliefs and record them in the patient’s health record
• if possible and if culturally appropriate for the patient population, have separate sections in the waiting room for men and women
• hold meetings for the clinical team to discuss and identify the unique health needs of lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA+) patients and those of other gender and sexual diversities
• display LGBTIQA+ symbols and/or flags
• have gender neutral toilets
• display the practice’s cultural protocols in the reception area, waiting areas and consultation rooms
• provide resources appropriate to the health literacy and cultural needs of patients
• consider having a patient representative or advocate who is invited to participate in meetings with partners and managers when changes need to occur in the practice, and when new policies or initiatives are being developed.

The practice could consider factors that may affect the provision of respectful and culturally appropriate care for a patient, including:

• the patient’s preference for a clinician of a specific gender
• the role of the patient’s family
• the patient's right to not have family present
• the impact of the patient’s culture on their health beliefs
• the patient’s history of traumatic events.

For information about patient rights and responsibilities, including posters that can be used by the practice to make patients aware of these, refer to the RACGP’s General Practice Patient Charter, which draws on the Australian Charter of Healthcare Rights.