2022-2023 Impact Report

Indigenous people experience widespread systemic racism in health care, resulting in a range of negative impacts and harm including loss of life. Compounding this, low trust in the health system means Indigenous people are often hesitant to lodge complaints – they doubt their issues will be addressed properly or, worse, have a negative impact on their care. 

Additionally, there is limited scope for incorporating Indigenous practices and approaches within the existing system and, once a complaint is made, there is often a lack of resolution or a satisfactory outcome.

In short, and as found in the In Plain Sight report, the current patient complaint processes do not work well for Indigenous peoples. Improving them would lead to safer and more accessible care. 

To activate the transformation of the patient complaints process, Health Quality BC (HQBC) and the Ministry of Health assembled the key players in the complaint management world for a day of dialogue and collective action on January 27, 2022. 

More than 100 experts representing 23 Indigenous and health service organizations collaborated on and validated Sharing Concerns: Principles to Guide the Development of an Indigenous Patient Feedback Process. The guide provides health authorities, regulatory colleges and other health partners a set of nine principles to build culturally safe and effective feedback processes. 

Mark Matthew, HQBC’s new Indigenous Health Director, describes why one of the first things the collaborating partners did was to drop the word “complaint.”  

“There was agreement that we must shift from the negative language of ‘complaints’ to the more inclusive term ‘feedback,’ ” Matthew says. “This not only avoids labelling Indigenous people as complainers but also fosters a safe space for voices to be heard, including positive experiences. By focusing on ‘sharing concerns’ we open the door for meaningful dialogue and continuous improvement in our health care system.”

Through a series of plenary and breakout sessions, patients, Indigenous Patient Navigators, Patient Care Quality officers, and senior health system leaders shared their best practices and thinking to improve feedback processes. 

Heidi Oetter, Registrar and CEO of the BC College of Physicians and Surgeons, says that the collective thinking of complaints management experts from across the system is helpful. 

“This was an important and very necessary discussion that every health regulator and health authority will benefit from as we all seek to do better and implement changes to make our processes culturally safe and accessible,” she says. “The nine principles in Sharing Concerns: Principles to Guide the Development of an Indigenous Patient Feedback Process provide organizations with a tangible, common foundation upon which the steps in our complaints processes can be assessed and improved.” 

The nine key principles for Indigenous feedback include:

1. Be Grounded in Indigenous Rights, Cultural Values and Traditional Protocols
2. Be Indigenous Patient- and Family-Centred
3. Take a Restorative and Accountable Approach
4. Remove Unnecessary Barriers to Engaging in the Patient Feedback Process 
5. Be Trauma- and Violence-Informed
6. Include Indigenous Peoples in Leadership and Positions Supporting the Patient
   Feedback Process
7. Be Responsive and Provide Clear, Timely Feedback
8. Provide Indigenous Patients and Families with an Indigenous Support Person
9. Provide an Opportunity for Indigenous Patients to Identify Their Indigenous/Aboriginal Ancestry 

Matthew says the nine key principles of Sharing Concerns are a sort of north star for the system when designing their own culturally safe feedback processes.

“Sharing Concerns is not necessarily a prescriptive document or a policy,” Matthew notes. “It provides some common elements and features across the complaint management and quality care world and, in that way, is a valuable tool to test your own complaint management work against to see if you’re offering the type of guidance that was collectively grown and validated across the system.”

Shari McKeown, Director of Patient Safety at Interior Health, describes how Sharing Concerns contributed to their commitment to anti-racism. “We were able to use these nine principles as a guide to validate some of the changes we had made and identify additional opportunities to improve the cultural safety and acceptability of our Patient Care Quality program. Clients now have a safe and accessible path to share feedback about their care, which ultimately helps us to improve health outcomes for Aboriginal peoples living in the Interior Region.”   

The Sharing Concerns guide has been read over 2,400 times and downloaded by 400 visitors to HQBC’s website since it was published in October 2022. It is also shaping the work of the In Plain Sight Task Team Working Group on Complaints and the Cultural Safety and Humility Patient Care Quality Collaborative.

Matthew has witnessed a major change in his 14 years in health care.

“Non-Indigenous people are a major part of the story and the solution. As Indigenous people, we do what we can do in terms of building knowledge, creating tools, resources, and guidance. Now, appropriate allyship becomes a really critical milestone. Non-Indigenous perspectives and energy is being applied to what Dr. Danièle Behn Smith calls ‘untangling the colonial knots.’ A new era is upon us where allies are spreading change, and they’re owning it.” 

Visit our Cultural Safety and Humility Resources Page to download the guide