This Hickey et al. (2018) article came into my news feed because the phrase ‘cultural safety’ is used. As I read the article I realised a problem (not with the article) for the advocacy for cultural safety in Australian healthcare governance is that it is used as a buzzword without genuine theoretical, intellectual, and methodological engagement.
The sentence in the article that captured my attention proposes that ‘If the model is successful and demonstrates a good return on investment, we will have developed and evaluated a culturally safe service model transferable to other settings for trialling in a broader context’ (p. 11).
The problems with this proposition is that the methods are not explicitly tied to cultural safety discourse, there are no citations to cultural safety articles, cultural safety is not a key word, and cultural competence is the primary concept underpinning the Birthing on Country service model. In other words, the impact and value of ‘cultural safety’ is being diminished and demeaned through association with ‘cultural competence’.
The second article by Eastwood et al. (2018) is similarly the case. I noticed two statements, 1) ‘Acknowledging our desire to better comply with cultural safety as a core principle in outbreak report writing with Aboriginal peoples ’ but the reference cited (Ogbuanu I, Kutty P, Hudson J et al. Impact of a third dose of measles-mumps-rubella vaccine on a mumps outbreak. Pediatrics 2012; 130 (6): e1567-e1574) doesn’t say anything about that topic. And 2) the statement ‘the principle of cultural safety in outbreak management is universal ’ is not supported by the reference (Western Australian Immunisation Strategy 2016–2020).
Eastwood replied to my email by supplying this reference: IESR. Guidelines for the Investigation and Control of Disease Outbreaks. Porirua, New Zealand. Updated 2011. However, the IESR guidelines have no key phrase about ‘cultural safety’ or ‘culturally safe’ but only focusses on cultural competence and cultural appropriateness. Therefore, at a strictly critical academic standard, the statements made in the article are invalid.
In a Facebook post, I wrote that the core distinction between cultural safety and cultural competence hinges on the concept of ‘power’ where ‘safety’ locates power in the hands of the patient while ‘competence’ maintains the dominance of the health professional. Therefore, I propose, there is a theoretical and intellectual conflict between a competent birthing service being a safe model of care. That is, there is a practical and academic movement to say safety is an outcome of competence which neatly cuts-out patient perspectives to maintain professional dominance.
However, I can’t test my proposition until much more research is done that is explicitly designed through the lens of cultural safety. Furthermore, this article has a fantastic methodology and excellent research process and so it will be interesting to review the outcomes of this evaluation work.