Meeting Purpose

The BC-PAN’s first operational phase meeting was a two-day Zoom conference meeting on September
30 and October 1, 2020. The intention of this day of the meeting was to gain insight from the public advisors on actions the colleges could take to promote anti-racism, cultural safety and health equity in healthcare regulation.

Key Learnings

• Cultural safety principles could benefit from being integrated into colleges’ programs and processes such as quality assurance or accreditation programs.
• There is confusion surrounding the complaints process; the process is daunting and difficult to navigate. Improving accessibility and simplifying the process may reduce some barriers of filing a complaint.

Meeting Orientation

Susanna spoke about her personal white privilege and explored concepts of race, privilege, and
intersectionality. She introduced the ideas of mirrors and windows:

• Mirrors: looking into ourselves and recognizing our own privileges.
• Windows: looking outside ourselves to understand the system that we live in.

Susanna made several points about the day’s discussion:

• People will make mistakes; it is important to focus on the impact of those mistakes and not the intent. We must commit to acknowledging mistakes and learning.
• Attendees should feel free to take a break at any time.
• Some will have lived experience, there is no pressure to contribute more than what feels comfortable.
• This is an important but difficult conversation.

Susanna initiated a poll to orient to a discussion about discrimination:

How familiar are you with discussions about identity and privilege?

The results were:

• The words are fairly new to me: 10%
• I’ve done a bit of reading and/or training: 24%
• I’m working to integrate these concepts into my life: 29%
• I am highly committed to advancing this work: 38%

Susanna reviewed the results with the group. She mentioned that the day’s discussion is focused on what the college partners can do. She invited participants to input in the chat the types of health care practitioners they use daily and emphasized the need to include the wide variety of health care professionals.

Talking Together About Privilege and Discrimination

Susanna asked Susan Prins, CPSBC Director of Communications and Public Affairs, to clarify the mandate
of colleges:

• Practice standards are expectations set by colleges that registrants must abide by and are held accountable to.
• Processes include processes for registering registrants, filing complaints, or administering quality assurance programs.
• Colleges provide oversight to ensure that registrants are competent and ethical through programs such as (in the case of CPSBC), peer practice enhancement programs and accreditation programs.

A brief group discussion followed:

• Confusion about the roles of health authorities and health care regulators.
• Regulatory mandates are sometimes in conflict with institutional policy and health authorities should be part of the conversation.
• College partners clarified that health authorities are accountable to the government through different means.
  • A health authority can bring concerns to a college if there are inquiries about individual health practitioners. Colleges are responsible for individual practitioners.

Susanna emphasized the urgency of the day’s conversation. A few days prior, a 37-year-old Indigenous
woman passed away in a hospital pleading for help and instead received racist, demeaning and
condescending remarks from those who were supposed to provide her care. Advisors were visibly upset
about the tragic incident and were moved to act towards addressing and deconstructing systemic
oppression. Inspiring words followed:

“This is one of the too many stories about Indigenous peoples receiving inequitable care and
avoiding care because of previous experiences. The need is great for our colleges to start to
dismantle systemic oppression … We are going to make mistakes – we are all learning how to
make powerful changes so let us be kind to each other and let us be brave.”

BC’s Health Regulators, Anti-racism, Cultural Safety and Health Equity

Gillian Vrooman, COPBC Director of Communications and Engagement, gave a presentation outlining the
steps colleges have taken to address discrimination in health care:

• Under the Health Professions Act, it is the duty of regulators to serve and protect the public as well as enforce professional ethics.
• BC Health Regulators pledged their commitment to making our health system more culturally safe for First Nations and Aboriginal Peoples in BC on March 1, 2017.
• BC Health Regulators, the First Nations Health Authority, and the Ministry of Health signed the Declaration of Commitment to Cultural Safety and Humility in Health Services in 2015.
• Following signing the declaration, different First Nations Health Authority events that bring together First Nation Peoples from across BC have created opportunities for regulators to listen, learn and begin to build trust.
• In 2018, BCHR identified a list of activities that health regulators agreed to continue to work on, such as reviewing complaints processes, policies, practices and programs with a lens of Cultural Safety and Humility.
• It is critical to acknowledge that there must be more done to address racism in health care. Mary Ellen Turpel-Lafond is leading an investigation into Indigenous-specific discrimination in B.C.’s health care following allegations of racist games played in some B.C. ERs.
  • BC Health Regulators fully support this investigation.
• The College of Pharmacists has established a Black Lives Matter Working Group within the College to focus on combatting the racism faced by Black people in B.C.

Patient Story

A public advisor shared their personal story about a time they faced discrimination based on their
Indigenous identity. They described a procedure with a specialist where they experienced heightened
levels of anxiety because of their already negative perceptions of health care providers. At the end of
the procedure, the specialist discretely whispered to them, “no drinking for 24 hours”.

The advisor closed with the following statement:

“I was so hurt and disappointed and upset as this was unbelievable to me … Unfortunately, this
happens often … Why in 2020 do we still have to deal with this is beyond me. That is systemic
racism and it seems to me that it will be around for my life span. Can I do enough to try and
change things? Is there any hope? Right now, I’d say there is no hope for me.”

All attendees paused to ruminate on the story. A brief discussion followed:

• Attendees outpoured their support and gratitude to the public advisor for being so brave to share their story.
• Most were saddened and appalled to hear of their experience.
• Why did the advisor not file a complaint about the specialist?
  • The advisor feared retaliation and did not think that their word would be taken seriously.
• It would be helpful if there was a regulatory process to address these types of issues without going through the formal disciplinary process.

Draft Principles of Cultural Safety for Health Professionals Review

Kelly Newton, CPSBC Policy and Engagement Lead, briefly provided background on draft cultural
principles for the public advisors to review. The College of Physicians and Surgeons of BC is working with
the BC College of Nurses and Midwives and the First Nations Health Authority in developing the
principles. The document is in the beginning drafting stages and colleges can individually determine its
use. The college partners are seeking feedback from the advisors on what stands out and what is
important to them.

Advisor feedback on Draft Principles of Cultural Safety

Which principles are likely to be most important for patients who might experience discrimination? Why?

• Acknowledgement of power and its effects – colonization is about power imbalance and decolonization requires its acknowledgement.
• Understand BC’s colonial history as well as patients’ past experiences, cultural values, beliefs and practices. 
• Trauma informed approach involves understanding that trauma can occur and understanding why individuals are the way they are.

Are any ideas missing in these principles for health professionals?

• Integrate the concept of compassionate care into clinical practice. Touch and non-verbal behaviour can influence a patient’s perception of cultural safety.
• Explain the purpose of interview questions and do not make assumptions about the individual.

What advice do you have for the college, or practitioners, about implementing these principles?

• Role play – provide opportunities for practitioners to experience being a patient.
• Require practitioners to undertake educational programs or professional development on residential care and provide certifications.
• Integrate cultural safety into quality assurance programs.
• Involve elders in the board of representatives to ensure that they have a voice.

Registering a Complaint of Discrimination

Susan Prins summarized colleges’ complaints processes and takeaways from recent events:

• When a patient is concerned about the care they have received, they can file a complaint with the regulating college.
• Colleges are aware that not everyone feels comfortable filing a complaint. It is a complicated process that requires written correspondence, investigations, and a letter of the patient’s experience.
• We know that there are problems in BC’s health care system. Mary Ellen Turpel-Lafond is conducting an independent investigation into Indigenous-specific racism in B.C. health care.
  • Nearly 3000 Indigenous people have shared their stories in a survey for the investigation, yet colleges have heard very little in the form of a complaint.
  • In a search through CPSBC’s complaint database over the past eight years using key words like discrimination, racism, and access to care, only 37 files were found.
• Colleges want to hear how they can support patients to come forward and file a complaint if they have had a negative experience. They want to tear down these barriers and improve internal processes.

Advisor feedback on registering a Complaint of Discrimination

What barriers might the discriminated person face in reporting the incident to a college or another
person who can support them?

• Public awareness: most members of the public do not know that colleges exist to protect the public or that they can submit complaints to a college.
• Lack of accommodation: people may have language barriers or different preferences in communicating information.
• There is a power imbalance between the public and health care practitioners – some fear retaliation. People in remote areas only have access to few health care practitioners.
• Many people do not know the process or how to navigate the system. It is not clear who to contact to make a complaint or who has authority. Most would rather give up than attempting to understand the process.
• Having to retell a negative experience can be retraumatizing.

What can a college do before and after an incident of health care discrimination to empower the public
to raise their concerns?

• Establish different levels of complaints and different mechanisms to address complaints.
• Provide the opportunity for the public to share concerns verbally; people should be able to speak to someone at the site of where the incident occurs.
• Have support available to guide the public during the complaint process.
• Ensure that the individual is not required to retell their story to the person who originally caused harm.
• An anonymous tip line for the public to address their concerns while protecting their privacy.
• For Indigenous people, issues are often brought forward through storytelling. It is important to make space for those stories to be told.
• Establish patient relations offices within communities and create an interface between those offices and colleges.
• It is beneficial to have visual material or easily accessible material in health care provider’s offices about making a complaint; a bill of patient’s rights or reinforce the charter of rights.
• Colleges should report on whatever action has been taken after the patient files a complaint. 

Other comments

• The complaint system must be simplified through a mechanism such as an online portal.
• Words matter – colleges can make the process softer by avoiding harsh words such as “complaint” or “discipline”.
• An independent third party who is a public advocate/navigator can support the public throughout the complaint process.
• Establish a post treatment process for patients to share their experiences through a questionnaire or kiosk approach that can be collected by colleges.