The first of its kind in Canada, the San'yas Indigenous Cultural Safety training was created by PHSA’s Indigenous Health program, under the leadership of Cheryl Ward, to improve the safety and quality of services Indigenous people receive. It is an accredited, online training program designed to increase knowledge, enhance self-awareness, and strengthen the skills of those who work both directly and indirectly with Indigenous people. More than 40,000 people have completed the San’yas training since its launch in 2010.
The San’yas team has been influential in working towards structural change by empowering health care employees to become leaders in Indigenous cultural safety and to address racism and discrimination towards Indigenous people. Cultural safety is about fostering a health care climate where all employees recognize the history of colonization and its impacts on Indigenous people in order to provide services that are equitable, respectful and safe.
Through interactive and facilitated online training, participants learn about colonization (past and present) and contexts for understanding social and health inequities. Participants also examine Indigenous diversity, stereotyping, and the impacts of colonization, while learning tools to develop more effective communication and relationship-building skills.
We spoke with San’yas Lead training facilitators Rain Daniels (Anishnaabekwe), Chelsey Branch (White settler), and Laurie Harding, (White settler), San’yas Knowledge Integration lead. All live and work on the unceded territory of the Musqueam, Tsleil-Waututh and Squamish Nations. They are sharing what makes this training program so special.
The San’yas Indigenous Cultural Safety Training team works every day to make the health care system a safer and fairer place for Indigenous people. It acts as an educational bridge to bring awareness to health care providers about attitudes and behaviours that can transform health care practice. We promote and facilitate system change.
Indigenous people face the greatest health inequities in BC and yet have the least access to care, and this is largely related to the legacy of colonialism in Canada and the ongoing racism embedded in our social systems. Indigenous people do not receive the same care as non-Indigenous people and there are significant health gaps.
The San’yas training is different from other online training programs in that it is heavily facilitated, with two-thirds of our team (of 25) in facilitation roles. The San’yas facilitators are a cross-racial team of highly specialized and skilled Indigenous Cultural Safety leaders who engage in critical conversations with employees on the issues Indigenous people face within the health care system, including racism, stereotyping and discrimination. They work collaboratively to deliver training to health and social service professionals throughout BC and across Canada. Other San’yas staff work in integration, program management and program development.
What gets us excited is seeing the potential for change. This is very demanding work and it would be impossible to do it every day if we didn’t believe in what we’re doing whole-heartedly. We see that the training is not just impacting health care, but also how people respond with their families and friends. Participants are taking their learning and spreading it to other aspects of their lives.
What is most rewarding about your job; what makes it all worthwhile?
It’s incredibly rewarding when people go through the training, and then want to keep going and learn more. It’s like a door has opened, and they make the connection between the training and their work or practice. This is a daily favourite moment – seeing someone make this connection and knowing that the learning will positively impact an Indigenous person.
Many participants note that they have had curiosity and wondered about racism in the system, but have not had the language to address it, or have not seen accountability. Learners are relieved to have a way to talk about what’s been going on. They also develop a sense of ownership – they can now talk about what they see happening and know what to do with their colleagues, or within their team or workplace. They feel more comfortable speaking up and looking at how to integrate the training into their workplace. They want to translate what they know to practice – making care safer and interrupting harm.
There have been so many significant milestones over the eight years of the program. A significant standout has been seeing leaders within PHSA recognize the necessity of Indigenous cultural safety. There have been many leaders who personally invested their own time to complete the training for themselves, and then made that investment visible to their staff and the organization to fully support completion of the San’yas training.
Seeing [PHSA CEO] Carl Roy on the list of San’yas participants was a specific highlight. Having him take the training and be a role model for other leaders and staff in the organization speaks to the importance of the training and how meaningful it is to the highest level of the organization.
It’s so gratifying when we hear stories from learners who have committed to moving towards equity and who have taken action to make health care safer for Indigenous people.
We’re also very proud of the system-level initiatives to improve the health care experience for Indigenous people such as the signing of the Declaration of Commitment on Cultural Safety and Humility in Health Services Delivery for First Nations and Aboriginal people in BC. The Declaration was signed first by the health authority CEOs and the Ministry of Health in July 2015, and then by BC’s 23 health regulatory bodies in March of this year.
This is a core San’yas value. We are working with respect, hearing this value in staff and supporting it every day.
We treat participants as both individuals and as representatives of a system, and we value the diversity of experience that people bring to the training. We are doing this work for Indigenous patients and their families. It is transformative learning, calling on learners to draw on their own experiences to bring about change and improvement. People are learning how Indigenous-specific racism is affecting care across a spectrum of professions. We help participants to gain an understanding that stereotyping exists and to make the link to their practice.
Part of the San’yas training is having tough, critical and courageous conversations. Some people coming into the training don’t know about Canada’s colonial history. Some people expect it’s going to be an easier conversation about learning Indigenous culture, not learning about themselves. Part of our job is to role model understanding and let people know that these inequities are not about good or bad people. It’s about acknowledging that there are socially learned, systemic biases and prejudices that all Canadians have consumed. We compassionately guide people to a new or greater place of understanding. We believe we can say anything if it’s said with compassion.
Dare to innovate
We see San’yas as a vehicle for change in addressing health gaps in BC and across Canada. It’s an intervention and a catalyst to start and support further conversation. Making health care safer and more equitable is a life-long process and we hope the training helps people commit to that journey. We encourage participants to find their place in that change and take action in their sphere of influence – to really look at their role and where they can make changes that will have an impact.
The program was developed for health care initially, in partnership with the health authorities and local organizations. Courses for mental health, child welfare and justice have since been added, and the program is now offered in Manitoba and Ontario. We are also co-leading a National Indigenous Cultural Safety Learning Series; a series of webinars focused on Indigenous cultural safety. We have created a community of practice and the training has also been getting national and international attention. The work is expanding a lot and requests for workshops are constantly growing.
Serve with purpose
The program has been rigorously evaluated over the past eight years which has confirmed what we see – that the training is effecting change. We receive consistent positive feedback from teams, patients and staff, both Indigenous and non-Indigenous – that can be connected to the San’yas work, about the imperative need for this training. We’ve heard from facilitators that when they do workshops, they can tell who’s taken the San’yas training. It says a lot about the level of passion and dedication of this team doing sometimes difficult work unpacking racial inequities. We have a very important purpose. We have commitment and clarity of purpose on the part of everyone on the team, and this is modeled by our Indigenous leader – Cheryl Ward (‘Namgis) who is the Interim Director of Indigenous Health and was the architect of the training. She has described her growing team as ‘small but mighty’. Cheryl sets the tone and guidelines for collaboration, and we have the privilege of enacting the vision of seeing the health care system become a safer and fairer place for Indigenous people.