Talking Circles: a step towards cultural safety
Estimated read & watch time: 10 minutes
CPSA has a responsibility to ensure all patients are receiving high-quality care—and feel safe to speak up if they’re not.
CPSA is committed to helping create culturally-safe spaces where Indigenous people receive equitable care. We are fortunate in Alberta to have many influential Indigenous physicians and community leaders we can learn from and partner with as we work together to promote culturally-competent care across our province.
Throughout 2021, CPSA worked alongside Dr. James Makokis, a Nehiyô two-spirit family physician from the Saddle Lake Cree Nation, to improve the complaints process for Indigenous people in Alberta by trialing a new approach to interviewing a complainant during an investigation in the format of a talking circle. These talking circles are an important step towards creating culturally and psychologically-safe spaces, which is part of our job as the province’s medical regulator. We have made mistakes in the past and we will likely make mistakes in the future, but we are committed to learning, growing and doing better.
“This has to stop.”
Removing barriers
At one of CPSA’s 2021 Council meetings, Elder Doreen Spence, a member of the Saddle Lake Alberta Band, shared a story about the significance of the ripple effect. To create waves, you need to start with small changes to the status quo—something CPSA’s Professional Conduct department has been working toward over the past few years as they review and transform their processes.
One of the areas identified as needing a new approach was how we investigate complaints from Indigenous patients or complainants about their experiences in care spaces.
“As a regulator, CPSA has a responsibility to make sure all Albertans receive safe, high-quality care, but we recognize our complaints process hasn’t always felt inclusive and safe for patients,” says Dr. Dawn Hartfield, Assistant Registrar, Professional Conduct. “We need to address and label the racism experienced within the healthcare system, and focus on removing barriers in an effort to restore and repair our relationship with racialized and Indigenous communities in Alberta.”
Across Canada, reports examining Indigenous people’s experiences in the healthcare system revealed that Indigenous people often don’t file complaints. When they do, CPSA’s Professional Conduct department noticed that some of the investigations taking place through our conventional process were unintentionally re-traumatizing the complainant, their families and their communities, and discouraging others with similar experiences from coming forward.
Piloting a new approach
When looking at alternative ways to support Indigenous complainants, it was critical for CPSA to recognize our gaps in knowledge and understanding, and involve those who have lived Indigenous experience and expertise—from both a physician and community standpoint. Dr. Makokis came on board as an external physician investigator, joining former CPSA investigator Dr. Jean Langley in trialing a new approach.
The first step was recognizing that, systemically, choices have often been taken away from Indigenous people. To help restore autonomy, the pilot approach allowed complainants to choose between a conventional process or an Indigenous-led process.
The second step was engaging with Indigenous Elders and knowledge holders who could help facilitate a safe space. As Dr. Makokis shares, that’s what led the team to a talking circle format:
“In a talking circle, everybody is equal. Everybody has the same amount of power. One person’s voice isn’t louder than the others and it creates a space of openness. Everybody also has a chance to listen, and listen respectfully.”
Starting and ending with ceremony and prayer, the talking circles were guided by an Indigenous facilitator and were rooted in listening, learning and healing. A CPSA investigator and external physician investigator were also present, in addition to a support person chosen by the complainant, if desired.
The last part of this pilot approach was giving the physician, who was the subject of the complaint, the same opportunity to participate in a talking circle, again fostering the notion of equality and openness.
While only a handful of talking circles, as a means to complete a complainant interview, have been facilitated to date, we are at the early stages of learning and integrating important changes into our regulatory processes. Looking forward, we hope to integrate this approach into our consensual resolution process where we may host one talking circle where both the complainant and the physician could participate together, giving each the chance to listen to one another—something Dr. Makokis says is critically lacking in all complaints processes across health care.
It’s important to change
“In the end, the hope is that there’s a learning that happens from both parties, as well as from CPSA,” says Dr. Makokis.
The learnings have already been immense for CPSA, and some of the lessons and skills gained throughout this process have begun to influence the conventional investigation stream.
“At the end of the day, it’s about respect and listening to both sides—not just to take their statements and be done, but to truly allow them to be heard,” Dr. Hartfield shares. “We know there’s no perfect process that encompasses every unique complaint we receive, but we believe this is a step in the right direction for restorative justice for Indigenous people in Alberta’s healthcare system.”
As for the feedback the team has heard from participants, there’s been a sense of empowerment and a recognition of the importance of change.
Dr. James A. Makokis
Dr. James A. Makokis (M.D, CCFP, M.H.Sc) is a Nehiyô two-spirit Family Physician from the Saddle Lake Cree Nation in Treaty Number Six Territory. He practises Family Medicine at the Kehewin Cree Nation and has a transgender health-focused practice in South Edmonton. He is also the inaugural Medical Director at Shkaabe Makwa at the Centre for Addiction and Mental Health in Toronto. In 2019, Dr. Makokis competed alongside his husband Anthony Johnson as “Team Ahkameyimok” on Season 7 of The Amazing Race Canada and won, becoming the first Indigenous and two-spirit married couple in the world to do so.