Cultural safety has long been recognized as a means to address inequities in health care and health care outcomes between Indigenous and non-Indigenous peoples. This has led to the development and implementation of frameworks, actions and interventions in health care settings across the world. However, demonstrating results of these interventions has been elusive due to complexities inherent in measuring cultural safety, such as measuring connections between one’s perception of cultural safety in accessing health services and whether this perception has influenced health outcomes. While health system performance and health outcomes measurement are well-established disciplines, a conceptual framework that measures cultural safety actions and interventions have seen minimal development to date.

This paper provides a starting point for measuring cultural safety. It undertakes a review and thematic analysis of available literature to build a system-level conceptual framework for understanding the relationship between cultural safety interventions, experience, and outcomes. The framework emphasizes the interrelationship between the concepts of cultural safety and relationality and how relationality must be considered in the measurement of cultural safety. The paper highlights the attributes of a culturally safe health care experience and identifies the domains and sample health system performance indicators of this proposed conceptual framework. It also proposes concepts to inform discussion among and with Indigenous Peoples and organizations about measuring cultural safety in health care, and thus serves as a launching pad to the development, adaptation and implementation of a framework for measuring cultural safety in the health care system.

• Read or download A conceptual framework for Indigenous cultural safety measurement (PDF).