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The health of Indigenous peoples across Canada continues to be significantly impacted by experiences of racism when seeking healthcare. Implementing cultural safety was identified by the Truth and Reconciliation Commission of Canada as a critical way to mitigate these negative health consequences. This systematic review aims to outline cultural safety and its associated derivatives in academia, what cultural safety is, and why it is important in the context of indigenous healthcare. A systematic search of PubMed was carried out refining searches to Canadian contexts, published after December of 2015, and limited to peer-reviewed reviews and systematic reviews. A thematic review of the articles identified four central ideas of importance regarding the information presented in the papers; definitions of cultural safety and associated derivatives, the importance of including culture in healthcare, recommendations to healthcare settings, and evaluation methods of cultural safety initiatives. It is clear that there is a need for an explicit and consistent definition of cultural safety with the inclusion of Indigenous peoples in the creation of this definition. To determine effectiveness, gaps and areas for improvement, evaluation methods inclusive of the unique Indigenous worldviews are imperative to develop culturally safe healthcare practices and institutions. [ABSTRACT FROM AUTHOR]

Introduction: Healthcare organisations serve clients from diverse Indigenous and other ethnic and racial groups on a daily basis, and require appropriate client-centred systems and services for provision of optimal healthcare. Despite advocacy for systems-level approaches to cultural competence, the primary focus in the literature remains on competency strategies aimed at health promotion initiatives, workforce development and student education. This paper aims to bridge the gap in available evidence about systems approaches to cultural competence by systematically mapping key concepts, types of evidence, and gaps in research. Methods: A literature search was completed as part of a larger systematic search of evaluations and measures of cultural competence interventions in health care in Canada, the United States, Australia and New Zealand. Seventeen peer-reviewed databases, 13 websites and clearinghouses, and 11 literature reviews were searched from 2002 to 2015. Overall, 109 studies were found, with 15 evaluating systems-level interventions or describing measurements. Thematic analysis was used to identify key implementation principles, intervention strategies and outcomes reported. Results: Twelve intervention and three measurement studies met our inclusion criteria. Key principles for implementing systems approaches were: user engagement, organisational readiness, and delivery across multiple sites. Two key types of intervention strategies to embed cultural competence within health systems were: audit and quality improvement approaches and service-level policies or strategies. Outcomes were found for organisational systems, the client/practitioner encounter, health, and at national policy level. Discussion and implications: We could not determine the overall effectiveness of systems-level interventions to reform health systems because interventions were context-specific, there were too few comparative studies and studies did not use the same outcome measures. However, examined together, the intervention and measurement principles, strategies and outcomes provide a preliminary framework for implementation and evaluation of systems-level interventions to improve cultural competence. Identified gaps in the literature included a need for cost and effectiveness studies of systems approaches and explication of the effects of cultural competence on client experience. Further research is needed to explore the extent to which cultural competence improves health outcomes and reduces ethnic and racially-based healthcare disparities. [ABSTRACT FROM AUTHOR]