Cultural Safety Concerns: Meeting the Standard for Aboriginal and Torres Strait Islander Care

Cultural safety has a specific meaning in the National Registration and Accreditation Scheme, agreed by Ahpra, the National Boards, accreditation authorities and Aboriginal and Torres Strait Islander health leaders. It has two parts.

• Cultural safety is determined by Aboriginal and Torres Strait Islander individuals, families and communities. The test is the person's experience of care, not the practitioner's intention.
• Culturally safe practice is the ongoing critical reflection of a practitioner's knowledge, skills, attitudes, practising behaviours and power differentials in delivering safe, accessible and responsive health care free of racism.

The National Scheme strategy sets out four things practitioners must do: acknowledge colonisation and systemic racism and the factors that affect individual and community health; acknowledge and address individual racism and their own biases, assumptions and stereotypes; recognise the importance of self-determined decision-making, partnership and collaboration; and foster a safe working environment through leadership that supports the rights and dignity of Aboriginal and Torres Strait Islander people and colleagues.

Cultural safety is not a body of facts about another culture, and it does not ask you to become an expert in every nation, language and community. It asks you to look at yourself, your service and the relationship, and to share power with the person you are caring for. Intent does not cancel impact.

Cultural safety is part of the legal framework of health regulation, not an optional extra. When a Board considers a concern about racist conduct, or care that ignored a person's cultural needs, the National Law gives it a clear basis to treat that concern as a matter of public protection. The process follows the usual pathway described on our notification help page; in New South Wales and Queensland the co-regulatory bodies may be involved.

Codes of conduct are used by Boards and tribunals as evidence of what good practice looks like. Not following the code is not automatically misconduct, but it can be used to judge whether conduct fell below the expected standard. In cultural safety matters, assessors are likely to consider:

• whether the conduct involved racism or discrimination, directly or through stereotyped assumptions that shaped clinical decisions
• whether there was clinical harm, such as a missed diagnosis, an unsafe discharge or consent that was not properly understood
• conduct outside work, including online posts, that may affect public trust in the profession
• how you responded when concerns were raised, and whether you understand the impact on the person and their family
• what you have done since, including learning that goes beyond a single online module

Racist conduct by a practitioner can lead to an employer investigation, a discrimination complaint to the Australian Human Rights Commission or a state body, a health complaints entity process and a notification, sometimes all at once. Ahpra is also working to make the notifications process itself culturally safe for Aboriginal and Torres Strait Islander people who raise concerns.

Because cultural safety is defined as ongoing critical reflection, a Board will be most interested in whether you can examine your own assumptions, values and power, not just your actions. Useful questions to work through include:

• What did I assume about this person, and where did that assumption come from?
• Would I have made the same decision for a non-Indigenous patient with the same presentation?
• Where did I hold power in this encounter, and did I make it visible or share it?
• Who did I ask, or fail to ask, about how the person wanted decisions made?
• What will I do differently in the next encounter, and how will I know it has worked?

Structured, written reflection helps, and so does reflecting with Aboriginal and Torres Strait Islander mentors where that is offered, without expecting colleagues to carry unpaid cultural education. Our reflective practice workbook gives you prompts and a format. Cultural safety is framed by the National Scheme as lifelong learning, so a national online course is one step, not the end point; only local Elders, community organisations and Aboriginal and Torres Strait Islander colleagues can teach you about the Country you work on and the services its community trusts.

Education is not a shortcut through a regulatory process, and no course can guarantee any outcome. If you have a condition or undertaking, check with Ahpra or your Board whether a particular course is acceptable before relying on it.

The label at triage

A teenager with abdominal pain is described at handover as "drug-seeking". The label shapes every later decision. A culturally safe response names alternatives, uses structured assessment and challenges the label before it causes harm.

Asking the identification question

A practice avoids asking some patients whether they are of Aboriginal or Torres Strait Islander origin, based on appearance. The standard question should be asked of everyone, explained if needed, and recorded as given. Identity is never judged by appearance.

Leaving before treatment ends

A patient wants to go home early. Rather than recording "discharged against medical advice" and moving on, explore the reasons, involve liaison staff, arrange follow-up with the person's usual service and document without stigmatising language.

A racist joke in the team meeting

A senior clinician makes a joke about Aboriginal patients. Colleagues can name it, redirect the conversation, support anyone affected and escalate. Workplace racism is a workplace conduct issue too; see our page on workplace conduct concerns.