Relationship earning and CPSA’s reconciliation journey
Estimated read time: 9 minutes
“Reconciliation is one of the most important aspects of our lives. It’s not just talking about it—it’s doing something about it.”
With more than 14,000 regulated members, CPSA has the important mandate to protect patients by guiding physicians and physician assistants in providing safe, high-quality care. CPSA must play a role in ensuring healthcare spaces are safe for patients and care providers, which includes addressing healthcare inequities—specifically when it comes to racism and discrimination in the medical profession and in the greater health system.
We have committed to walking the path towards safe care for equity-deserving communities, including First Nations, Métis and Inuit Peoples, and we need guidance from those with lived experience to make meaningful progress. This guidance comes to us through building relationships or, as we’ve learned, earning relationships.
While CPSA is in the early days of our reconciliation journey, we are committed to taking action in our role as Alberta’s medical regulator to make change that results in equitable health care for Indigenous patients. In 2023, we gained momentum in collaboration with Indigenous health leaders. However, our efforts towards earning relationships began in earnest in 2020. Read on to learn about the early steps we’ve taken towards reconciliation and how authentic relationships will continue to guide us towards equitable health care for Indigenous patients.
Earning relationships: how we got here
In 2020, several Indigenous physicians and allies reached out to CPSA to share their concerns—and the concerns of the Indigenous patients they are privileged to serve—about the inequities and outright racism Indigenous patients face in health settings.
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These Indigenous physicians and allies very clearly called on CPSA to set expectations around the care Indigenous patients receive from regulated members. Through ongoing connections with these health leaders, we soon learned we would need long-term guidance from those with lived experience on how to make meaningful progress towards improved healthcare experiences and outcomes for Indigenous people. This ultimately led to the formation of the Indigenous Advisory Circle.
We express our gratitude to the physicians who first called us to action, and for the bravery of First Nations, Métis and Inuit patients who have shared their experiences.
Indigenous Advisory Circle: how it was formed
Through collaboration with the Indigenous physicians and allies who first reached out to us, we began our work towards establishing an Indigenous Advisory Circle, which is now a CPSA Council priority committee. Priority committees provide advice and recommendations to Council and include physician and non-physician members with expertise and lived experience in a strategic priority area.
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The physicians who took the first step to contact us ultimately gave us the gift of engagement. Through their willingness to share feedback on areas where CPSA needs to grow, they guided us in defining the purpose of the Circle. They also recommended recruitment methods and helped us bring together a selection panel of Indigenous health experts who would recommend the Circle’s membership composition to CPSA Council.
CPSA Council formally established the Indigenous Advisory Circle in December 2021. Since then, the Circle has guided us on our path towards reconciliation, helping us reflect on our regulatory processes to identify how we can better support Indigenous patients and better guide the regulated members who provide their health care.
We are honoured to receive this guidance from Circle members, who include an Elder, Indigenous and non-Indigenous physicians, and Indigenous health leaders and community members.
Indigenous Advisory Circle: what we’ve learned so far
The Indigenous Advisory Circle first met in February 2022. Since then, the Circle has been guiding CPSA on steps we must take towards culturally safe and equitable health care.
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Over the past two years, the Circle membership has created a safe space for collaboration and sharing guidance, experiences, and ideas. Relationships are foundational to our work with the Circle, and it was through a member of the Circle that we learned about the importance of not just building relationships but earning them. Audra Foggin, Associate Professor of Child Studies and Social Work at Mount Royal University and retired member of the Circle, shared how building relationships might feel timebound and transactional, while earning relationships is grounded in reciprocity. “Earning relationships takes time, and is shown through actions and earning trust,” explained Foggin. “It happens when we allow ourselves to be vulnerable and meet on another level of connection, concern and care for each other.”
Just as important is incorporating Indigenous ways of knowing into the work we do together. In practice, this includes beginning and ending every Circle meeting with a prayer or blessing from Cree Elder Dr. Grandmother Doreen Spence, a leader, healer, mentor to many across the world, and the heart of the Circle.
Dr. Grandmother Doreen’s wisdom and leadership have rooted CPSA’s engagement with the Circle in authenticity as she guides us on ways to work together to improve healthcare experiences and outcomes for Indigenous people. This guidance led to a first for CPSA when in October 2023, Dr. Grandmother Doreen hosted the Circle for a land-based day of learning, reflecting, and building momentum in our work together.
Listen to Dr. Grandmother Doreen’s stories of racism in the health system, reconciliation, and resilience, which she shared in September 2023.
Circle member Dr. Charlene Lyndon also shared reflections on reconciliation from her perspective as a physician with settler heritage.
Siksika Nation: the gift of partnership
It was a gift for CPSA to be called in by Indigenous physicians and allies advocating on behalf of Indigenous patients. This was one of our most significant experiences with relationship earning as a foundation of our reconciliation journey.
Another gift was a public member appointment to CPSA Council. In 2021, Dr. Tyler White, CEO of Siksika Health Services in Treaty 7, joined CPSA Council and soon became co-chair of the Indigenous Advisory Circle.
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Our working relationship with Dr. White led to an invitation for CPSA Council and leadership to visit Siksika Nation. There, CPSA Council and members of our leadership team had the honour of meeting with the Siksika Chief and members of Council, as well as members of the Siksika Health Services team. We were fortunate to participate in ceremony and traditional dance, and to share a meal together. We also heard difficult truths about how the health system perpetuates systemic racism and causes harm and re-traumatization to the people of Siksika Nation.
Having the honour of being hosted by Siksika Nation led to a deeper relationship and a shared goal of taking action to change behaviour—within CPSA, and among healthcare providers. To effect meaningful change, it was clear we must acknowledge and embrace self-determination for Indigenous Peoples in Canada, particularly when it comes to health care.
Historic partnership: Siksika Nation and CPSA sign MOU
The relationship between CPSA and Siksika Nation led to the co-development of a Memorandum of Understanding (MOU) in 2023, through which CPSA respects the autonomy and self-government of Siksika Nation, and Siksika recognizes CPSA’s regulatory authority over regulated members practising in their community.
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The signing of the MOU on Oct. 5, 2023 at Blackfoot Crossing, where Treaty 7 was signed, was a historic and significant event that will further strengthen the relationship between Siksika Nation and CPSA. The MOU outlines our commitment to incorporating Indigenous knowledge, perspectives and elements of Truth and Reconciliation Commission Calls to Action into the framework we use to regulate members.
“This MOU is a testament to our dedication to working together towards addressing racism and discrimination that Indigenous people face when accessing healthcare,” said councillor Ike Solway, board chair of Siksika Health Services. “We believe that by combining our efforts, we can achieve greater impact and make a positive difference in all Albertans’ care. We look forward to the journey ahead and the positive outcomes that will result from our partnership.”
“CPSA recognizes that we’ve played a role in past harms and trauma to Indigenous Peoples and communities in Alberta,” said Stacey Strilchuk, former CPSA Council Chair. “This MOU is more than a partnership and shared objectives. It’s an expression of mutual respect, a recognition of the autonomy of Indigenous Peoples and a willingness to work together to ensure Indigenous peoples receive safe, equitable health care. I want to personally thank Siksika Nation and Siksika Health Services for taking this step with us and I hope it signals our desire to earn and build authentic and meaningful relationships with other First Nations and Indigenous communities.”
As we continue to grow our relationship with Siksika Nation, we hope to begin earning authentic relationships with more First Nations and Indigenous communities.
Our commitment
The organic nature of the relationships we have worked to earn over the past few years has informed the development of CPSA’s strategic plan, which highlights Authentic Indigenous Connections as a key strategic direction for our organization. It has also resulted in early work towards CPSA’s Path to Truth and Reconciliation, our action plan to addressing the healthcare inequities Indigenous people continue to face.
In 2024, we are working to strengthen connections and earn relationships with First Nations, Métis and Inuit Peoples, communities, and organizations across Treaty 6, Treaty 7 and Treaty 8 territories. We are incredibly grateful to the Indigenous leaders who partner with us and guide us on this journey. We’re also grateful to our partners across the health system who are committed to making change that will improve health outcomes for the Indigenous patients we are here to protect.
Authentic Indigenous Connections
It’s through substantive and authentic connections and relationships that we can help create culturally safe spaces where Indigenous people receive equitable health care. CPSA’s five-year strategic plan outlines our commitment to nurturing relationships that help us provide quality care in partnership with Indigenous Peoples.
We are committed to:
- authentically engaging with and listening to Indigenous Peoples, incorporating their wisdom into our work and processes.
- acknowledging the historical health inequities that have been and are experienced by Indigenous Peoples and using our legislated mandate to reduce these inequities, improving the quality of care provided by our regulated members.
- actively addressing the recommendations from the TRC that relate to health care and CPSA’s role.
