There has been a complaint made by the family of an Indigenous patient, that the behaviors of staff members in your intensive care unit were culturally unsafe and inappropriate, when they visited their relative in the ICU.
The family has shared their concerns in writing to the unit.
As a specialist in the unit how would you address the experience shared by the family?
You must answer this question from the perspective of your most familiar CICM place of practice (e.g., Australia OR Aotearoa New Zealand). Candidates sitting from outside of Australia may answer from the perspective of EITHER Australian OR Aotearoa New Zealand clinical practice.
(70% of marks for complaint resolution process)
(30% for cultural awareness content)
Aim: To explore the theory and process of complaint resolution, a key skill in ICU leadership. Specifically in relation to written complaints and cultural safety.
Key sources include: IC 20- CICM document, Paper 2022.2 Q22. CanMEDS Communicator.
Discussion: Complaint resolution is a repeat topic from last paper 2022.2. and comprised most of the marks. A high level of detail in the complaint resolution process was expected given its importance and its recency in the previous paper. Candidates gained more marks if they addressed concerns AND provided appropriate sensitive follow up in a quality and safety structural format. These candidates did better than candidates who diffused the situation only, without closing the review process in minimal or absent detail.
A list of statements without structure or prioritisation did not address the question as well as a prioritised step wise outline of appropriate investigations and resolution. Some answers escalated the complaint inappropriately suggesting lawyers, police, and hospital administration involvement. The better answers included appropriate referrals through formal or informal channels of resolution and identified the key drivers of change for improvement within the department. The expert answers concluded with methods to monitor and maintain sustainable change for future best practice in this area.
Cultural safety 30% marks – The importance of health equity has been an important topic in health education for many years. No candidate failed this question on cultural safety content. Some candidates went into great depth about specific care and sensitivity to patients with diverse cultural backgrounds they bring to their practice. They were allocated expert pass marks accordingly and are to be commended.
The CICM document IC-20 (Prevention of Bullying, Discrimination and Harassment in the Workplace) is fifteen pages of dense bleak horror that was published many years ago and that has remained unaltered since 2016. It is therefore unsurprising that such a large number of trainees were able to score so highly on this SAQ. Moreover, as the answer is right there on the college website, there was no excuse for getting it wrong.
As the college answer has pointed out, Question 22 from the second paper of 2022 has already warned people that something like this might be coming, and considering the pass rate has improved (from 40.4% to 66.3%) they clearly paid attention, suggesting there is still some value in doing the past papers.
So: a standard conflict resolution process is produced below, as it would have satisfied the 70% component:
Cultural awareness content for 30% of the marks would likely have been passed by the candidate mentioning that they would make a referral to the Aboriginal Liaison Officer (in Australia) or a corresponding healthcare service position in Aoteroa NZ. However this is really the same thing as reflexively calling for the social worker the moment a family starts crying in your waiting room, and "great depth about specific care and sensitivity to patients with diverse cultural backgrounds" is probably a better standard to aspire to. But how would you demonstrate that standard in three minutes?
The specific main principles of cultural safety (not listed in IC-20) are self-determination, social and restorative justice, equity, partnership, reciprocity, accountability, sustainability and cultural context. It would have been useful for the candidate to demonstrate that they are aware of these principles; and at the same time it would have been difficult to do so without peppering the answer with stock-sounding phrases like "increased advocacy for, and partnering with, Indigenous communities and health organisations". Some kind of bare minimum answer would probably have consisted of something like this, mainly derived from the excellent 2019 MJA paper by Paul Secombe et al.
Recognition of the importance of health equity:
Practical interventions to improve the healthcare experience of Indigenous Australians requiring ICU:
Specific interventions in response to the family's complaint
Secombe, Paul J., et al. "Equity for Indigenous Australians in intensive care." Medical Journal of Australia 211.7 (2019): 297-299.