“You can do it in another way”: healthcare provider reflections on cultural safety training in Australia’s Northern Territory

Background Cultural safety and effective communication are essential to equitable quality healthcare. Cultural safety requires critical reflection - an active process which can be transformative when it supports a shift from awareness to practice change. Australian government departments, training organisations and regulation authorities require healthcare providers to complete cultural safety training but methods for effectively teaching critical reflection are not well described and evidence for their impact is limited. In Australia’s Northern Territory, a culturally safe communication training program called Ask the Specialist Plus (ATS+) was delivered as part of the Communicate Study Partnership. This study documents healthcare provider reflections on this locally-designed training. Methods A mixed methods approach included post-session participant surveys, pre and post training interviews, and participant observations. Survey participants provided free text responses and rated training sessions across five domains. Semi-structured interviews were conducted with purposefully sampled participants prior to the training and 3–6 months after completion. Data was analysed using constructivist grounded theory to facilitate critical inquiry. Results Data was collected from doctors, nurses, clinical managers, allied health professionals, medical imaging professionals and medical students. 337 surveys were collected, 30 interviews were conducted (15 pre-training and 15 post-training) and five staff were observed. Over 90% of survey participants agreed the training was relevant, engaging, supportive, and prompted reflection and change. Interview participants realised that their personal transformation and practice changes could make a difference to culturally safe communication and also identified departmental and hospital barriers. Reflection and action are evidenced by the gerunds and phrases ATS + participants used to describe training impacts: acknowledging, considering, reflecting, confronting, becoming aware, unpacking, interacting, building, creating, rearranging, implementing, making time, supporting, committing, realising, constraining, feeling powerless, doubting, taking responsibility and continuing. Conclusions ATS+, a locally-designed culturally safe communication training program co-delivered by First Nations and White facilitators in partnership, stimulated healthcare provider critical reflection and supported meaningful decolonising action. Learning Health System models offer pathways for addressing the structural and systemic barriers participants identified and for accelerating the translation of research into system-wide practice of cultural safety. Trial registration ClinicalTrials.gov protocol ID NCT05629416