A blueprint for cultural safety: Embedding meaningful practice across a major hospital network

As Australia’s largest paediatric healthcare service, the Sydney Children’s Hospitals Network (SCHN) is committed to creating an environment where Aboriginal patients and staff feel safe, supported and empowered. This commitment is central to SCHN’s mission to deliver world-class care to children, young people, and their families, and to be a workplace that celebrates diversity and nurtures future Aboriginal leaders.

Like many large health organisations, SCHN was seeking to move from commitment to practice across diverse clinical and corporate environments. There were examples of good work already underway, such as the focus on inclusive and welcoming buildings in the redevelopment of Randwick and Westmead and the establishment of the Aboriginal Health Directorate. 

Nous partnered with SCHN to develop their first Cultural Safety Framework and Implementation Plan. We worked to help translate SCHN’s commitment into a clear, evidence-based, practical and shared approach, one that could support consistent action and accountability, build capability and enable progress to be tracked and strengthened over time. 

“This project was exciting as it was the first of its kind for SCHN,” says Director Georgia Stern, “and also because of the scale of impact, across Aboriginal patients and their families as well as Aboriginal staff.” 

We adopted a collaborative, partnership-based approach, anchored in the leadership and expertise of SCHN’s Aboriginal Health Directorate. From the outset, the work was guided by a core principle: that cultural safety must be shaped by Aboriginal perspectives and strengthened through a shared responsibility for change across the organisation. 

“We worked closely with the Aboriginal Health Directorate to set the direction and define what “good” looks like,” says Stern, “while also working with leaders, managers and staff across the Network to clarify their role in embedding cultural safety in everyday practice and to paint a picture of their cultural safety journey which is not linear and involves ongoing learning.” 

We began with a rapid evidence review, drawing on leading cultural safety models in Australia and internationally, alongside an assessment of SCHN’s current state. This provided a strong foundation for a shared understanding of best practice, while also highlighting where SCHN could build on existing strengths and take a more deliberate, coordinated approach. It also supported alignment of the Framework to the National Agreement on Closing the Gap, NSW Aboriginal Health Plan, National Aboriginal and Torres Strait Islander Health Plan and National Aboriginal and Torres Strait Islander Health Workforce Strategic Framework.

We complemented this with consultations with partner organisations, peak bodies and other health services that had developed or implemented cultural safety frameworks and programs. These conversations grounded the work in practical experiences, particularly around governance, capability building and the conditions needed to support successful implementation.

Building on this foundation, we worked with SCHN stakeholders through consultations and workshops involving the Aboriginal Health Directorate, the Executive Leadership Team, and a broad cross-section of clinical and corporate staff. These sessions defined what success would look like for SCHN, identifying opportunities and challenges, and co-designing priorities that were ambitious yet achievable. 

An emphasis throughout was on moving from priorities and principles to delivery and action, ensuring the Framework would be a tool that teams could actively use, rather than a document that sat on the shelf. To this end, Nous co-designed a range of tools with SCHN to support the Framework (see below) and facilitated a large implementation workshop with the ELT and 50 staff from across SCHN. This workshop introduced some of the tools, connected staff to the Framework’s vision and priorities and supported staff to develop detailed sub-actions against each priority, alongside clear measures, dependencies, timelines, and accountable leads.

The project resulted in SCHN’s first Cultural Safety Framework and Implementation Plan, endorsed by the Aboriginal Health Directorate, Chief Executive and Board. The Framework articulates a shared vision for cultural safety at SCHN, alongside a set of priorities and principles that underpin how the Network operates. Importantly, it positions cultural safety as a whole-of-organisation responsibility with accountability distributed across the Network, rather than concentrated in a single function or group.

To support implementation, the Framework is accompanied by a suite of practical tools developed with SCHN. These include: 

• Three circles of action that outline the action and behaviours that individuals, teams and the Network can take to contribute to cultural safety. The intent of this tool is to provoke critical thinking and provide insight to staff on everyday actions and behaviours that support cultural safety. 
• A patient and staff journey map that reflects a culturally safe healthcare journey for children, families and staff.
• A principles in practice vision that shows what cultural safety looks like for patients, Aboriginal staff, non-Aboriginal staff, the Aboriginal Health Directorate and SCHN as a whole.
• The Implementation Plan which sets the actions, responsibilities, timeframes and measures of success to enable SCHN to track progress and adapt as needed, noting that change is rarely linear. 

The impact of the work extended beyond the Framework, Implementation Plan and the tools. The collaborative, 6-month process created space for meaningful conversations across the organisation, helping to build a shared understanding of cultural safety and a sense of collective ownership for change. 

This shift in mindset is critical. By embedding cultural safety into the way SCHN operates – rather than treating it as a standalone initiative for which the Aboriginal Health Directorate is responsible – the organisation has established a durable foundation for long-term change. It positions SCHN to deliver more culturally safe, responsive, and effective care for Aboriginal children and their families, and to create a more inclusive and supportive environment for Aboriginal staff.

"The approach to cultural safety has been shaped through the collective voices of Aboriginal and non-Aboriginal staff across SCHN," says Lizzy Ramsay, Deputy Director Aboriginal Health at the SCHN. "The result is a Framework that belongs to the whole organisation, creating a shared understanding of what cultural safety means and what each person can do to contribute to it. This approach has strengthened ownership, accountability and our collective responsibility for improving outcomes for Aboriginal children, young people, families and staff."