About HSO Standards

HSO standards are the foundation on which leading-edge accreditation programs and evidence-informed public policy are built. Standards create a strong people-centred health care system that interest holders can rely on to enable people around the world to continuously improve quality of care.

HSO standards are formatted using the following structure:

• Section title. A section of the standard that relates to a specific topic.
• Clause. A thematic statement that introduces a set of criteria.
• Criteria. Requirements informed by evidence that describe what is needed by people to achieve a particular activity. Each criterion outlines the intent, action, and accountability.
• Guidelines. Additional information and evidence to support the implementation of each criterion.

HSO standards integrate gender responsiveness though three key mechanisms:

• Diverse representation. The Technical Committee for each standard includes a diverse range of genders and professional backgrounds. This composition supports the inclusion of lived experiences and clinical perspectives on gendered differences in care delivery that are central to the development process.
• Evidence-informed research. HSO Standards draw on research that explores gender-based differences in health issues and care delivery. This includes examining variations in prevalence, symptom expression, access to and experiences of care, treatment, outcomes and service standards.
• Inclusive language. HSO standards use inclusive gender-responsive language that respects diverse gender identities and reflects both physical and physiological as well as social and cultural dimensions of gender.

Refer to Annex A for additional equity-based principles integrated throughout all HSO standards.

About This Standard

This is the first edition of CAN/HSO 75001:2026 (E) Cultural Safety and Humility. This standard focuses on the  collaborative design, delivery, and evaluation of culturally safe health and social services with and for First Nations, Inuit, and Métis Peoples and communities. The target audiences for this standard include governing bodies, organizational leaders, and teams within health and social service organizations.

This standard was developed to address the deep and longstanding inequities in the experience, quality, and access to health and social services for First Nations, Inuit, and Métis Peoples. First Nations, Inuit, and Métis 
Peoples have long upheld health and wellness through strong interconnections between the land and people, systems that were disrupted by settler colonialism, resulting in colonially inherited disparities across health and wellness indicators. This standard recognizes that First Nations, Inuit, and Métis Peoples have distinct cultures, languages, territories, histories, and communities that need to be respected in the design, delivery, and evaluation of culturally safe health and social services.

This standard builds on HSO 75000:2022 British Columbia Cultural Safety and Humility, developed in partnership with the BC First Nations Health Authority, and responds to a national scoping survey conducted by the Canadian Indigenous Nurses Association, which revealed a strong call to action from First Nations, Inuit, and Métis communities, governing bodies, and organizations to establish a national standard for cultural safety and humility.

This standard was created in spirit and grounded in ceremony. Guided by the voices and experiences of First Nations, Inuit, and Métis Peoples, this standard reflects decades of advocacy work to amplify First Nations, Inuit, and Métis perspectives, integrate traditional knowledge, address Indigenous-specific racism, and uphold the rights of First Nations, Inuit, and Métis Peoples. This standard is further informed by findings from literature reviews, clinical expertise, and evidence-informed practices. The published evidence used to inform this standard can be found in the bibliography. This standard has been gender assessed. Gender-disaggregated data was considered during literature reviews, and gender considerations are embedded throughout the standard. At the time of publication, there was limited literature on gender-specific culturally safe care. This standard incorporates gender considerations based on technical committee guidance and reflects Indigenous worldviews that acknowledge diverse, fluid, and inclusive understandings of gender and identity.

This standard guides governing bodies, organizational leaders, and teams within health and social service 
organizations on

• upholding shared governance and self-determination;
• delivering high-quality, culturally safe, and people-centred care;
• maintaining a culturally safe and supported workforce; and
• promoting a culture of continuous learning and quality improvement. 

The content of this standard is structured into six key sections: 

1. Shared Governance and Self-Determination
2. Transformational and Collaborative Leadership
3. People-Centred Care
4. High-Quality and Culturally Safe Services
5. Culturally Safe and Supported Workforce
6. Continuous Quality Improvement
   

All six sections are essential to drive meaningful change, working in relationship together to support alignment, momentum, and lasting impact.

This standard is informed by several foundational documents, including the following: 

• United Nations Declaration on the Rights of Indigenous Peoples (2007)
• United Nations Declaration on the Rights of Indigenous Peoples Act (2021)
• Canadian Human Rights Act (1985)
• Constitution Act, Part II, Rights of the Aboriginal Peoples of Canada, Section 35 (1982)
• Canada Health Act (1985)
• Reclaiming Power and Place: The Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls (National Inquiry into Missing and Murdered Indigenous Women and Girls, 2019)
• Report of the Royal Commission on Aboriginal Peoples (Royal Commission on Aboriginal Peoples, 1996)
• Truth and Reconciliation Commission of Canada Calls to Action (Truth and Reconciliation Commission of 
  Canada, 2015b)
• Joyce's Principle (Council of the Atikamekw of Manawan and Council de la Nation Atikamekw, 2020)

This standard is intended to be used as part of a conformity assessment. This standard will undergo periodic  maintenance. HSO will review and publish this standard on a schedule not to exceed five years from the date of publication. 

Guiding Principles

The following principles were identified by the technical committee to guide the development and content of this standard.

This standard is 

• built on the work of those who have gone before us;  
• intended to be transformational, focusing on actions that advance cultural safety and are accountable, transparent, and measurable;  
• applicable to all types and sizes of organizations considering geographic settings and resource allocation;  
• inclusive of First Nations, Inuit, and Métis governance and community voices, including Elders, Traditional Healers, and Knowledge Keepers who are integral to the co-creation of the standard;  
• informed by the diverse perspectives and experiences of patients, families, providers, and others who 
  participate in the design, delivery, and evaluation of services;  
• strengths-based, people-centred, and trauma-informed, acknowledging the distinct histories and lived experiences of First Nations, Inuit, and Métis communities; and
• based on relational practices and accountability. 

Underlying these principles are shared values that are fundamental to the development and content of the 
standard, including the following: 

• Respect. We respect one another. We respect the diversity of our experiences and our cultures. We respect the generations past and generations to come.
• Relationality. We are all related. We care for one another. We are connected to and care for the Earth.
• Humility. We are all on a journey of learning and growth.
• Culture. Culture is the foundation of our work. 

Scope

Purpose

This standard sets out the requirements and accountabilities for governing bodies, organizational leaders, and teams in health and social service organizations to collaboratively design, deliver, and evaluate culturally safe services with and for First Nations, Inuit, and Métis Peoples and communities, and to address Indigenous-specific racism in service delivery. This includes affirming the right of First Nations, Inuit, and Métis Peoples and communities to self-determination, and recognizing that achieving First Nations, Inuit, and Métis health and wellness goals and outcomes is an essential component of cultural safety and humility in health and social service delivery.

This standard emphasizes a distinctions-based approach that recognizes that First Nations, Inuit, and Métis
Peoples have distinct cultures, languages, territories, histories, interests, priorities, and circumstances.

This standard provides guidance on the organizational structures and procedures needed in governance,
leadership, and service provision to support cultural safety and humility and Indigenous-specific anti-racism. This standard also promotes the delivery of health and social services that are aligned with First Nations, Inuit, and Métis rights, cultures, protocols, and values. This standard emphasizes the importance of traditional knowledge and the roles of Elders, Traditional Healers, and Knowledge Keepers in supporting health and wellness. This standard also includes guidance on First Nations, Inuit, and Métis workforce planning and the psychological and physical safety of the workforce.

Applicability

This standard is intended to be used by governing bodies, organizational leaders, and teams in health and social service organizations to guide the design, delivery, and evaluation of culturally safe health and social services. This standard applies to the delivery of care for all First Nations, Inuit, and Métis Peoples that an organization serves, including those living on- or off-reserve, with or without legal status under the Indian Act, living in traditional territories or away from home, and living in urban, rural, or remote settings.

This standard applies to First Nations, Inuit, and Métis Peoples' health and wellness journeys across the health system, including health promotion, disease prevention, access to health and social services, admission, assessment, treatment, discharge, and end-of-life care.

While this standard focuses on culturally safe services and structures for First Nations, Inuit, and Métis Peoples, the teachings and principles it contains are broadly applicable across diverse populations and knowledge systems.