Cultural competence requires an awareness of cultural diversity and the ability to function effectively and respectfully when working with and treating people of different cultural backgrounds.
Cultural competence means a healthcare professional has the attitudes, skills and knowledge needed to achieve this.
What is cultural competence?
All health professionals are expected to provide culturally competent care to people and their whānau or families, yet cultural competence is a complex idea to understand. Understanding of what it means has evolved over time.
Initially, cultural competence was presented as a checklist of what the health professional should do if they were working with a person from a different culture, eg, a Pakeha nurse working with a Māori person.
However, nowadays people understand that cultural competence is much more complex than a checklist.
Cultural competence is now recognised as being about the self-awareness, attitudes, skills and knowledge of the health professional. This requires the health professional noticing when they feel uncomfortable or uncertain in a situation and realising that means they need to understand what is inside them that is making them uncomfortable, rather than thinking the other person is the problem.
Researchers have described cultural competence as meaning the health professional and health coach have to understand:
what assumptions they are making about the situation they are in and the person they are working with
their own beliefs and biases that are making them feel so uncomfortable
what is really going on for the person they are working with.
Definitions of cultural competence
Mauri Ora defines cultural competence in the following way:
"Individual values, beliefs and behaviours about health and wellbeing are shaped by various factors such as race, ethnicity, nationality, language, gender, socioeconomic status, physical and mental ability, sexual orientation and occupation. Cultural competence in healthcare is broadly defined as the ability of health practitioners to understand and integrate these factors into the delivery of healthcare practice."
Another definition that attempts to capture this more contemporary complex understanding of cultural competence comes from the Medical Council of New Zealand:
“Cultural competence requires an awareness of cultural diversity and the ability to function effectively and respectfully when working with and treating people of different cultural backgrounds. Cultural competence means a doctor has the attitudes, skills and knowledge needed to achieve this.
A culturally competent doctor will acknowledge that:
New Zealand has a culturally diverse population
a doctor’s culture and belief systems influence his or her interactions with patients and accepts this may impact on the doctor-patient relationship.
a positive patient outcome is achieved when a doctor and patient have mutual respect and understanding."
What cultural competence is not
Sometimes it is easier to say what cultural competence is not.
A bias is when you are prejudiced against a person or group in a way that is unfair.
From the time we are born, we learn and take on beliefs and values about the world. We get most of our beliefs and values from our family, friends and the media. If you believe that the Treaty of Waitangi happened a long time ago and should not affect what happens today, then you won’t be in favour of Treaty settlements, Māori seats in Parliament, Māori land rights and Māori rights over water.
Even well-meaning people who do not think of themselves as being racist have these unconscious biases as part of their upbringing.
Understanding your biases is a really important part of cultural competence. It is your unconscious biases that make you feel uncomfortable in new or unfamiliar situations. If you understand that, you will be more able to feel uncomfortable and not react badly.
Your implicit biases act like shortcuts and affect your thinking and actions, especially in situations:
where there are time pressures
where there are not enough resources
where there is not enough information
that need high levels of critical thinking.
Why is cultural competence important?
Because culture impacts on care, health professionals need to be aware of cultural diversity and learn to function effectively and respectfully when working with and treating people of different cultural backgrounds.
Cultural competence helps to address the inequities (lack of fairness) in the healthcare system. For example, there is a lot of information that Māori and Pasifika peoples have much worse health outcomes than other population groups, especially Pakeha. So cultural competence is one way of addressing those inequities that are caused by:
the design of the health system
prejudice by healthcare providers and healthcare professionals,
e.g. beliefs that different groups are not as able, motivated or keen
to be as healthy as other groups, such as Pakeha
discrimination by healthcare providers and healthcare professionals,
e.g. actions such as not referring Māori people to rehabilitation programmes.
Cultural competence service design and implementation
Dr Api Talemaitoga is a practicing GP of Fijian heritage. Api is a Distinguished Fellow of the New Zealand College of General Practitioners and is actively involved in leadership and governance at both local and national levels.
In this video he talks about some of the practical things that anyone can do in their practise to deliver a more culturally competent service to Pacific People.
See also our page on the work of Debbie Ryan and Pacific Perspectives.
Cultural competence training modules and handout
Learning and education modules on understanding bias in health care
The learning and education videos below were developed for Wiki Haumaru Tūroro – Patient Safety Week 2019 by Health Quality & Safety Commission, NZ.
Statement on cultural competence New Zealand Medical Council
Cultural competence Pharmacy Council New Zealand
Tofa Saili: A review of evidence about health equity for Pacific Peoples in New Zealand Pacific Perspectives Limited, NZ
Foundation course in cultural competency Mauri Ora, NZ