Cultural competency and cultural safety for healthcare providers

Cultural competency is the process of developing skills from another culture to enable healthcare providers to effectively and respectfully work with and treat patients from other cultures.

Examples of developing cultural competency include:

• learning key words and phrases in another language (eg, greetings in te reo Māori)
• learning key concepts of another culture (eg, knowing that patients of Muslim faith fast during the Ramadan period; knowing that members of the LGBTQ+ community may prefer to choose their own pronouns beyond the binary sex they were assigned at birth.

Healthcare providers should take time to reflect on the cultural diversity in their community and consider what skills they may need to develop their cultural competency.

However, while developing cultural competency is important, it's now recognised that this isn't sufficient to achieve health equity. Culturally safe practice is required.

The Medical Council of New Zealand defines cultural safety as “the need for doctors to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery”. This definition is relevant to all healthcare providers.

The first step towards cultural safety is self-reflection, where the healthcare provider examines their own beliefs, biases, and attitudes towards other cultures.

This process can be confronting and challenging, as it requires honesty and a willingness to question deeply ingrained assumptions. However, it is a crucial step in acknowledging any unconscious biases and working towards overcoming them.

This process is not about feeling guilty for any privileges one may have, but rather understanding how those privileges can impact on others and how they can be used to promote cultural safety.

The ultimate goal of cultural safety is to provide equitable healthcare. In Aotearoa New Zealand, attaining health equity is of particular importance to Māori. However, the provision of healthcare in a culturally safe manner is expected to provide benefits across a wide range of individuals and communities including those who are at  risk of inequity due to age, gender, sexual orientation, socioeconomic status, religious belief and/or disability.

It's important to acknowledge that cultural safety is not about treating everyone the same. In fact, it's recognised that treating everyone the same makes health inequity worse, not better.

Guidance

Te whānau Māori me o mahi – guidance on Māori cultural competencies for providers(external link) ACC, NZ, 2022
Health literacy, equity, cultural safety and competence(external link) HQSC, NZ, 2023
Tikanga – best practice for primary and community healthcare in the rohe of Ngati Whātua(external link) Te Kahu Pōkere & Ngāti Whātua, NZ

Training modules

Part A – facilitator guide modules 1 and 2 Training module or facilitator guide(external link) developed by Healthify He Puna Waiora and Health Literacy NZ 
Part B – handout modules 1 and 2 Training handout(external link) developed by Healthify He Puna Waiora and Health Literacy NZ

Improving outcomes for Pacific patients – Soālaupule(external link) Goodfellow Unit, NZ
Soālaupule is an approach that creates equity by sharing power and decision-making. This short course helps us understand how to harness the power of Soālaupule to improve communication between health staff and Samoan and other Pacific families to assist with adherence to rheumatic fever (RF) management and treatment, including secondary prophylaxis.

Cultural competence for health professionals(external link) eCALD
These courses provide top tips for the provision of culturally competent and linguistically appropriate care for culturally and linguistically diverse (CALD) groups from Asian & Middle Eastern, Latin American and African backgrounds.

• With growing ethnic diversity in New Zealand, clinicians are increasingly more likely to care for clients with language, experiences, beliefs and cultures different from their own.
• Culturally competent care is central to the provision of quality, equitable and responsive services.
• Health practitioners and interpreters should be familiar with how to interact in virtual health consultations, especially with the need for stricter social distancing.

View courses for working with CALD patients(external link)
View guidelines and courses for health practitioners working with interpreters(external link)
View guidelines and courses for interpreters in the healthcare setting(external link)
View calendar of available remote F2F courses(external link) 

You will need to register for an account or login to your existing eCALD account to access these courses.

Foundations in cultural competency(external link) LearnOnline
Understanding bias in health care(external link) LearnOnline
Foundation course in Māori cultural competency(external link) Mauri Ora

Test yourself

Quiz – understanding bias in health care 
Quiz – understanding bias in health care answers 
Harvard Implicit Association Test(external link)

Brochures

Statement on cultural safety(external link) Medical Council of New Zealand, 2019
Cultural competence partnership and health equity symposium(external link) Medical Council of New Zealand and Te Ohu Rata o Aotearoa (Te RA), 2019
Cultural competence(external link) RNZCGP, NZ, 2007

Lecture/webinar

Public lecture on meihana method for better understanding Māori patients' health needs(external link) University of Otago, NZ
Webinar – ACC cultural safety policy Kawa whakaruruhau(external link) ACC, NZ, 2023

General resources

Health equity assessment tool (HEAT)(external link) Ministry of Health, NZ
Te pae mahutonga Māori health models(external link) Ministry of Health, NZ, 2017
Māori health models – Te whare tapa whā(external link) Ministry of Health, NZ, 2023
Māori health models – Te wheke(external link) Ministry of Health, NZ, 2023
Medicines and older Māori(external link) He Ako Hiringa, NZ, 2021
Improving Māori health through clinical assessment: waikare o te waka o meihana(external link) New Zealand Medical Journal
The hui process – a framework to enhance the doctor–patient relationship with Māori(external link) New Zealand Medical Journal
Te aka Māori dictionary(external link)
Te reo Māori(external link) University of Otago, NZ
Tikanga best practice policy(external link) Waitematā and Auckland DHBs, NZ