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NOTE: This article contains descriptions of culturally insensitive interactions.
When you work in healthcare, you engage with a lot of different people every single day. For some healthcare practitioners, that diversity is exactly why they chose to work in the health industry in the first place.
So over the past few years, the idea of ‘cultural sensitivity’ has emerged as a core tenet of Australia’s healthcare offering, particularly given the generally poorer health outcomes of Indigenous Australians. But what does the term ‘cultural sensitivity’ actually mean, and how can you ensure your day-to-day practice is culturally safe for you, your colleagues and your patients?
What is ‘cultural sensitivity’ in healthcare?
The purpose of cultural sensitivity in healthcare is to create a space where ideal health outcomes are available for everyone, and prejudice is non-existent. Cultural sensitivity embraces and engages with everyone’s different cultural identities and values, which ultimately creates an environment that is optimally comfortable and productive.
Cultural identity can refer to someone’s age, sexual orientation, religious beliefs, nationality, cultural background or ability (Australian Indigenous HealthInfoNet, 2020).
Background of cultural sensitivity in healthcare
Given this is a functional and dynamic theory, cultural sensitivity in healthcare did not just spring into consciousness overnight. The idea has been actively developed and tested for many years by many different healthcare practitioners and organisations. As such, the idea of cultural sensitivity is still developing today.
It’s important to remember that, although these terms mostly replace each other, they don’t negate each other. Cultural safety was built using the principles of cultural competence, and cultural sensitivity was built using the principles of cultural safety. Some people still use ‘competence’, and that’s okay: this language is just a way to describe all of the steps forward in the direction of equity in healthcare.
The idea of cultural competence was based on this theory: that if you learned about a certain culture, you’d provide better care for someone with that cultural background (Khan, 2021). This was quickly removed from the vernacular of healthcare workers because it created a sort of ‘ticking the box’ effect where lifelong cultural learning was not being completed.
The idea of cultural competence sprung out of the 60s and 70s as a result of the civil rights movement in the US, as well as the movement’s aftershocks felt across the world – especially in Australia (Khan, 2021). This idea is generally believed to have paved the way forward for the term ‘cultural safety’.
Back in 1989, an assembly of Māori nursing students expressed concern regarding their safety when learning and working in mono-cultural schools and placements (TRC, 2009).
Led by nurse and anthropologist Irihapeti Ramsden, the idea of cultural safety in healthcare was developed from an idea within the Māori nursing community (Richardson, 2010). Soon, it had become a measured portion of education for all New Zealander healthcare practitioners and professionals.
There was significant contention when the idea was first being implemented in policy and regulation around the world. The main issue was identified in New Zealand: a review by the NZ Nursing Council in the 1990s found that the cultural safety education provided to healthcare practitioners ‘favoured’ or ‘privileged’ Māori practitioners at the expense of other minorities (Richardson, 2010). The review sparked the creation of new cultural safety educational material that was more inclusive to all aspects of the New Zealand healthcare industry (Richardson, 2010).
Cultural Sensitivity and Humility
Cultural sensitivity is a newly developed step onward from cultural safety. This is the term generally used today to describe the act of making sure patients' and practitioners' cultural needs and values are listened to, respected and given room to grow (Khan, 2021).
Cultural humility is an addition to sensitivity, which encourages self-reflection in the course of practicing cultural sensitivity (Khan, 2021). For example, examining your own prejudices and investigating how they may alter the care you provide to different groups would be a great example of cultural humility. Going out of your way to correct that and provide the same level of care to all of your patients would be a great subsequent example of cultural sensitivity in healthcare.
The terms ‘sensitivity’ and ‘humility’ have been used in some healthcare bodies' regulations and policies recently due to the terms being far more empathetic than ‘safety’ and ‘competence'. Practicing cultural safety or competence could be a simple act that can be ticked off and forgotten about, while practicing cultural sensitivity and humility will pervade every single aspect of the healthcare practitioner’s work.
How is cultural sensitivity embedded in healthcare?
As a first step, most workplaces define their values and make those values accessible to everyone in the organisation. This could be a list that’s available on the workplace intranet, or maybe an interactive source that must be completed by each employee every year as mandatory training. Whichever way it’s done, there must be an accessible and readable list of values available to employees at all times.
Second, most workplaces will explain the meaning of each value in the context of the organisation itself. For example, if you’re working in a GP clinic and one of the workplace values is ‘respect’, this may be explained using a graphic that shows a person calling in sick. In the graphic, the manager is asking if the employee needs any personal medical assistance and the employee is explaining that they don’t want to get anybody else at the clinic sick. From this, people working in that workplace would see that respect is an interactive, two-way expression of care for those around them.
Lastly, it would be ideal that team leaders facilitate the active and ongoing monitoring of the cultural sensitivity of the workplace. This means they should create a few different workflows: first, an anonymous reporting system where employees can voice their concerns and experiences; second, an online forum or discussion group where colleagues can share great resources regarding cultural sensitivity and humility, or celebrate their own cultural identity. All employees are accountable for their growth in terms of cultural sensitivity, but team leaders should be responsible for creating workflows and avenues to pursue this growth.
In terms of governance, there are corporate training exercises and courses that organisations can purchase or host in order to train managers in the art of recognising culturally unsafe practices. While the whole workplace must proactively engage with the idea of cultural sensitivity and humility, it is still the leadership team’s responsibility to govern this using specific metrics, such as the number of personal complaints lodged this quarter, or, perhaps on a larger scale, the demographic breakdown of employees who moved on from their role within the company over a year.
What does cultural sensitivity look like in everyday healthcare practice?
It really depends on where you’re working, who you’re working with, and what you’re working on!
There are elements of cultural sensitivity that pertain to the whole world. For example, if someone is practicing Ramadan, it would be an example of cultural sensitivity if the management team were to send out an email explaining the meaning, origin and practice of Ramadan. On the other hand, it would be culturally insensitive for non-Muslim colleagues to liken their pre-summer diet to the Muslim tradition of fasting.
There are definitely examples of cultural sensitivity that pertain specifically to Australian workplaces. For example, it would be culturally sensitive for an Australian healthcare practitioner to research the First Nations Peoples who traditionally owned the land of the workplace and then forward this information to their colleagues. However, it would be culturally insensitive for a healthcare practitioner to dismiss the concerns of an Indigenous Australian person who thinks their child may have an ear infection: this would be insensitive as Australian Indigenous children are far more likely to experience ear conditions than their non-Indigenous peers. What the practitioner should do is take the concern seriously, investigate for an ear infection, and then provide information to the parent so they can monitor their child’s ears when at home.
How are healthcare practitioners protected from cultural insensitivity from patients?
Generally, cultural sensitivity is mostly applied to workplaces, or, more specifically, relationships between colleagues. However, in healthcare, a majority of time is spent working with patients.
But how can healthcare partners (people receiving healthcare) be held responsible for upholding the cultural sensitivity and humility standards of a service provider they’re not employed by? For example, how can an Australian nurse whose parents were born and raised in China protect herself if a terminally ill white patient refuses her care? Though theoretically she can argue her case and possibly ‘win’ her right to care for this patient, the whole act of arguing for – or defending – her cultural background destroys the cultural sensitivity of that relationship. Realistically, there’s not a lot that she can do.
This is the largest issue regarding cultural sensitivity in healthcare at the moment: how can you govern patients? Is it against Australian healthcare’s ethical code to refuse someone non-life saving treatment due to them creating a culturally unsafe environment for the healthcare practitioners present? How would you enforce cultural safety in your workplace with your patients? Perhaps it may not often pertain to you, but would it pertain to your colleagues?
Ultimately, this sensitivity has to be the result of a social shift. Maybe the issue of vast cultural insensitivity will taper off and lessen, or maybe the industry will have to take an active stand – much like it has by using billboards and TV advertisements to advocate for first responders experiencing high levels of violence.
How do you think the healthcare industry should approach this?
What can you do now?
You can read more and contextualise cultural sensitivity within your own practice! First, ask yourself these questions:
Would I describe my workplace as culturally sensitive?
Would my colleagues who identify as minorities describe the workplace as culturally sensitive?
Is there a way my colleagues and I can anonymously report culturally insensitive behaviour?
How do we deal with culturally insensitive behaviour perpetrated by a patient or healthcare recipient?
Next, discuss these questions with your colleagues. If you’re all in agreement that the workplace is culturally sensitive, that’s great! If you’re all in agreement that it’s culturally insensitive, this is also good in a way: you can get to work immediately creating an inclusive and responsible space. If there is a mixture of responses, perhaps it’s a good idea to elevate this to the leadership team and encourage them to facilitate growth in this area.
While this is happening, read up on your literature so you have a better understanding of cultural sensitivity and humility – but also so you can send people in the right direction when they want to learn more, too! Use the following as a good start:
Keep in mind you should continuously check in to see what new literature and studies are being published, as this is not something you can learn overnight – cultural sensitivity is dynamic, and you’ll need to keep up to date.