What is cultural competence and what it means in terms of integrating cultural safety into your own work and workplace?

Table of Contents Show

What is cultural awareness and cultural competency?
What are the benefits of taking action?
Suggested strategies

Historically, the Australian health system has not provided safe and high-quality care to meet the needs of Aboriginal and Torres Strait Islander people.31 The health system in the past included segregated wards and service entrances, deliberately different (substandard) care, forced removal of newborn babies from mothers who were considered ‘not competent’ or not able to provide the ‘right upbringing’, and removal of children from home while parents were sick in hospital and failure to return these children to their parents’ care.

A study of 755 Aboriginal Victorians in 2013 reported that nearly all respondents (97%) had experienced at least one incident that they perceived as racist in the preceding 12 months.32

Institutionalised racism is ‘the collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture, or ethnic origin. It can be seen or detected in processes, attitudes and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantage minority ethnic people’.33,34 This should be seen in the context of systematic racism, which ‘operates across political, legal, economic and social systems’34 and is a predeterminant of institutionalised racism. Both forms of racism result in assumptions and attitudes that lead to bias in the safety and quality of health care, and can result in inadequate care and poorer health outcomes for Aboriginal and Torres Strait Islander people.

These historical events and experiences, coupled with personal and family experiences of institutionalised racism and disrespectful communication, contribute to mistrust in the system by Aboriginal and Torres Strait Islander people and, at times, an unwillingness to engage with healthcare services at all.

A 2017 evaluation of Victorian hospitals found that Aboriginal and Torres Strait Islander people continue to experience hospitals as sites of trauma and the Aboriginal and Torres Strait Islander workforce experience dangerous levels of vicarious trauma, cultural load and isolation.35,36

What is cultural awareness and cultural competency?

The literature considers cultural awareness and cultural competency on a continuum, contributing to a culturally safe environment that is respectful of Aboriginal and Torres Strait Islander patients and workforce.

Cultural awareness is a basic understanding that there is diversity in cultures across the population. Cultural competency extends beyond individual skills or knowledge to influence the way that a system or services operate across cultures. It is a process that requires ongoing learning.37-39 One-off training does not create a culturally competent workforce, but could increase cultural awareness.40 A culturally safe workforce considers power relations, cultural differences and the rights of the patient, and encourages workers to reflect on their own attitudes and beliefs.1 Cultural respect is achieved when individuals feel safe and cultural differences are respected.1,41

What are the benefits of taking action?

Benefits for the health service organisation include:

A whole-of-organisation and whole-of-system approach to improvements for Aboriginal and Torres Strait Islander people
Effective and appropriate communication with Aboriginal and Torres Strait Islander patients and families that minimises discrimination
Reduction in clinical variation across the patient population
Cost-effective and efficient delivery of care
Greater cultural capability, which could benefit all vulnerable or culturally and linguistically diverse patients
Increased understanding of Aboriginal and Torres Strait Islander health issues, health needs, and the complex personal experience of individuals, families and communities
Increased understanding of the diversity of Aboriginal and Torres Strait Islander communities
Reduced stress for the organisation’s Aboriginal and Torres Strait Islander workforce from a reduction in racially discriminatory practices, and subsequent reduction in their vicarious trauma, cultural load and isolation
Increased recruitment and retention of the Aboriginal and Torres Strait Islander workforce
Increased confidence of the overall workforce in interacting with Aboriginal and Torres Strait Islander patients and their families42
Increased confidence and satisfaction of all employees who provide care for Aboriginal and Torres Strait Islander patients
Reduction of racism and discrimination

Benefits for the Aboriginal and Torres Strait Islander community include:

Improved patient perceptions and experiences of care within the health service organisation
Greater ability of patients and families to be involved in health care43,44
Improved wellbeing of the Aboriginal and Torres Strait Islander workforce through the reduction of racially discriminatory practices
Increased access to the health service organisation by Aboriginal and Torres Strait Islander people
Improved equality and reduced disparity of health outcomes.

Key tasks

Use the national Cultural Respect Framework 2016–2026 for Aboriginal and Torres Strait Islander Health to develop, implement and evaluate cultural awareness and cultural competency strategies1
Implement an ongoing professional development program of cultural awareness and cultural competency that is tailored to the needs of the local Aboriginal and Torres Strait Islander community
Evaluate the effectiveness of the cultural awareness and cultural competency strategies
Develop and maintain mechanisms to partner with Aboriginal and Torres Strait Islander communities to gain feedback on, and improve, cultural competency
Develop and implement an Aboriginal and Torres Strait Islander employment strategy that incorporates:
- training and ongoing professional development processes
- workforce support, including systems to retain employees and provide appropriate employee assistance programs
- recruitment of Aboriginal and Torres Strait Islander people to positions at all levels of the organisation
- increasing employment opportunities for Aboriginal and Torres Strait Islander leaders by establishing leadership development programs and pathways
Use continuous quality improvement processes to improve the cultural safety of the health service organisation
Incorporate into the professional development program opportunities to discuss and develop the workforce’s cultural awareness and cultural competency
Report on the effectiveness of the cultural awareness and cultural competency training to the governing body, the workforce, and the Aboriginal and Torres Strait Islander community.

Suggested strategies

Cultural awareness and safety programs are often believed to only benefit people from Aboriginal and/or non-Anglo, non-English speaking heritage in the workplace.

But, a well-developed and engaged cultural safety program will also create a general openness, increase workplace respect, and assist in mentally healthy work practices for all workers. It makes good business sense to commit to workplace cultural safety.

We no longer need to argue a case for productive diversity. We are living it.

Community Relations Commission for a multicultural NSW

The Economic advantages of Cultural Diversity in Australia

A culturally safe workplace has a defined set of values and principles, and demonstrates behaviours, attitudes, policies, and structures that enable all workers to work effectively cross-culturally.

In a culturally safe workplace all workers feel comfortable, supported and respected. Workers will feel they can contribute to all appropriate discussions, they will work safer and be more productive.

In the diverse environments in which we all live and work, the importance of being culturally safe at work cannot be underestimated.

Baumeister, R. (2011). The need- to-belong theory. Handbook of theories of social psychology, 2, 121–140.

Colby, S. L. & Ortman, J. M. (2015). Current population reports: Projections of the size and composition of the U.S. Population: 2014 to 2060. Washington, DC: U.S. Census Bureau.

Dovidio, J. F., Gaertner, S. E., Kawakami, K., & Hodson, G. (2002). “Why can’t we just get along? Interpersonal biases and interracial distrust”. Cultural Diversity & Ethnic Minority Psychology 8 (2): 88–102.

Federal Bureau of Investigation (2014). Bias breakdown (note: News release from the Annual Hate Crime Statistics Report). Accessed from https://www.fbi.gov/news/stories/2014/december/latest-hate-crime-statistics-report-released

Mendes, W. B., Gray, H., Mendoza-Denton, R., Major, B., & Epel, E. (2007). Why egalitarianism might be good for your health: Physiological thriving during stressful intergroup encounters. Psychological Science, 18, 991–998.

Nuwer, R. (2015). When cops lose control. Scientific American Mind, 26(6), 44–51.

U.S. Census Bureau (2008). Hispanic population in the United States: 1970 to 2050. Accessed November 28, 2011 from http://www.census.gov/population/www/socdemo/hispanic/hispanic_pop_presentation.html

U.S. Census Bureau (2010). The Hispanic population: 2010. Accessed November 28, 2011 from http://www.census.gov/prod/cen2010/briefs/c2010br-04.pdf

Vescio, T. K., Gervais, S. J., Heiphetz, L., & Bloodhart, B. (2014). The stereotypic behaviors of the powerful and their effect on the relatively powerless (pp. 247–266), in T. D. Nelson (Ed), Handbook of prejudice, stereotyping and discrimination. New York: Psychology Press.

Wong, G., Derthick, A. O., David, E. J. R., Saw, A., & Okazaki, S. (2014). The what, the why, and the how: A review of racial microaggressions research in psychology. Race and Social Problems, 6, 181–200.

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