A Simple Guide to Cultural Competence
Why Cultural Competence?
We live, learn and work in a multicultural environment. We trust our intrinsic humanity and good nature as we pride ourselves on being curious and tolerant to other cultures. Yet, we interact, try to teamwork, make assessments, judge behaviours and attitudes based on our frameworks without always considering the cultural context. A better understanding of individual cultures and the context which individuals bring to their educational and work space can only strengthen our organisations.
What is culture? It is a learned set of shared interpretations about beliefs, values and norms that affect the behaviours of a relatively large group of people1
Many global industry leaders include cultural competence in their leadership, management and employee training. Many Educators who handle multicultural classrooms are showing an increasing awareness of the competencies required to get the best out of their diverse learners. Culture is a medium that touches and alters all aspects of human life, including personality, how people express themselves, how they emote, the way they think, how they move, and how problems are solved2.
Journey of discovery
I grew up in South India and now live and work in the United Kingdom. Over the past twenty five years I have experienced the similarities and differences in the culturally diverse population that I have encountered. I am constantly energised by the value of such cultural diversity as a strength based relationship, I am also equally wary of the misunderstandings and misperceptions that can lead to stereotyping and create mutual bias. While a lot of cultural awareness grows from exposure and interaction, defining the core principles of cultural competence can only help. This helps us to look at how we develop this in everyone - whether they have or have not grown up or worked in a culturally diverse setting.
As a Physician, Educator and a Health Care Leader, I find meaningful cultural contexts in everyday interactions. This made me reflect and look up the fundamentals of cultural competency - what is it, how do we develop it in ourselves and others and how do we benefit from it and move onto excellence...
Cultural Competence Attitude Quiz
As a Physician, Educator and a Health Care Leader, I find meaningful cultural contexts in everyday interactions. This made me reflect and look up the fundamentals of cultural competence: what is it, how do we develop it in ourselves and others and how do we benefit from it ...
Why Diversity Matters?
Before we move onto cultural competence, perhaps it is worth dwelling on why diversity matters. The world grows multicultural and benefits from cultural confluence. We enjoy the food, the music, the trade opportunities, the mutual learning and thrive in a world that is increasingly growing closer and more inclusive.
However, in times of strife, economic downturn and Global unrest, it is inevitable fear and anti-diversity sentiments can surface from time to time in communities.
Thankfully todays successful organisations thrive on diversity as we work in a Global marketplace. There is every evidence to say diversity and inclusion can benefit us individually and organisationally.
Diversity exists in various levels and is broadly categorised as primary, secondary, organisational and cultural - There is a visible primary dimension that encompasses age, gender, ethnicity, sexual orientation and mental physical abilities. A secondary dimension arises from religion, education, geographic location, relationship, appearance, working styles, learning styles, language and family status.3
Further dimensions can exist in workplace status, management level, experience, department and are collectively called organisational diversity. Structure, flexibility, communication styles, time, being or doing, power and authority, body language, conflict resolution preferences, individual or team preferences and even body language can represent cultural diversity.
This helps us to understand that when we talk about culturally diverse populations, we are not just talking the obvious divides of race, ethnicity and religion, we can still be of the same race, same religion and same gender and be culturally diverse due to our upbringing and our formative/educational experiences.
...when we talk about culturally diverse populations, we are not just talking the obvious divides of race, ethnicity, nationality and religion. We can be of the same race, same religion, same nation and still be culturally diverse...
What is Cultural Competence?
Cultural competence can be defined in numerous ways. Simply put, it is a set of values, beliefs, behaviours, skills and policies that comes together to enable us work effectively in cross cultural situations. In 1989 Cross et al defined attitudes, structures, policies that enable an individual and an organisation achieve cultural competence. The paper outlines five essential elements that contribute to the development of cultural competence4.
- Valuing diversity
- Having the capacity for cultural self-assessment
- Being conscious of the dynamics inherent when cultures interact
- Having institutionalised culture knowledge
- Having developed adaptations to service delivery reflecting an understanding of cultural diversity
In Healthcare, cultural competence can be described as the ability of systems to provide care to patients with diverse values, beliefs and behaviours, including tailoring delivery to meet patients’ social, cultural, and linguistic needs5.
The elements of cultural competence can be broadly defined as firstly an awareness that enables a cultural self -assessment, a sensitivity and understanding of cultural interactions, the knowledge of different cultural norms and the skills to communicate, problem solve, educate and teamwork effectively in a culturally diverse setting.
What does it mean to me?
Whether you are a healthcare professional, social care worker, educator or simply anyone who works in a multicultural environment it is worth reflecting on the question: what does cultural competence mean to me?
From my own personal experience, there perhaps has been an institutional fatigue to the concept of Equality and Diversity - this has become an organisational cliché - a dusty policy manual filed away after being signed by everyone. The term 'mandatory training' is another much used phrase- this can further endanger an individuals willingness to reflect on cultural diversity.
The desire to become culturally competent should be intrinsic. While extrinsic factors- the needs of the job, the pressures of working multiculturally, the demands of the organisation may well sign post us to the possibilities of cultural competence.
However, it is the innate desire to understand, share, learn from each other, celebrate multi-culturalism and seek out diversity that will enable us to truly become culturally competent.
Cultural Competence Skills Quiz
...it is the innate desire to understand, share, learn from each other, celebrate multiculturalism and seek out diversity that will enable us to truly become culturally competent.
Cultural Competence Continuum
One only have to look at the media and the political winds that blow to sense the dissonance that exists in the world of understanding cultural diversity, embracing variety. Whatever one's views are about immigration, borders and political divides, cultural isolation is not a solution. Cross-cultural transactions enrich, energise, enlighten, enthuse and empower people.
A person may start anywhere in the cultural competence continuum based on their beliefs, values, cultural attitudes, prior learning, upbringing and prior exposure to diverse backgrounds.
At the extreme left of the continuum is cultural destructiveness where bias, intolerance and racism exist. However many of us may exist in the zones of cultural incapacity, cultural blindness or cultural sensitivity.
Moving from sensitivity to competence and then on to proficiency requires reflection, self evaluation and skill development.
Yet, not many of us actively seek out to become culturally proficient as part of a larger development plan. In the world without borders, many of us chose to work abroad, travel wide, converse and interact daily with varying cultures. It is as good a time as any to set our goals at cultural proficiency.
In many developed countries, the professional group that is engaged in such culturally diverse conversations on a day to day basis are social workers. Their vocations take them into the heart of communities and their cultural competency is vital to an engaged client base and enables problem solving.
The National Association of Social Workers compiled a set of standards and indicators for a culturally competent workforce. Many of the themes I have outlined below is gleaned from their excellent handbook7.
Moving from cultural sensitivity to competence and then on to proficiency requires self reflection, self evaluation and skill development...
Goals & Objectives
The NASW set out ten standards for their social workers towards cultural competency7. These set of standards form a firm foundation for cultural competence. In this context cultural competence is the integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes used in appropriate cultural settings to increase the quality of services, thereby producing better outcomes. As a Physician and Educator I find these contexts in day to day patient care and in educating learners from multicultural backgrounds.
Standards for Cultural Competence
Ethics and Values
An individual, a group or an organisation needs to set a code of values and ethics. They need to ensure that their existing codes of practice have a clarity in dealing with culturally diverse themes, staff and clients. These sets of values need to be embraced, internalised and celebrated. The Hippocratic oath and the Good Medical Practice guide already contain key principles of equity. In the cultural competence context it goes further into commitment, shared vision and cultural humility.
Awareness of one's own cultural identity, a tolerance to different view point, a growth mindset and ability to reflect on personal strengths and development needs. Also approaching a diverse culture with no sense of ' Let us fix them' superiority is vital
Cross Cultural Knowledge
Having a specialised knowledge of history, traditions, rituals, values , family systems , artistic expressions of the cultural groups and cross cultural communication.
Cross Cultural Skills
Ability to communicate, activate and negotiate with various clients ( patients, learners, employees etc.) and using cultural understanding to problem solve.
Using networks of support specifically available to cultural groups, making appropriate referrals and signposting. Identifying gaps in support systems in order to address them.
Empowerment and Advocacy
Understanding how policies and procedures can impact on diverse cultural groups, ensuring equity of law while protecting the groups from discrimination. Helping develop policies and protocols that aid and enable.
Support, advocate and promote a workforce that is representative of the population it serves and encourage development of marginal groups that may not seek certain roles within the systems.
Cultural competence is not just a solitary milestone. We need to sign up to a continuing professional development , a programme of learning in and out of the job and ongoing development of proficiency.
Language and Communication
This is a two way conduit. We need to ensure the means and methods we use ot communciate are fit for purpose to the groups that we communciate with while at the same time ensuring our communciation skills are constantly developed as we facilitate the development those of the groups we onteract with.
We need to commit to being change agents, where 'things that have gone before' are not just taken on at face value but are scrutinised, refined, updated and new pathways developed towards a culturally proficient team and organisation.
Cultural competence is not just a solitary milestone. We need to sign up to a journey of continuing professional development; a programme of learning in and out of the job and an ambition towards proficiency...
Whether it is between Doctor/ Patients, Teacher/Students, Social workers/ Families, races, religions, majority or minority groups there is always an inevitable power differential that can lead to a cultural superiority from one against the other.
Good physicians approach patient centred care with a humility that the patient knows their bodies much better and offer insight and professional advise in patient centred, contextualised, holistic context. Good teachers adopt a strength based approach and learn as much from their students as they teach. Social workers work closely with families and understand them before offering unsolicited advice.
An important factor in professional identity is one of cultural humility. This encourages self evolvement, self evaluation as much as evaluating those we interact with. We do not judge others by our contexts without fully understanding what the cultural context is. A non (m)paternalistic approach creates better therapeutic, learning and mutually beneficial partnerships.
Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient–physician dynamic, and to developing mutually beneficial and non-paternalistic clinical and advocacy partnerships with communities on behalf of individuals and defined populations8
As a Physician the large scale evidence based medicine can overwhelm individuality. I always treat each person in front of me as unique. They bring their own culture, opinions, fears, expectations, personal narratives and ideas that I need to explore. This help me listen and arrive at a mutually beneficial therapeutic relationship.— Mohan Kumar
The word journey is a much used cliché. Everyone is having a journey. In its original meaning, it meant a distant covered in a day ( French: jour-nee)
In the context of cultural competence, it is indeed a journey. Not just one of a day, but one of many days, months and years. We grown, we assimilate, we get skilled in dealing with others not like us. The journey of a thousand miles still starts with that first step. The willingness and desire to embrace all cultures and to develop skills of teaching, working with and treating all, irrespective of their colour, creed, cultural origins.
This needs to be the universal motto, if we are to move to a truly global outlook. One World. One vision.
1Lustig, M. W., and Koester, J. (2003). Intercultural competence: Interpersonal communication across cultures. Boston: Allyn and Bacon.
2Samovar, L.A., and Porter, R. E. (1991). Communication between cultures. California : Wadsworth.
3Schaefer, R.T. (2011). Racial and Ethnic Groups (12th ed.) Upper Saddle River, NJ : Pearson
4Cross, T., Bazron, B., Dennis, K., & Isaacs, M., (1989). Towards A Culturally Competent System of Care, Volume I. Washington, DC: Georgetown University Child Development Center, CASSP Technical Assistance Center.
5Betancourt, J., Green, A. & Carrillo, E. (2002). Cultural competence in health care: Emerging frameworks and practical approaches. The Commonwealth Fund.
6 Srivastava, R. RN, PHD. (2007) The Healthcare Professionals Guide to Clinical Cultural Competence.Toronto : Mosby
7 Standards and Indicators for cultural Competence in Social Work Practice ( 2005) The National Association of Social Workers. USA : NASW
8 Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117–125
© 2016 Mohan Kumar
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