Cultural Competency

Cultural competency focuses on the patient experience to define and improve the quality of care. It involves doctors reflecting on their own views and biases and how these could affect their decision-making and health outcomes for the patient.

The Medical Council of New Zealand defines cultural competency as:

• The need for doctors to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery.
• The commitment by individual doctors to acknowledge and address any of their own biases, attitudes, assumptions, stereotypes, prejudices, structures and characteristics that may affect the quality of care provided.
• The awareness that cultural competency encompasses a critical consciousness where healthcare professionals and healthcare organisations engage in ongoing self-reflection and self-awareness and hold themselves accountable for providing culturally safe care, as defined by the patient and their communities

Cultural competency benefits all patients and communities, not just any specific ethnicity. This may include communities based on Indigenous status, age or generation, gender, sexual orientation, socioeconomic status, ethnicity, religious or spiritual belief and disability.

A focus on cultural competency must be embedded within all your recertification activities and form part of your reflection across all of the core elements of InPractice.

When considering the needs of your patients, cultural competency requires you to reflect on, take ownership of, and consider in your practice:

1. The effect of your own culture, history and attitudes.
2. The ongoing development of your own cultural awareness and an understanding of how your social-cultural influences inform biases that impact your interactions with patients, whānau, and colleagues.
3. Consciously not imposing your cultural values and practices on patients.
4. Recognising that there is an inherent power imbalance in the doctor-patient relationship, and ensuring that this is not exacerbated by overlaying your own cultural values and practices on patients.
5. Challenging the cultural bias of individual colleagues or systemic bias within health care services, which may contribute to poor health outcomes for patients of different cultures.

Cultural competency requires you to engage in ongoing self-reflection and self-awareness. This includes:

1. Being aware that there are limits to what you know and being open to learning from your patients.
2. Understanding how our colonial history, systemic bias and inequities have impacted Māori and Māori health outcomes, and ensuring that your interactions with and care of patients do not perpetuate this.
3. Acknowledging that general cultural information may not apply to specific patients and that individual patients should not be stereotyped.
4. A respect for your patients’ cultural beliefs, values and practices.
5. Understanding that your patients’ cultural beliefs, values and practices influence their perceptions of health, illness and disease; how they respond to and manage their health; and their treatment decisions and interactions with doctors, other health care professionals and the wider health system.
6. Understanding that culture is dynamic and evolves over time, extends beyond ethnicity, and that patients and their whānau may identify with multiple cultural groupings at any one point in time.

Cultural competency requires you to consider the sources and determinants of inequities and to implement reflective practice so that you are able to:

1. Build a relationship and provide a health care environment that supports the cultural safety of all patients.
2. Self-assess and learn to recognise when your actions might not be acceptable to patients.
3. Develop diagnoses and formulate treatment plans in partnership with patients that fit within their cultural contexts, and are balanced by the need to follow the best clinical pathway.
4. Include the patient’s whānau in their health care when appropriate.
5. Communicate effectively with all patients and:
   • Recognise that the verbal and non-verbal communication styles of patients may differ from your own and that you will need to adapt as required.
   • Work effectively with interpreters when required.
   • Seek help when needed to better understand what your patient needs in order to achieve cultural safety.

Cultural competency is relevant to all aspects of a doctor’s practice: teaching, leadership, management, research, advocacy, and patient care.

There are multiple cultural dimensions; indigenous status, age, gender, sexual orientation, socioeconomic status, ethnicity, religious or spiritual belief and disability.

Cultural competency medical practice recognizes and addresses colonialism, racism, sexism, heterosexism, cissexism, classism, ableism, sizeism, ageism and other forms of oppression that have resulted in health and social inequities in NZ.

Understanding and addressing implicit bias