Regular cultural competency and diversity training ensures all team members are provided with accurate and consistent information to deliver culturally safe care and be responsive to the cultural needs of patients. When determining which trainings to complete, consider the enrolled population groups within the practice, such as an underrepresented ethnicity, migrants, refugees, religious groups, those with disabilities or impairments and those who identify as gender diverse.
CALD stands for ‘Culturally And Linguistically Diverse’ and refers to people who are migrants and refugees from Asian, Middle Eastern and African backgrounds.
E-CALD (an agency of the three Auckland DHBs) delivers a range of courses for practitioners who have knowledge and orientation in the New Zealand health system, and who work with CALD patients. The courses are available online, and e-CALD also offers face to face services in the Auckland region.
CALD Cultural Competency ‘Courses for Working with CALD’
Diversity Works NZ
NZ is a national membership organisation aiming to help businesses develop diverse and inclusive workplaces. Diversity Works NZ provides public and customised training in a range of diversity respect and inclusion-related areas.
is an organisation offering tools to help organisations become innovative and inclusive. They assist with policies and processes to drive a supportive and productive workplace that specifically recognises and welcomes sexual and gender diversity.
provides services for queer and gender diverse youth and their wider communities across Aotearoa. One of their professional development workshops is entitled Gender and Sexuality 101.
is a charitable trust that offers health and disability information, advice and equipment to enable people to live the life they choose. Life Unlimited provides disability training workshops to businesses, local authorities, government and community organisations to share up-to-date information on disability issues.
Learning cloud: Disability Awareness – Working with People with Disabilities
More resources, guidance and training are available below.
Diversity in the population
The Health Practitioners Competence Assurance Act 2003 includes a requirement for registration bodies to develop cultural competence standards and to ensure practitioners meet those standards.
The population of New Zealand is becoming increasingly more diverse; there are many ‘cultures’ to be aware of and they are not necessarily based on one’s ethnicity, race, nationality or religion. In addition to these, the concept of diversity considers human differences in many different dimensions, including indigeneity, gender, gender identity, sex characteristics, sexual orientation and expression, age, ability, impairment and disability. Some groups of people with common lived experience consider their way of life to be a specific culture – and as such there are shared values, language, norms and practices (all elements of culture) that inform and shape their daily lives. The patients can and will often belong to multiple cultures simultaneously.
There are implications not only on the demographic composition of the practice populations but also the health workforce. One of the major barriers to culturally appropriate, accessible, safe and equitable health services is the lack of cultural awareness, knowledge and skills of health professionals. Current thinking around these matters describes cultural competence and cultural safety.
Cultural competence and cultural safety
Cultural competence refers to the skill set of the general practice staff that enables them to recognise issues of cultural difference that may lead to miscommunication and inappropriate treatment. Cultural competence training will help them to take positive actions to help maintain a strong rapport, a clear understanding and practice that is consistent with the culture of the patient and their whānau or family.
Cultural safety is grounded in the experience of the patient. Factors other than the cultural competence of practitioners can contribute to the presence or absence of cultural safety for a patient, for example, environmental factors.
It is important to realise simply knowing the information is insufficient; to achieve cultural competence, and for patients to experience cultural safety within the practice, general practice teams must integrate their knowledge into specific practices and policies that are applied to appropriate settings.
Developing an understanding of cultural competence will allow the practice to:
- Build strong relationships with patients.
- Find out more about the patient and their condition in order to make a more informed diagnosis.
- More effectively explain the diagnosis, treatment and what the planned follow-up will be by using a patient-centric approach to the consultation.
- Provide an environment within the general practice setting that is not inconsistent with the values, language, norms and practices of their patients.
- Understand each patient’s own environment and make recommendations that are more realistic and likely to succeed.
- Significantly affect numerous patient outcomes, including emotional health, symptom resolution, function, physiologic measures (e.g. blood pressure and blood sugar level) and pain control.
- Increase doctor and patient satisfaction.
- Enhance continuity of care.
- Avoid unintentional offence.
Ethnicity data capture
Providing quality ethnicity data will ensure the government is able to track health trends by ethnicity and effectively monitor its performance to improve health outcomes and reduce health inequities.
Ethnicity data must not be transferred from another form as it may have been incorrectly collected. When collecting ethnicity, self-identification must be the process used to identify a patient’s ethnic group(s). The registration form includes a field to capture ethnicity data.
It is unacceptable for the collector to guess any patient’s ethnicity or to complete the questions on behalf of the patient based on what they perceive to be the respondent’s physical appearance.
Ethnicity capture must align with enrolment requirements for providers and primary health organisations. The ethnicity question must be worded as specified in the Ministry of Health policy. See the ethnicity data protocols for the health and disability sector.
Interpreters and communication resources for people with limited English language proficiency
The team should be able to access interpreters and resources for people with limited English language proficiency. Where possible, engage the services of an experienced interpreter who has been trained in medical terminology and concepts. The practice should hold a list of contact details for interpreter services for the staff and patients.
The use of trained interpreters is often not possible because of lack of access or high cost. Friends and family members are frequently used as ‘communicators’ or de facto interpreters for the patient, but is not an ideal option, especially when young children may be the interpreter. Any requirements and provisions the practice identifies for each patient should be clearly documented and the need for any interpreter flagged in the patient’s clinical record.
Consider how staff can identify patients with a hearing, sight or speech impairment. Once these patients have been identified, the practice will need to make provision for these patients to communicate with the practice. For example, consider whether lip-readers can clearly see the receptionist’s face (e.g. they are not obscured by a computer monitor or high countertop).
These are some of the ways the practice can communicate with patients with hearing, sight or speech impairments:
Pursuing equitable outcomes for diverse groups
The enrolled practice population will include different cultural groups.
The practice team can determine a patient’s cultural connections by asking their ethnicity, hobbies, profession and other aspects of their life. Practice teams should also directly ask if there are any elements the practice needs to be aware of that are important to the patient (e.g. religious beliefs may influence end-of-life care plans). In this way the practice can create a culturally safe environment.
Use audit findings to implement evidence-based and practice-wide activities to address the needs of cultural groups within the practice, ensuring equitable outcomes.
Examples of initiatives to embrace diversity, inclusion and equity:
- Posters and leaflets in other languages (these may be available through the DHB).
- Evening or weekend clinics for working parents.
- Involving patients (maybe on an advisory panel, or by focus group or surveys) and using their feedback to come up with ideas.
- Providing kaiāwhina support for Māori patients and whānau in response to Māori patient requests for cultural and spiritual assistance and pastoral care.