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4.1 Diversity

4.1 Responsiveness to diversity

Being responsive to diversity means understanding that each individual is unique, recognising their individual differences. There are many dimensions to diversity, which include not only ways of being, but also ways of thinking and believing.

Standard - what we'll be assessing on Evidence to provide for assessment

The practice is knowledgeable about the diverse groups within its enrolled populations (for example transgender, refugees etc) and plans and provides for their health care needs.
  • Diverse groups within the enrolled population are identified using practice data.
  • Completed continuous professional development (CPD) activities in relation to the diverse groups within the practice population.

New Zealand has a highly diverse population. Those known to experience health inequities in our population could include groups with one or more of the following characteristics:

  • Cultural
  • Racial
  • Religious
  • Age
  • Sex
  • Gender
  • Sexual orientation
  • Disability

Identifying diverse groups using practice data and pursuing equitable outcomes

In planning healthcare for groups or individuals who experience inequities in our health system, capturing patient information and data is the first step. This information also helps determine the training needs for the team, equipping them to deliver healthcare services in an equitable and inclusive way.

Data cannot identify all diverse groups in a population, so team members can make a difference by learning about these individuals and groups within their own populations.

Practices team members who have received effective cultural CPD are better prepared for any type of interaction and can endeavour to make these interactions inclusive and safe.

When collecting information from patients, you must comply with the Health Information Privacy Code 2020.

Audits run on your practice data can be used to implement initiatives to embrace diversity, inclusion and equity which can be included in the Quality plan (criterion 8.2).

Some examples of improvement initiatives may include:

  • Health information in a variety of languages
  • Extending opening hours to evenings and/or weekend
  • Including patients and whānau by asking for feedback and ideas on healthcare delivery.
  • Providing kaiāwhina support for Māori patients and whānau in response to Māori patient requests for cultural and spiritual assistance, and pastoral care.
Dr Melissa-Jane Austen (left) with a patient
Dr Melissa-Jane Austen (left) with a patient.

Cultural safety and cultural competence

Cultural competency is the process of developing skills from another culture. Cultural safety involves self-reflection on the part of the healthcare provider on the potential impact of their own culture on their interactions with their patients. The goal of culturally safe healthcare practice is health equity.

The Medical Council of New Zealand (MCNZ) has published work on cultural safety which is vitally important to promoting health equity; this can be explored further on their website.

Their definition is: “Cultural safety focuses on the patient and provides space for patients to be involved in decision-making about their own care and contribute to the achievement of positive health outcomes and experiences.”

It's 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.

Training and continuous professional development

Cultural competency and diversity training along with ongoing professional development will help team members deliver culturally safe care and be responsive to the cultural needs of patients. When deciding which training may best suit your team, 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. If a team member has previously completed cultural diversity training, it is expected there is a continuation of professional development activities in this area. At times a practice may design their own training to reflect the needs of their diverse groups. This could be delivered by an inhouse trainer.

Links to resources