Being culturally competent is not enough

1 minute to Read + 2 minutes to Delve
He Ako Hiringa
21 June 2021
Bulletin #4

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Being culturally competent is not enough

Focusing on practical cultural competencies, such as how to engage, does little to encourage practitioners to confront health inequities, and is not enough to improve health outcomes.1,2 A shift from cultural knowledge to an approach based on cultural safety will support the achievement of equitable access to healthcare and medicines for people of all cultures. Cultural safety necessitates practitioners critically question themselves and the possible impact that their own culture, history and attitudes may have on the patient.3

What’s required to practise cultural safety?

Below are some points to assist in embedding cultural safety into your practice.2,3

  1. Acknowledge your biases and understand how they impact on your interactions.
  2. Work on underlying prejudices and stereotypes (eg, do you believe your patient is not attending for their medicines because different groups are not as able or motivated to be as healthy as other groups?).
  3. Recognise the inherent power imbalance in the practitioner–patient interaction.
  4. Engage with your patient, share the decision-making – balancing the need for best clinical pathways – and form a treatment plan that fits within their cultural context.
  5. Don’t impose your own cultural beliefs, values and practices on patients, and do respect theirs.
  6. Understand that the patients’ beliefs and values will influence their perception of illness and how they manage their health (eg, your patient may have had to choose between picking up their medicines or caring for a relative).
  7. Recognise that patients’ verbal and non-verbal communication styles may not be the same as yours, and that you will need to adapt (eg, ask your patient to relay their understanding of when and how to use their medicines). Use an interpreter if necessary. Include the patient’s whānau if appropriate.
  8. Learn to recognise when your actions may not be acceptable to your patient.

Cultural competence vs safety – related, but different

A culturally competent practitioner knows about the beliefs and behaviours of patients from different cultures, and has the skill to apply this knowledge to healthcare delivery. Although important, cultural competence alone is not enough to improve equitable access to healthcare.1,2

Practising cultural safety requires practitioners to critique tacit power structures, by exercising self-reflection and awareness, and addressing their biases, attitudes and assumptions that may affect provision of healthcare. Culturally safe practice engages patients, empowering them to be involved in decision-making and contribute to achieving positive, equitable health outcomes.3


  1. Carter M, Potiki M, Haggie H, et al. Cultural safety within vocational medical training. Report of Te ORA and the Council of Medical Colleges. April 2021.
  2. Medical Council of New Zealand. Statement on Cultural Safety. October 2019.
  3. Curtis E, Jones R, Tipene-Leach D, et al. Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. Int J Equity Health 2019;18:174.