What is Cultural Competence?ompetence?

May 26, 2016

In this occasional blog feature, CFHI staff explore key topics in healthcare improvement. This month, Rose LeMay, Director of Northern and Indigenous Health, discusses topics that impact Indigenous health and a vision for reconciliation.

Indigenous Canadians access health and mental health services from multiple jurisdictions, and partnership between providers and leaders is essential for effective services. CFHI is committed to supporting partners to contribute to closing the gap in Indigenous health, through spreading knowledge, facilitating partnerships, and encouraging a vision of reconciliation.
Learn more about CFHI’s work in Indigenous Health »

Cultural competence can sometimes be a loaded phrase, and we all bring our previous histories and our personal perspective into the discussion. So in transparency, I’m Tlingit First Nation, I speak on this topic at national and international conferences, and I care about how we as a country interact with each other.

In my discussions around the world with Indigenous leaders including the Wharerātā Group*, this is the foundation of what I believe is cultural competence. The topic is complex – don’t believe anybody who says this is simple!

Even the term is complex. Cultural safety, cultural competence, cultural capacity, cultural humility? All are used in Canada, and for the purposes of this piece, cultural competence will be used for consistency.

Perspective

Is cultural competence simply a transfer of facts about one culture to somebody from another culture? I argue that it’s more than that. The study-it approach to culture is about the objective scientist studying the “other culture”, finding static facts about the “other culture”, but rarely leads to understanding between peoples. The “othering effect” doesn’t lead to understanding, and may even increase the divide by describing that other culture in a snapshot kind of way. The “othering effect” often leads to judgment over that other culture, how different it is from mine.

While I am on the topic of who instructs on cultural competence…. Knowledge about a specific culture is best shared by somebody from that culture and lived experience. Simply put, an instructor with lived experience is going to have credibility on the topic. Workshops on Indigenous culture should not be given by a nonIndigenous instructor. The best practice is to model cultural competence – the instruction Team is half Indigenous and half non-Indigenous to model the principle and practice partnership.

How about we learn from each other? It turns out that cultural competence is strengthened in relationship, with people from other cultures.

Knowledge

Cultural competence is partly about knowledge. Canada’s history and relationship with Aboriginal peoples is complex and still a bit hidden. First Nations, Inuit and Metis Canadians expect nonAboriginal Canadians to know some of that history, because the impacts of that history continue today. Case in point – the often anonymous comment on Aboriginal news stories “just get over it”, and the resulting outrage by Aboriginal posters. Sometimes the drive to move forward feels like a refusal to learn from the past. Indigenous cultural competence includes a knowledge of Canada’s history, so that we don’t repeat mistakes from the past.

And cultural competence is more than knowledge. One can learn some things about another culture from a book, but does it lead to increased skills to build relationship with people from that culture? Cultural competence leads to effective relationship.

Action matters here.

Self-awareness

Cultural competence starts with you first. Everybody has culture – there is no such thing as cultural neutrality. One cannot turn off one’s values, beliefs, assumptions. The more that you are aware of your own culture, values and beliefs, and how they impact on your view of the world and your actions… the more that you are able to view other’s potentially different cultures as a learning opportunity. Cultural competence starts with an understanding of how culture and cultural differences play out in almost every human interaction.

Cultural humility is, “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 populations.”
(Tervalon and Murray-Garcia, 1998)

Effective skills

Cultural competence is about working effectively together, and actions matter. Are you able to anticipate how your values and beliefs may create unintentional barriers for others, and then avoid imposing your own perspective? Are you able to see the interaction from your client’s point of view?

And here’s the reality check – in the relationship, if you are the person with the perceived power (government, doctor, professional), the person with the perceived less power is the evaluator of your cultural competence. Does that person feel culturally safe with you?

More often than not, a lack of cultural safety feels like a lack of power to the client. An imposition of one’s own culture and values over another is also about power, and this is one of the most difficult aspects for critical reflection. Cultural competence is a journey, not a destination.

Thinking about the future

Cultural competence is about the past so we know where we all came from, but not stuck in the past. It’s also about choosing to describe what we want in the future.

Can we do better in this country on cultural competence, with a vision that Canadians feel valued for who they are including culture, that children grow up without fear that they might be targeted because they are from a different culture?

Would you believe me if I simply said, as a First Nations person, that we can do better?

What’s your vision?

Rose LeMay
@CFHI_RLeMay

* The Wharerātā Group is an international network of Indigenous leaders working in mental health and addictions.

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