4. Communication

Communication capability in a cross-cultural setting refers to overcoming cultural and linguistic barriers to achieve shared understanding and convey information. It also requires the capacity to adapt communication styles and take cues from people to achieve mutual understanding.

American studies have found that ethnic minorities receive less information about their health conditions and treatment from doctors than non-ethnic white Americans due to several entrenched attitudes and factors, including a lack of cross-cultural communication capability. In addition, studies have also found that CALD patients prefer a service provider from the same cultural or linguistic background, feeling it will result in better understanding, communication, and service.

Studies have also found that communication is a significant workplace issue. Communication is implicated in adverse events and documented in sentinel reporting literature as a major contributing factor. Between-group conflict and poor integration across organisations compounds poor communication and is further implicated in adverse events, quality and safety. Occupational health and safety may also be compromised by poor communication and exacerbated by cross-cultural communication barriers.

Communication, particularly among diverse groups, is a critical factor in developing collegial relations in the work team. "Research highlights a significant association between racial diversity and difficulties with communication and conflict resolution in teams." Without adequate diversity management strategies and cross-cultural communication training, health organisations stand to miss out on the benefits of a diverse workforce.

This is particularly relevant for Queensland Health which relies on a highly skilled, overseas-trained and recruited workforce. One of the greatest barriers to integration of overseas-trained professionals, despite having English as a first or second language, is the Australian vernacular. Sarcasm, irony, and subversiveness are well appreciated Australian communication and humour styles that do not always translate well across cultures.

Cultural competent communication in the cross-cultural context also entails 'linguistic competency' which is defined as "the capacity of an organisation and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse audiences, including persons of limited English proficiency, those who have low literacy skills or are not literate, and individuals with disabilities. Linguistic competency requires organisational and provider capacity to respond effectively to the health literacy needs of the populations served. The organisation must have policies, structures, practices, procedures, and dedicated resources to support this capacity.

This may include, but is not limited to, the use of:

  • Bi-lingual/bicultural or multilingual/multicultural staff
  • Cross-cultural communication approaches
  • Sign language interpreter services
  • Multilingual telecommunication systems
  • Videoconferencing and telehealth technologies
  • Print materials in easy-to-read, low-literacy, picture, and symbol formats
  • Materials in alternative formats (e.g., audiotape, Braille, enlarged print)
  • Varied approaches to sharing information with individuals who experience cognitive disabilities
  • Materials developed and tested for specific cultural, ethnic, and linguistic groups
  • Translation services including those of:
    • legally binding documents (e.g. consent forms, confidentiality and patient rights statements, release of information, applications)
    • signage
    • health education materials
    • public awareness materials and campaigns.

Knowledge Skill Behaviour
1. Know that different cultural norms and styles in verbal and non-verbal communication exist. (when to talk, eye contact, pacing and pausing, directness etc.)

Can take cues from the other (e.g., eye contact, formality) and adapts or reciprocates accordingly to achieve a positive communication experience.

Avoids assumptions and works to understand different cultural norms in communication.

Does not attribute negative behaviours on to a person without considering further possible personal or cultural contexts.

Treats all clients equally regardless of communication styles and English-language proficiency.
2. The need to be directly and fully informed about health condition is a Western cultural norm. In many cultures, it is not acceptable to directly inform patients about serious conditions or ask direct questions that might result in losing face, loss of hope, or shame. Family members may gradually deliver 'bad news', downplay the harsh realities, or choose to conceal some information.

Skilled at gauging the level and amount of direct information that a patient will tolerate and how this information will be conveyed by family members or carers. Skilled at working with families and carers to deliver information that is necessary such as informed consent and diagnoses and determining ways in which it can be sensitively delivered (See also cultural capability five: collaboration).

Does not impose own cultural norms of communication on to others (i.e. does not demand eye contact).
3. Translating medical discourse into culturally appropriate and palatable terms can often improve health outcomes.

Skilled at employing cultural understanding to adapt communication style to suit the audience and deliver messages in a culturally appropriate manner.

Exhibits sensitivity to different cultural taboos around health.
4. Communication issues are found to be amongst the most common contributing factor in adverse events, patient satisfaction and outcomes. Language barriers are associated with adverse outcomes.

Manages risk relating to language barriers and understands that a professional interpreter allows quality of care and ethical standard of care.


5. Interpreter services must be obtained for low- English proficiency speakers. Children and other family members should not be used as interpreters. Other factors in relation to dialect, class and gender may undermine the effectiveness of the interpreter services.

Skilled at assessing when an interpreter is required by asking open-ended questions and asking clients to repeat, in their own words, the information that has just been given.

Has training in working with interpreters and understands the interpreter's role. Is able to request an interpreter. Skilled at working with interpreters, building in time for pre-interview/briefing and identifying any barriers in relation to dialect, class, gender or other factors that may impede the quality of the service or accuracy of information provided.

Integrates interpreter services as an essential aspect of equitable quality care.
6. Verbal skills do not always equate to high English proficiency or having adequate literacy or numeracy to comprehend complex written documents or lengthy discussions. Translated information may be required.

Skilled at assessing literacy and resourcing translated materials.

Avoids making value judgements about non-English speaking people or speakers with low-English proficiency.

Ensures the same standard of information and care is given to patients with low-English proficiency.

7. Cross-cultural communication may require more time; building in more time for communication with patients in initial consults is likely to improve outcomes, compliance and understanding, and avoid re-admission or additional consults.

Capacity in giving clear information and skilled at summarising and clarifying information.



8. Research shows that native English-speaking Australians tend to assume that speakers with 'foreign' or 'thick' accents are inferior, uneducated, stupid or even childlike. Culturally and linguistically diverse staffs face discrimination because of the perception that they are not able to meet professional standards in oral and verbal communication.

Skilled at communicating with speakers whose first language is different.

Values bi or multi-lingualism and does not prohibit conversation between people in languages other than English.

Does not discriminate against persons whose first language is not English.

Provides necessary support to colleagues whose first language is other than English.