Why Telling Healthcare Workers to 'Be Culturally Aware' Often Isn't Enough

When we first moved from Australia to Uganda, the house we were to live in needed carpentry and plumbing work before it was fit to move into. The job of speaking to the workmen fell to me.

So I asked them the obvious questions. Are you able to do this work? Can you do it today? Will you need to come back tomorrow?

I got no verbal answer. What I got, each time, was a raise of the eyebrows.

Where I come from, when a man looks at a woman and raises his eyebrows at her, it tends to mean one thing, and it isn’t a quote for plumbing. I was confused, and quietly a little offended that I might be coming across as that kind of woman. It took me some time to learn that in Uganda raised eyebrows are simply an informal “yes.” In the meantime, I handed the workmen over to my husband to save myself the embarrassment.

The behaviour was never the problem. My reading of it was. I had assigned a meaning that belonged to my culture, not theirs, and I was completely certain I was right.

That is exactly the gap most cultural awareness training never closes. People are told what they should do without first being shown how their own culture shapes the way they interpret communication, behaviour and relationships. And so they leave a training session still unsure what cultural awareness actually looks like in practice.

Before I lived cross-culturally, my own habits and assumptions were invisible to me, because they simply felt “normal.” I had never really stopped to consider how deeply culture shaped the way I read questioning, silence, eye contact, disagreement, authority, humour, family involvement, and communication itself.

I had already had excellent intercultural training before we left. But it was the combination of that training and living inside another culture that changed me. Behaviours I once interpreted automatically slowly became visible as culturally shaped, rather than universally true.

Over the years I have watched the same light-bulb moment happen again and again while training doctors, nurses and healthcare teams. These are people who genuinely care about communicating well across cultures. Most have simply never been shown how powerfully their own worldview colours the way they read everyone else.

One idea that helped me name this came through Milton Bennett’s work on intercultural sensitivity, where he quotes the psychologist George Kelly:

“People do not respond directly to events; they respond to the meaning they attach to events.”¹

In healthcare, that sentence is everything.

Patients, families and staff are rarely reacting to words, silence, tone, authority or behaviour itself. They are reacting to the meaning they attach to those things. Two people can sit through the very same interaction and walk away having experienced something completely different.

A clinician may believe they have been clear and respectful, while the patient experienced the same minutes as rushed and intimidating. A nurse may read silence as understanding, while the patient is simply being polite, or is frightened, or won’t challenge someone in authority.

This is why telling staff to “be culturally aware” is so often not enough. They also need the chance to see how their own worldview shapes the way they interpret communication, relationships and behaviour, the same way I had to see what I was doing with a pair of raised eyebrows.

The problem with awareness without development

One of the most useful frameworks I met early in cross-cultural work was Milton Bennett’s Developmental Model of Intercultural Sensitivity.² What makes it so practical is that it treats cultural awareness as a developmental process, not a checklist. People move, over time, from unconscious cultural assumptions toward genuine intercultural awareness and adaptability.

In healthcare, many people start from what Bennett called minimisation: “I treat everyone the same.”

This almost always comes from good intentions. But treating everyone identically does not mean everyone experiences communication, authority, safety or care the same way.

For example, a patient nodding politely may still be confused. A junior staff member may avoid questioning a senior colleague despite a real safety concern. A family closely involved in a decision may be read as interfering rather than supportive.

Without reflective development, healthcare workers keep interpreting these behaviours through their own cultural lens, and feel sure they have read them correctly. I know, because I did exactly that with a pair of raised eyebrows.

Why this matters in healthcare

In healthcare, communication is tied directly to patient safety.

Misunderstandings around discharge instructions, consent, medication explanations, speaking up, escalation of concerns or family communication can all change clinical outcomes.

This is why cultural awareness cannot stay theoretical or treated as a compliance box. Staff need practical opportunities to recognise how culture shapes interpretation, how worldview shapes communication, and how differing assumptions shape a clinical encounter.

It is not about becoming an expert in every culture. That is impossible. It is about developing a sharper awareness of our own assumptions, our own communication style, and the simple, humbling fact that another person may read the same interaction in a completely different way.

In other words, this is less about learning cultural “facts” and more about learning to notice interpretation itself, including how culture shapes communication in ways we rarely see in ourselves.

From awareness to insight

The biggest shift I see in healthcare teams happens when staff recognise their own invisible assumptions for the first time.

Suddenly, silence is no longer automatically read as understanding, directness is no longer assumed to be universally respectful, and reluctance to question authority is recognised as culturally shaped, not simply passive.

At that point, cultural awareness stops being abstract and becomes practical. Staff start adapting on purpose, slowing explanations down, checking understanding differently, making space for psychologically safe conversations, and paying attention to how their communication is received rather than just delivered. This is closely related to cultural humility: a willingness to keep learning rather than assume we already know.

This is where intercultural awareness starts to improve not only relationships and inclusion, but patient safety itself.

Cultural awareness is a learned skill

Many healthcare workers are compassionate, intelligent and clinically excellent, and have simply never been taught how culture shapes perception and interpretation.

Cultural awareness is not achieved by memorising stereotypes or sitting through a single session. Like communication itself, it develops gradually, through reflection, experience and guided learning. It is the same gradual work that underpins culturally safe practice.

In increasingly multicultural healthcare settings, helping staff move from unconscious assumptions toward reflective intercultural awareness may be one of the most valuable communication and patient-safety investments an organisation can make.

How Culture Creek approaches cultural awareness training

At Culture Creek Australia, we believe cultural awareness training becomes most useful when healthcare workers are helped to see how culture shapes communication, interpretation and workplace interactions in ordinary, everyday settings.

Rather than focusing on memorising facts about different cultures, our training explores worldview, communication styles, authority, speaking up, silence, family involvement, and the hidden assumptions that shape healthcare interactions.

Using real healthcare examples, reflective discussion and communication-based learning, we help teams move beyond being told to “be culturally aware” toward genuine intercultural insight, adaptability and psychologically safe communication.

In multicultural healthcare environments, these are not interpersonal niceties. They are closely connected to teamwork, trust, communication, and patient safety.³

If your organisation wants to strengthen culturally responsive, psychologically safe communication, explore our Communication for Safety course or book a free consultation with Culture Creek Australia.

References

1. Kelly, G. A. (1963). A Theory of Personality: The Psychology of Personal Constructs. New York: W. W. Norton. Quoted in Bennett (1986). ↩

2. Bennett, M. J. (1986). A Developmental Approach to Training for Intercultural Sensitivity. International Journal of Intercultural Relations, 10(2), 179–196. ↩

3. Nursing and Midwifery Board of Australia & Ahpra. Code of Conduct and Professional Standards. Read more. ↩