Cultural humility is the ongoing practice of recognising that we do not fully understand another person’s culture, worldview or lived experience. It involves self-reflection, listening carefully, recognising power differences, and remaining open to learning from patients, families and colleagues rather than assuming we already understand their perspective.
In healthcare, cultural humility matters because so much of care depends on shared meaning. A diagnosis explained, a medication instruction given, a consent conversation held, a discharge plan handed over: each one assumes the meaning arrived intact at the other end. Cultural humility is the habit of checking that assumption instead of trusting it.
In Australian healthcare, conversations around culture often focus on learning about different cultural groups, customs or communication styles. While this can be helpful, cultural humility goes deeper. It shifts the focus away from becoming an “expert” in another culture and toward recognising how our own cultural values, assumptions and communication styles shape the way we interact with others.
One of the biggest shifts in my own understanding came through living and working cross-culturally myself. Before that, many of my own communication habits and assumptions felt invisible because they simply seemed “normal” to me. What once felt universal gradually became visible as culturally shaped. I began recognising how differently people interpreted authority, questioning, silence, eye contact, disagreement, humour, family involvement, and communication itself.
Although I had already received invaluable intercultural training before working cross-culturally, it was the combination of that training and then living and working within another cultural context that truly changed my understanding. Over time, I realised that many communication misunderstandings occur not because different things happen, but because people attach different meanings to the same interaction.
As psychologist George Kelly observed, later quoted by Milton Bennett in his work on intercultural sensitivity:
“People do not respond directly to events; they respond to the meaning they attach to events.”1
That insight sits at the heart of cultural humility.
It also helps to see how cultural humility sits alongside two related terms you will often hear in Australian healthcare.
Three related terms, at a glance
Cultural safety, the third of these terms, has a foundation of its own, first mapped by Māori nurse Irihapeti Ramsden. If you want that history and how it applies in Australia today, see the principles of cultural safety.
Cultural humility vs cultural competence in healthcare
For many years, healthcare organisations focused heavily on “cultural competence.” This generally refers to developing knowledge and skills for working effectively across cultures. It often includes learning about communication styles, traditions, beliefs, family structures or health practices associated with different cultural groups.
Cultural humility takes a different approach.
Rather than assuming we can become fully “competent” in another person’s culture, cultural humility recognises that every patient, family and colleague is an individual. It also acknowledges that we ourselves are cultural people. The way we communicate, ask questions, interpret silence, use humour, express disagreement or understand professionalism is often deeply shaped by our own worldview and upbringing.
One of the challenges in healthcare is that many people are encouraged to “be self-aware” without ever being shown what this looks like practically. In my experience teaching doctors, nurses and healthcare teams, many genuinely want to communicate well across cultures, but they have never been shown how deeply their own worldview shapes the way they listen, explain, interpret behaviour and understand respect.
One of the most useful frameworks I encountered during cross-cultural training was Milton Bennett’s Developmental Model of Intercultural Sensitivity (DMIS).2 Bennett’s model describes how people gradually move from unconscious cultural assumptions toward greater intercultural awareness and adaptability. What makes the model so practical is that it explains why cultural awareness often feels difficult at first: people are not simply learning information about other cultures. They are learning to recognise their own invisible assumptions.
Over the years, I’ve repeatedly watched the same “light bulb” moment happen during training sessions. Once healthcare workers begin recognising their own cultural assumptions and communication patterns, cross-cultural interactions suddenly become much easier to understand. One doctor who attended a training workshop later described this shift as:
“the single greatest help to me in understanding how a person’s worldview informs their thoughts and feelings, words and actions.”
The NMBA and Ahpra also emphasise that culturally safe practice requires practitioners to reflect on how their own culture, values and behaviours influence patient care and workplace interactions.3
The three principles of cultural humility
The framework most commonly cited in healthcare literature, developed by Tervalon and Murray-García,4 describes three core principles.
1. Lifelong self-reflection
Cultural humility is not a one-time training session or checklist. It is an ongoing process of reflecting on our assumptions, communication habits, unconscious biases, and the way our own culture shapes how we interpret behaviour.
This is especially important in healthcare because clinicians often work under pressure and may unintentionally interpret behaviour through their own cultural lens. Silence may be mistaken for understanding. Lack of eye contact may be interpreted as disengagement or dishonesty. A patient who politely agrees may still feel confused or unsafe asking questions.
Cultural humility encourages healthcare workers to remain curious and reflective rather than overly certain in their interpretations.
2. Recognising power imbalances
Healthcare naturally involves power differences. Clinicians hold medical knowledge, authority and institutional power. Patients, families, support workers and junior staff may feel vulnerable, intimidated or reluctant to speak openly.
In my own cross-cultural experience, I began noticing how differently people can relate to authority figures in healthcare settings. I remember African friends and workers returning from medical appointments with medication but very little information about their diagnosis, expected recovery, follow-up care or what to do if symptoms continued.
I would find myself asking questions that felt obvious to me: “What did the doctor say?” “How long will recovery take?” “Did they explain the diagnosis?”
What surprised me most was not simply the lack of information, but that they often did not seem concerned about not asking further questions. Over time, I realised I was also interpreting the interaction through my own cultural assumptions about communication, authority and the role of the patient. In many cultures, doctors are viewed with very high authority, and questioning them may feel unnecessary, disrespectful or intimidating.
Again, Kelly’s insight becomes especially relevant:
People often respond not simply to events themselves, but to the meaning they attach to them.
The same medical interaction may feel reassuring to one patient, intimidating to another, respectful to one family, or dismissive to someone else, depending on the meaning attached to authority, questioning, tone, silence or communication itself.
Cultural humility recognises these dynamics and encourages practitioners to actively create psychologically safe interactions where patients and staff feel comfortable asking questions, seeking clarification and expressing concerns. In multicultural healthcare settings, understanding how authority and communication are interpreted differently can significantly improve both trust and patient safety.
3. Institutional accountability
Cultural humility is not only an individual responsibility. Healthcare organisations also play a role in creating culturally safe systems, workplaces and communication practices. This includes reflective leadership, a supportive workplace culture, accessible communication and interpreter use, culturally responsive training, and systems that encourage respectful, patient-centred care.
Australian healthcare standards increasingly recognise that culturally safe care is connected to organisational culture, communication and safety systems, not simply individual goodwill.
A real-life example of cultural humility
When we were living in Uganda, our housekeeper came to me one day with a chesty cold, holding a tub of Vicks VapoRub. It was a remedy widely used in her community. I told her she should use it, that it would help her breathing. It felt like the simplest, most obvious advice in the world.
A little later, I came upon her eating it. I was shocked.
When I explained how I had meant her to use it, she was just as confused as I was. Taking it that way was simply how Vicks was used where she came from. She had always used it like that, and so had the people around her.
What has stayed with me is not what she did, but what I had assumed. “Use it, it’ll help your breathing” felt like a complete instruction, because in my world those words only mean one thing. I had handed over advice and assumed the meaning travelled with it. It hadn’t.
I think about that moment often in the work I now do with healthcare teams. At a bedside, when a clinician explains a medication or talks a patient through a discharge plan, a nod and a polite “yes” can feel like understanding. But understanding is not the same as shared meaning. It’s why I encourage the clinicians I work with to check rather than assume. I suggest they ask something like:
“Can you tell me in your own words what the plan is when you get home?”
That small shift, checking instead of assuming, is cultural humility in practice. And when the instruction concerns a medication or a treatment, it can be the difference between safe care and a quiet, well-meant mistake. These are the everyday cultural assumptions that cause real clinical errors, in pain, consent and discharge alike.
Examples of cultural humility in healthcare
The question I am asked most often in training is what cultural humility actually looks like on a shift, when the ward is busy and there is no time for reflection. It is a fair question. The following are patterns that come up again and again in the sessions I run with Australian health, aged care and disability teams. None of them take extra time. They take a different assumption.
A patient nods and agrees, and the clinician checks anyway. A nod is one of the most misread signals in healthcare. In many cultures it means “I am listening” or “I am being respectful”, not “I understand and I agree.” Cultural competence might prompt a clinician to learn which cultures nod that way. Cultural humility prompts a different move: ask the patient to explain the plan back in their own words, every time, regardless of who they are.
A patient reports little pain, and the nurse asks a second question. Pain is expressed differently across cultures, and stoicism is valued in some more than others. A clinician practising cultural humility does not assume a quiet patient is comfortable, or a vocal one is exaggerating. They ask what the pain is stopping the person from doing, which is far harder to answer stoically than a number out of ten.
A family arrives together, and the clinician asks who should be in the room. In many cultures a health decision belongs to the family rather than the individual. The humble version is not guessing either way. It is asking the patient directly who they would like present and who they would like told, and then recording the answer.
An interpreter is booked even though a relative offered. Using a family member is quicker, and families often volunteer. Cultural humility recognises what that costs: the relative filters, softens and sometimes withholds, and the patient loses the ability to say something private. Booking a professional interpreter is an admission that goodwill is not the same as accuracy.
A colleague goes quiet in handover, and the senior clinician makes room. Cultural humility is not only for patients. Where a workplace treats questioning a senior as disrespectful, an internationally trained nurse who disagrees may simply say nothing. The humble response is not to insist people speak up, but to build the moment where speaking up is expected, by asking directly for the view of the person who has not spoken.
What links these is that none require knowing anything about a specific culture. They require holding your own interpretation loosely enough to check it.
How to practise cultural humility day to day
Cultural humility is a habit rather than an achievement, and habits are built from small repeatable actions.
Start with teach-back on anything that matters clinically. Medication, wound care, red flags to return for, and discharge instructions are where misunderstanding becomes dangerous. Asking a person to tell you the plan in their own words costs about thirty seconds and catches what a nod hides.
Notice your own reaction before you interpret someone else’s behaviour. When a patient or colleague does something that strikes you as odd, rude, evasive or overly emotional, that reaction is data about your own cultural frame as much as about them. The pause between noticing and concluding is where most of the work happens.
Treat the person as the authority on their own experience. You are the expert on the medicine. They are the expert on their life, their family, their beliefs about illness and what they can actually manage at home. A care plan built without that second expertise tends to fail quietly, after the person has left.
Ask rather than predict. Questions like “Is there anything about your beliefs or your family I should know to care for you well?” and “Who should I be talking to about this?” are quick, respectful, and better than any assumption drawn from a name or an accent.
Make it a team practice rather than a private virtue. Where teams debrief on interactions that went badly, without blame, the learning compounds and the culture shifts. Where individuals are left to be quietly reflective on their own, nothing changes. That is why our workshops work with whole teams rather than individuals.
Why cultural humility matters for patient safety
Cultural humility is not simply about being polite or inclusive. It is closely connected to communication, trust and patient safety.
When healthcare workers become more reflective about their own communication style and assumptions, they are often better able to recognise misunderstanding early, build trust with patients and families, reduce communication breakdowns, support psychologically safe teams, and improve patient engagement and adherence.
In increasingly multicultural healthcare environments, these are not “soft skills.” They are practical safety skills.
At Culture Creek Australia, our approach focuses not simply on providing information about different cultures, but on helping healthcare workers recognise how culture shapes perception, interpretation and communication within everyday healthcare interactions.
Cultural humility is not about becoming an expert in every culture. It is about learning to recognise the invisible assumptions we carry into healthcare interactions and remaining willing to listen, reflect and adapt.
If your organisation is looking to strengthen culturally responsive communication and psychologically safe practice, explore our Communication for Safety course or book a free consultation with Culture Creek Australia.
References
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Kelly, G. A. (1963). A Theory of Personality: The Psychology of Personal Constructs. New York: W. W. Norton. Quoted in Bennett (1986). ↩
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Bennett, M. J. (1986). A Developmental Approach to Training for Intercultural Sensitivity. International Journal of Intercultural Relations, 10(2), 179–196. ↩
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Nursing and Midwifery Board of Australia & Ahpra. Code of Conduct and Professional Standards. Read more. ↩
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Tervalon, M. & Murray-García, J. (1998). Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education. Journal of Health Care for the Poor and Underserved, 9(2), 117–125. Read the article. ↩
Updated 28 July 2026
