Why DEI Training Isn't Enough for Healthcare Teams

I was in Tanzania, three days into a week-long course, teaching cross-cultural awareness to about twenty staff of a linguistics organisation. A room full of people who worked across cultures for a living, being taught about cultural difference, by me.

Day three was first aid. I always open a lesson with a demonstration: a story, a picture, a bit of theatre. For this one I had quietly recruited an enthusiastic young participant to fake an epileptic seizure on my signal. I would give the introduction, give him the nod, he would go down, and I would step in and show everyone what to do. He promised me he could play it well.

I never got the chance. The moment he hit the floor, the room moved faster than I could. Several people pinned his arms and legs. One of the senior men began an exorcism.

I froze. I had assumed they would see a demonstration. I had assumed that because this was a first-aid lesson, everyone would read a seizure the way I did, as a medical event. They didn’t. They read it as a spiritual one, and they responded with complete conviction.

When I finally cut in to stop it, they weren’t relieved. They were annoyed with me for interfering in what they plainly understood to be a struggle with something demonic. And when they rolled the young man over and saw the grin on his face, they were not amused.

Here is the part worth sitting with. I was the one teaching cross-cultural awareness that week. It was the very thing I was in the room to teach. And I walked straight into it anyway, because my own assumption, that a seizure is “obviously” a medical event, was invisible to me. It didn’t feel like a cultural belief. It felt like reality.

Decades earlier, the researcher Milton Bennett had defined the whole problem in a single line. To be ethnocentric, he wrote, is to assume “that the worldview of one’s own culture is central to all reality.”¹ Not central to my culture. Central to reality itself. That was me, standing in that classroom, certain everyone shared a frame that turned out to be mine alone.

Which brings me to the diversity training.

What DEI training actually does, and doesn’t

Most HR managers have heard the question: have we done the diversity training? And in most organisations the answer is yes. An annual session, an online module, a half-day on cultural awareness and unconscious bias. The box is ticked, the commitment signalled.

Then the same tensions keep surfacing anyway. The internationally trained nurse who won’t speak up in a team meeting. The family confused about why decisions seem to be made without them. The manager watching handovers become a safety problem because two people are communicating past each other.

Diversity, equity and inclusion training has real value. It raises awareness that difference exists, and it signals that an organisation takes inclusion seriously. But notice the direction it points. It looks outward: here is what to know about other cultures, here are the categories to be mindful of. It rarely turns the lens back on the person in the seat and asks what they are assuming without noticing.

And that unexamined assumption is the thing that actually drives the interaction. It was not a gap in my knowledge of Tanzanian belief that tripped me up. It was a frame of my own I couldn’t see.

Awareness alone doesn’t change behaviour

This isn’t just my read of it. The research is blunt.

Frank Dobbin and Alexandra Kalev examined three decades of data from more than 800 US companies, published in the Harvard Business Review in 2016.² They found that mandatory diversity training often backfires: forced to sit through it, people can respond with resistance, and the training can activate the very bias it set out to reduce. Across their data, these programs were frequently followed by fewer women and minorities in management, not more.

In 2020 the UK Government commissioned a review of unconscious bias training. Its conclusion: “there is currently no evidence that this training changes behaviour in the long term or improves workplace equality.”³ On that basis the UK civil service decided the training “does not achieve its intended aims” and phased it out.

Read that carefully, because it is easy to take the wrong lesson from it. The problem is not that the people are bad, or that the trainers are bad. The problem is structural. A one-off session that delivers information about other people does not reach the place where the difficulty actually lives: your own automatic interpretations, running quietly in the background, feeling like plain common sense.

The “we’re all the same” trap

There is a particular idea that a lot of diversity training leaves people resting on, and it sounds lovely. Underneath it all, we’re really all the same.

Bennett had a name for that stage, and he did not mean it as a compliment. He called it minimisation, and he placed it among the ethnocentric stages, not beyond them. It feels like progress, and in a divided world the sentiment is generous. But in a clinical setting it is a quiet liability.

“We’re all the same underneath” would have told me nothing useful on the floor of that Tanzanian classroom. The entire problem was that we were not seeing the same event. One room, one young man on the ground, two completely different realities. Flattening that difference doesn’t make care safer. It blinds you to exactly the thing you most need to see: that how a person shows pain, whether they question authority, who speaks for a family, whether silence means yes or means fear, are genuinely different, and they have consequences.

As Bennett put it, trouble in cross-cultural communication is “nearly always attributable to a disavowal of cultural difference, not to a lack of appreciating similarity.”¹ Appreciating similarity is the easy part. Staying honest about difference is the work.

What actually changes behaviour

If awareness pointed outward is the trap, the way through points inward.

The shift is from learning facts about other people to noticing how you yourself are making meaning, interpreting, assuming. Bennett described developing intercultural sensitivity as turning your attention back onto yourself as the meaning-maker. It is the same move that sits under culturally safe practice: you start with your own assumptions, not with a catalogue of someone else’s customs.

This is also why it can’t be done in a half-day. Catching your own frame is developmental work. It takes guided reflection, real contact across difference, and time. It is a process, not an event.

For a healthcare team, that is not abstract. It is the internationally trained clinician from a steep-hierarchy system who needs to understand why speaking up is expected here, and feel safe doing it. It is the local staff member learning to read a colleague’s silence as a different relationship with authority rather than disengagement. It is a manager seeing that a breakdown was two sets of invisible assumptions colliding, not bad intent. None of that comes from a module titled “Culture X values family.” It comes from people learning to catch themselves in the moment.

Interestingly, when Dobbin and Kalev looked at what did work, it wasn’t more control or more compulsory training. It was engaging people in solving real problems together, bringing them into genuine contact across difference, and building accountability. In a care team that looks like ongoing reflective practice and habits built into the work, teach-back, psychological safety, real conversations, not an annual tick.

The practical outcomes are concrete: internationally trained clinicians who understand how Australian teams actually operate and can adapt without losing themselves; local staff who can tell the difference between a disengaged colleague and a culturally different one; team leaders who read communication breakdowns as colliding assumptions rather than bad attitudes; and safer handovers, clearer escalation, and teams that trust each other across difference.

The better question

When organisations evaluate their diversity programs, they tend to ask: have we done the training?

The more useful question is: are our teams communicating differently as a result?

Think back to that classroom in Tanzania. The test was never whether I knew about cultural difference. I was standing at the front of the room teaching it. The test was whether I could catch my own assumption before it cost something. That is the actual skill, and it is the one worth building in a team.

This article is the evidence that the tick-box approach falls short. For the fuller argument, where it leaves DEI and what should replace it in Australian healthcare, I have made the case in why Australian healthcare needs to move beyond DEI training.

If your organisation is ready to move past the tick-box and toward training that changes how people actually communicate, book a free conversation with Culture Creek Australia. We’d love to talk.

References

1. Bennett, M. J. A Developmental Model of Intercultural Sensitivity (DMIS): ethnocentrism, the minimisation stage, and intercultural sensitivity as self-reflective meaning-making. ↩ ↩²

2. Dobbin, F. & Kalev, A. (2016). ‘Why Diversity Programs Fail.’ Harvard Business Review, July–August 2016 (analysis of three decades of data from 800+ US firms). Read it. ↩

3. Government Equalities Office / Behavioural Insights Team (2020). Unconscious Bias Training: An Assessment of the Evidence for Effectiveness. Read the UK Government statement. ↩