Tips for Working Cross-culturally in Health Care Settings and Beyond

Through my years of living, working, and communicating across cultural boundaries I’ve realized two things that sum it all up: one — this road is humbling and two – it’s a life-long learning process. Just when I think I have it all figured out, something, someone will come into my life and challenge my thinking and my well-worn tool box of ‘how to live and communicate across cultures’.

This is setting the stage for this post that is co-authored (though she doesn’t know it yet) by my cultural broker, colleague, and close friend Cathy. Cathy has taught me much about living and working across cultural boundaries. We have worked together to bring resources and workshops on culturally responsive, culturally competent care to health care providers in the Northeast for a number of years. Together we have come up with this list, compiled from a variety of sources. While we work primarily with health care providers, this list can be used in other situations.

So here’s our tool box for working and communicating across cultural boundaries:

  • Be aware of your cultural values and the beliefs you hold. This is a first and critical step to being able to effectively communicate across cultures. If you don’t understand the importance of culture — why you value what you do, how you make decisions, essentially how you live all of life, then it will be difficult for you to understand how culture affects others.
  • Become a student of the culture and the community. Even if you’re an expert in a certain area it’s important to rethink your role and be willing to learn as a student.
  • Recognize differences in narrative styles and practical behaviors across cultures. Be willing to research these differences and ask questions.
  • Understand that  limited language proficiency (whether your’s or another’s) does not mean limited intellectual ability. People with limited language skills are usually capable of communicating clearly and effectively in their native language.
  • Have a high tolerance of ambiguity.
  • Seek help from bilingual/bicultural co-workers and individuals – find those who can help explain cultural nuances, the complexity of culture, dual causality and more.
  • Know the role of interpreters and learn to use interpreters effectively.
  • Allow the use of story-telling and props when speaking with others – we learn so much more in a story than in a list of facts. For healthcare providers, realize the symptoms are often in the story.
  • Include the patient and family as partners in determining both treatment plan and outcomes.
  • Recognize the primary person you are working with may not be the decision maker in the family.
  • Use empathy, curiosity, and respect as you work across cultural boundaries. Empathic listening, curious questioning, respectful observing.
  • Be able to laugh at yourself and potential mistakes — if you don’t laugh you’ll find yourself crying way too much.

What would you add to this list? I would love to hear from you through the comments.  

Chive Boursin MuffinsThis week’s muffins are a delicious savoury mixture of chives and goat cheese. Stacy says this: “I used goats’ cheese with herbs and garlic to complement the chives.  Delicious!  This one will be a surprise to those who think muffins can only be sweet.”

For Chive Boursin Muffins head here.

14 thoughts on “Tips for Working Cross-culturally in Health Care Settings and Beyond

  1. It was helpful reading through your list. I would put at least 5 exclamation points after “Have a high tolerance of ambiguity”, however. (I write this as we go through yet another long season of ambiguity, as opposed to the daily kinds we face!)

    I enjoyed clicking back to your discussion on being capable of complexity. I’ve hoped to read Mountains beyond Mountains before, but it’s always checked out of the library. Your reminder just took me over to the library website, and now it’s waiting for me to pick it up! :)

    I think I would also add something about being prepared to shed your independence and live in community. This is true in so many ways, both with other expatriates (teams and missionary communities), as well as national neighbors and co-workers who enter more deeply into your lives than most of your extended family. In our season of waiting in the US, I find that life in community is what I miss the most.


    1. I’m so sorry I missed this comment! I agree with the exclamation points. This was the thing we stressed the most when we would orient students to living overseas. You will love Mountains Beyond Mountains – interesting story and tremendous wisdom in the pages. I like that you add the community piece – we don’t realize how culturally bound we are to the high view of independence in the west until we are living in community and have to give up ‘self’ — now there’s a blog post! Thanks for weighing in and sorry for the delay in response!


  2. This is so important to anyone living outside of their own culture, Marilyn, but I am sure it becomes vital to health professionals. I learned quickly in Indonesia and Malaysia that folks there smile and laugh when they are nervous or uncomfortable so if a person didn’t know that, the reaction would seem odd in many circumstances. Also, no one likes to tell another person no, so an invitation will likely be accepted but then the invitee just doesn’t show up. They also don’t like to admit when they don’t understand something so you can’t listen to assurances from their mouths, you have to look into their eyes for confirmation. They also have a much greater sense of family responsibilities than most westerners, with older children often not marrying until their thirties because whatever money they earn goes back to the family to see the younger siblings though school. And this is just for starters. It is indeed humbling to study and be sensitive to local norms but the value of the friendships I’ve formed are worth every step toward understanding.


  3. I am always humbled (and still surprised!) when you say that you have learned anything at all from me because I see it SO differently. You have taught ME more about living and working cross-culturally than any other single person. Grateful am I, dear Golden Partner!


    1. Ahh! What a welcome comment on a dreary, discouraging day. Thank you! It’s mutual admiration for sure which is why it works so well I think. I’d love for you to meet my Hindi teacher. She lives in Belmont – moved 3 years ago. She said this when she was teaching us the Hindi word for neighbor “Here in Boston – I don’t think you need to know this word because no one knows their neighbors. But where I am from – this is very important….” felt so sadly true.


    1. Loved.loved that you shared this Dianne – thank you. I also was perusing your website today and so impressed with what I see. I’ve gone there before but to take an indepth look at your continual additions to the Cultural Detective products is amazing. This work is so critical – my hat is off to you for your work.


  4. Great list! My job puts me in cross cultural situations every day (which is why I love it), and I am constantly learning new things about the various cultures our office serves. Although the list is for working with patients, it also carries over to working with clients in the legal field.


    1. That makes so much sense (that it carries over) – I would love to hear some of your stories, some of the differences. And legal is the same as healthcare….the ramifications and outcomes can be lethal to the people involved if we don’t take culture into account. Thanks Jenni.


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