Appreciating Cultural Differences to Improve Team Dynamics
Background
In an increasingly globalized world, our ability to communicate effectively across cultures is more crucial than ever. When working on diverse teams, understanding cultural differences in professionalism can be the key to building strong, respectful relationships. On the other hand, when teams do not proactively manage cultural diversity, they run the risk of negatively impacting workplace climate and patient safety.1 Therefore, it is important to understand how team members’ perspectives on workplace dynamics are influenced by the systems around which they were socialized. For instance, this is impacted by familial traditions, geographic cultural differences, structural barriers that constrain resources or opportunities, among other factors.
Communication
Communication styles vary widely across cultures, and these differences can significantly influence the way decisions are made, how messages are conveyed, and how respect is shown. In some cultures, which rely on hierarchical structures, decision-making is often top-down, and individuals not making these decisions may be less inclined to speak up and challenge decisions. Contrastingly, egalitarian cultures emphasize more collaborative decision-making, where input from all members is valued. In addition, the level of formality in communication can be affected based on the way organizations are structured, where some teams may rely on formal titles and interactions reflecting professional boundaries while others prefer addressing one another more casually to foster approachability and community. On a more personal level, some team members may communicate directly while others communicate more subtly, avoiding confrontation. However, these different communication styles can be misinterpreted as a result of one’s own communication preferences, often leading to conflict. Moreover, nonverbal cues, such as eye contact, hand gestures, and body language, play a significant role in communication and can often be misconstrued depending on one’s cultural background.
Moral Distress: When an individual knows the morally right decision, but is unable to make it due to other constraints–resources, systems, patient values.2
Ethical Dilemmas
In healthcare, ethical decisions are often influenced by cultural beliefs and practices, which can sometimes create tension between medical ethics and cultural norms. Understanding how cultural considerations affect ethical decision-making is essential for healthcare teams to offer compassionate, patient-centered care. Healthcare providers may face moral distress when cultural practices conflict with ethical obligations, such as patient confidentiality. For instance, some cultures may request that a patient's diagnosis or prognosis not be disclosed to them, creating tension with the principle of transparency and patient autonomy. Additionally, cultural and ethnic backgrounds can shape healthcare decisions, particularly regarding gender roles. In some cultures, a woman’s decision about contraception may depend more on her husband’s preferences than her own, limiting her autonomy in healthcare choices. Providers must respect cultural practices while ensuring the patient’s voice is heard, which can be challenging. Some patients, particularly women, may prefer to be seen by a healthcare provider of the same gender. If this preference is not met, patients may choose to forgo care. Understanding and respecting these preferences is important for providing culturally sensitive care.
Boundaries
The degree of separation between personal and professional life is a delicate balance that is heavily influenced by the sociocultural backgrounds of the parties involved.3,4 Healthcare providers display varying abilities to balance personal and professional relationships. It is often easier for them to develop healthy inter-professional relationships, than to develop a balanced provider-patient relationship.3 The reasons for this are varied and multiple, including the effect that blurring of the divide between professional and personal life may have on the healthcare provider’s ability to maintain ethical responsibilities. The provider often wonders what they can share, and how much. Similarly, patients often wonder about the appropriateness of sharing certain personal information.
Also, the rate of development of conversations–“friendly banter”–between two strangers is often proportional to the degree of commonality between them. For example, it is easier to continue conversations when two people have similar hobbies, food preferences, educational backgrounds, etc. Having similar backgrounds typically helps break the ice; the impact of this in dispelling the mistrust that certain individuals have in the healthcare system is significant. It has been shown that when such individuals encounter providers from similar backgrounds to them, they are more likely to jettison their mistrust.
Considerations and Solutions
The solution to this enigma is multidimensional in nature. It is important that everyone acknowledges diversity and how this may affect how we communicate, and how others may perceive our communications. To fully harness our interactions, participating in training focused on cultural humility/sensitivity and how to tackle communication challenges are usually helpful. Training focused on promoting active listening, and self-reflection have been found to be beneficial.3 Ultimately, there is a need to acknowledge, appreciate, and understand the diversity of perspectives that are encountered in a typical work environment, healthcare inclusive.
Standardized conflict resolution processes which would act as failsafe mechanisms should be instituted in the healthcare environment. In workplaces where it is practicable, individuals should be offered an opportunity to discuss how they communicate best, and how they want to receive feedback.
Additionally, encouragement of employee participation in policy development, promotion of inclusiveness, engagement in ice-breaking activities, and employee empowerment impacts communication outcomes significantly.4 When employees and other stakeholders are involved in creation and maintenance of workspace communication policies and expectations, they often comply better with set standards.
References
- Schmidt M, Steigenberger N, Berndtzon M, Uman T. Cultural diversity in health care teams: A systematic integrative review and research agenda. Health Care Manage Rev. 2023 Oct-Dec 01;48(4):311-322. doi: 10.1097/HMR.0000000000000379. Epub 2023 Aug 7. PMID: 37615941.
- Epstein, E.G., Delgado, S. Understanding and addressing moral distress. The Online Journal of Issues in Nursing. 30 Sept 2010.15:3(1).
- Musitia, P., Boga, M., Oluoch, D., Haaland, A., Nzinga, J., English, M., & Molyneux, S. (2022). Strengthening respectful communication with patients and colleagues in neonatal units—developing and evaluating a communication and emotional competence training for nurse managers in Kenya. Wellcome Open Research, 7.
- Nielsen, K., & Randall, R. (2012). The importance of employee participation and perceptions of changes in procedures in a teamworking intervention. Work & stress, 26(2), 91-111.