A follower of my blog went to the ‘Suggest A Topic’ section of my website and posed this question: “As a program manager, and/or supervisor – how does one promote and enforce cultural humility and an inclusive workplace?”

This is a great question, and I appreciate the opportunity to address it.  It’s also a very BIG question—articles, chapters, and books have been written about both cultural humility and inclusivity in the workplace.  Given time constraints, I’ve taken the liberty of rewriting the question and dividing it into two more easily digestible posts, the second of which will appear next week.

Although I’d intuited what cultural humility might mean, in all honesty I hadn’t heard the term until this question was put to me.  This despite the fact that I went to a really good grad school.  Was I absent that day?  Was there an elective I didn’t elect?  Where was this crucial concept hiding, in the course curriculum?  While perplexed and slightly troubled that cultural humility hadn’t found its way into my social work lexicon, I assume I’m not alone.  So before delving into ways a supervisor or manager might promote cultural humility in the workplace, I’ll first explore what it is.

What is “cultural humility” (and what does it have to do with “cultural competence”)?

To practice cultural humility is to maintain a willingness to suspend what you know, or what you think you know, about a person based on generalizations about their culture.  Rather, what you learn about your clients’ culture stems from being open to what they themselves have determined is their personal expression of their heritage and culture, what I call their personal culture.

In a compelling YouTube video by Director Vivian Chavez, Melanie Tervalon, a physician and consultant, and Jann Murray-Garcia, a nursing professor at UC Davis, thoughtfully discuss the philosophy and function of cultural humility.  Here’s the URL:

They describe cultural humility as having ‘three dimensions.’

1)  Lifelong learning & critical self-reflection — to practice cultural humility is to understand that culture is, first and foremost, an expression of self and that the process of learning about each individuals’ culture is a lifelong endeavor, because no two individuals are the same; each individual is a complicated, multi-dimensional human being who can rightfully proclaim “My identity is rooted in my history… and I get to say who I am.”

2)  Recognizing and challenging power imbalances for respectful partnerships — while working to establish and maintain respect is essential in all healthy and productive relationships, the root of effective social work practice is in acknowledging and challenging the power imbalances inherent in our practitioner/client dynamics.

3)  Institutional accountability — organizations need to model these principles as well (from micro, to mezzo and macro practice)

This model incorporates and expands upon what some adherents view as the limitations of “cultural competence.”  Here is an excerpted passage from the video that illustrates a consequence derived from a reliance on cultural competence without cultural humility.

“An African American nurse is caring for a middle-aged Latino woman several hours after she’d had surgery.  A Latino physician, on a consult service, approached the bedside and, noting the moaning patient, commented to the nurse that the patient seemed to be in a great deal of post-operative pain.  The nurse summarily dismissed his perception, informing him that she took a course in nursing school in cross-cultural medicine, and knew that Hispanic patients over-express the pain that they are feeling.  The Latino physician had a difficult time influencing the perspective of this nurse, who focused on her self-proclaimed cultural expertise.”

The video goes on to point out that the Latino doctor might have been a resource for the nurse, but because of the nurse’s self-perception of cultural competence she did not grasp the opportunity to learn that was right in front of her.  She was not seeing her patient as a unique individual, but as a “Hispanic patient.”  Confident in her cultural competency training the nurse believed she knew all that she needed to know in order to make a critical call about the patient’s well being in that moment.  Sadly, this is not an uncommon belief.

Tervalon and Murray-Garcia cite an assumption among some who view their practice as culturally competent that they’ve “got it down”—that among providers, they are the expert and they know better than the consumer what the consumers’ experience is and needs are.  Nothing could be more arrogant or further from the truth.  Our clients are the experts on their lives, not their service providers.  This personal belief, which in practice I have held inviolable, is the single thing that had me realize that although I’d not heard the phrase cultural humility I was, in fact, practicing it.  Imperfectly, to be sure, but like I said—it’s a lifelong endeavor, the central tenet of which is a respect for the unique cultural experience of the individual and a commitment to learning that knows no end.

Cultural competence is a helpful starting point in the development of a caring, compassionate, and effective practice, but in light of a deepening understanding of cultural humility its limitations are revealed.  In the example of the Latina patient, what the nurse claims was “true” for Hispanics was not true for her.  If she’d had the opportunity to develop an understanding of the philosophy and practice of cultural humility it is likely she would have recognized what the Latino doctor suggested to her as an opportunity to learn.  As a result, she might not have been so quick to dismiss her patient’s pain.

NEXT WEEK:  Cultural Humility, Part II – Promoting Cultural Humility In the Workplace

Questions for Further Consideration

1)   What is the relationship between the practice of cultural humility and expressions of cultural pride?
2)   What experiences and qualities comprise your “personal culture?”

Additional Information On Cultural Humility

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 (May 1998)

http://muse.jhu.edu/journals/hpu/summary/v009/9.2.tervalon.html

Foundations For Community Health Workers, Berthold, Miller, Avila-Esparza (2009)