Cultural Safety in Health Tourism is Important

Excerpt of article published 03-Dec-20 by Stackpole & Associates

Cultural safety in health tourism may seem to be a bit of an anomaly, however cultural competence or cross-cultural sensitivity is extremely important in health tourism and medical travel. The ability of health and medical providers to put foreign consumers at ease is critical to communication, clinical outcomes, and to the reputation of those providers and of the destination itself.

Hofstede's cultural dimensions
Hofstede’s Cultural Dimensions

The concept of cultural safety emerged from nursing education in New Zealand and refers to the experience of a person or family from one culture encountering educators and/or providers from another culture. When the provision of health or medical care was exclusively a local phenomenon, cross-cultural competence and safety were required only in rare or highly selective circumstances. As international healthcare, health tourism and medical travel have grown, the importance of cross-cultural competence and cultural safety has taken on greater importance.

Health and medical providers are, of course, concerned about achieving the best possible outcomes in each of their treatments and interventions. Destinations that attract health and medical consumers from different cultures want to create loyalty and positive word-of-mouth among these traveling health consumers. Both goals are advanced by developing skills in and sensitivity to cultural safety.

An “unsafe” cultural practice is defined as anything which demeans or diminishes the cultural identity of a patient, person, or family. This could include objects, such as symbols or religious items, individual behaviors, such as physical or eye contact, gender insensitivity, or social practices, such as observing or not observing certain holidays or events. Cultural elements include, but are not restricted to, age or generation; gender; sexual orientation; occupation and socioeconomic status; ethnic origin or migrant experience; religious or spiritual beliefs; and/or physical or psychological ability. Unsafe cultural practice includes any action which diminishes, demeans, or disempowers the cultural identity and wellbeing of an individual.

Cultural safety, therefore, requires that destinations and providers consider the cultural contexts of patients and their families who receive care at their destination, or who may be visiting and seek or require care.

The Four Principles:

  1. Improve health status and well-being
  2. Improve the delivery of health services
  3. Appreciate the differences among the people who are being treated
  4. The power of health services to impact individuals and families.


The standards of cultural safety are met through constructive actions that recognise, respect, and nurture the unique cultural identity of patients and their families. Central to this effective practice is the recognition that safety is not determined by the provider or the destination, but rather by the patients, or their families. Compliance with, or adherence to, the standards of cultural safety can only be measured by carefully evaluating the experience of the patients themselves. It is here that a well-designed customer satisfaction measurement system is critical to ongoing operational improvements and brand loyalty.

Cultural Safety

An effective customer satisfaction measurement system not only includes the routine survey but also includes interviews, which attempt to secure insights about the experiences of the consumers/patients and their families. These interviews themselves can demonstrate cultural safety by being conducted in the individual’s dialect. Through these interviews with our customers/clients/consumers, we can better understand the opportunities to improve the cultural safety of the care we provide.


The principles and standards of cultural safety contribute to the development of measures, training and continuous quality improvement in healthcare services. The construction of a culturally safe environment begins with an assessment of existing cultural elements, which are integrated within the providers delivering services and the physical environment greeting the patients and consumers.

Training in cultural safety includes basic introductions to the cultures and customs of the consumers currently served or those whom you believe will be served. Beyond the basics, interactive exercises will help frontline staff to appreciate how their own biases impact the experience of those being served.

The final element of the system design is further measurement of both consumers (patients, clients, whatever you may call them) and the staff. Through reflective interactions based on the measurements of customer satisfaction, a deeper appreciation of cultural safety will develop among the staff, improving their skills and ability to put customers and patients at ease, ultimately improving healthcare experiences.

Also from the experts at Stackpole & Associates Inc. “Marketing for Health Tourism” by Laszlo Puczko & Irving Stackpole is available for pre-order now.

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