To analyse communication and cultural barriers within health services where English is a second or third language

New Zealand
Health and Medicine
To analyse communication and cultural barriers within health services where English is a second or third language featured image


During my study overseas, it became apparent that it didn’t matter where I travelled or what language was spoken when visiting the various Organisations, common barriers exist.

Many hospitals already recognise the disparities in health care delivery and have included ‘best practice’ tools that includes Cross-Cultural awareness training for all staff, however we need to recognise teaching hospitals have a high turnover of staff who may have a different working culture and English as a second language.

  • Cultural and communication barriers are over arching and errors are more likely to occur when language and cultural barriers exist between patient and their health-care provider and can contribute to an adverse event.
  • Some hospitals may treat very few patients from the minority groups so may not have issues around inequalities and therefore not believe it important to change its working culture or systems. Changing the attitude of hospitals will depend on their Risk Management Strategies and if it includes a patient that was ‘culturally at risk’.
  • My overseas travel reinforced the need for hospitals to include cultural safety mechanisms into their quality improvement and risk management policies.
  • The comparative study revealed common attributes of Indigenous people is, when communication or cultural barriers exist, patients will ‘vote with their feet’, this means a patient will walk out of the hospital without notifying medical staff. 

The terminology used in the Alice Springs Hospital is Take Own Leave (TOL) or Abscond. This is different to ‘Discharge against Medical Advice’. Discharge against medical advice’ is when a discussion takes place between medical staff and patient signs a form stating they take full responsibility for their health once they leave the hospital.

There are times when it is simply a life or death situation and operations are performed without a patient’s consent, but where the procedure/operation can be delayed until family can arrive, should be considered.

Reasons for communication barriers are complex. Addressing communication barriers should be an important component of an organisations risk management strategy and accreditation regulations.

For long-term sustainability in mainstream services, there needs to be more than the ‘cultural awareness’ programs.

The problem with cultural awareness today is staff lack cultural competency and the only way forward is to understand the past practices and develop cultural security policies and improve the health-care work culture.


Eileen Van Iersel

Eileen Van Iersel


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