Professional practice
for cultural safety
Organisational Leadership — Level 1 Foundation
Include cultural safety learning goals in appraisal and development plans of staff and peers. Use consistently culturally safe language in internal and external communications.
Cultural safety is not a training module to tick off — it is a living practice embedded in how organisations hire, develop, communicate and lead. This module asks you, as an organisational leader, to make cultural safety visible in your everyday professional practice.
Three things to understand
Foundational ideas underpinning this outcome
Three concepts underpin this learning outcome. Engage with each one before moving on.
Know the difference
| Concept | What it means | Who determines it |
|---|---|---|
| Cultural Awareness | Knowledge about Aboriginal and Torres Strait Islander histories, cultures and contexts | Self-assessed — can be achieved through training |
| Cultural Competence | Skills and behaviours for working effectively across cultural contexts | Often self or institutionally assessed |
| Cultural Safety | The outcome — whether a person feels safe in their cultural identity when engaging with services or workplaces | Determined solely by Aboriginal and Torres Strait Islander individuals, families and communities |
What does the research say?
Curtis et al. (2019) — International Journal for Equity in Health
This 2019 literature review makes the evidence-based case for why cultural safety — not cultural competency — is the right framework for achieving health equity. As an organisational leader, understanding this argument is what separates embedding cultural safety as a genuine professional expectation from treating it as a training exercise.
What they did
This was a literature review of 59 international articles on definitions of cultural competency and cultural safety, commissioned by the Medical Council of New Zealand. The authors — all from Te Kupenga Hauora Māori at the University of Auckland — conducted their analysis from an explicit Indigenous research positioning, drawing from Kaupapa Māori theoretical approaches. The review spans literature from the USA, Canada, Australia, New Zealand, Taiwan and Sweden, and includes direct consultation with Māori medical practitioners.
The paper argues that cultural competency — the dominant framework in most health system training — is insufficient and potentially counterproductive. The problem with cultural competency is not that it is wrong, but that it is misframed. Continue to the next page to explore the four specific problems the paper identifies with the cultural competency model.
The four problems with cultural competency
What the cultural competency framework gets wrong
Curtis et al. identify four specific problems with framing this work as "cultural competency". Each one points to why the framework needs to be reframed as cultural safety.
The proposed definition
Curtis et al. recommend a definition that reframes the work
From their literature review, the authors recommend a single definition of cultural safety designed to make the locus of responsibility — and the locus of judgement — explicit.
"Cultural safety requires healthcare professionals and their associated healthcare organisations to examine themselves and the potential impact of their own culture on clinical interactions and healthcare service delivery. This requires individual healthcare professionals and healthcare organisations to acknowledge and address their own biases, attitudes, assumptions, stereotypes, prejudices, structures and characteristics that may affect the quality of care provided. In doing so, cultural safety encompasses a focus on: institutional accountability and the quality of care as defined by the patient/consumer."
Two features worth noticing
First, the definition is explicit that cultural safety is something organisations — not just individuals — must examine and address. The locus of responsibility is institutional as well as personal.
Second, the quality of care is defined by the patient or consumer. This is the move that distinguishes cultural safety from awareness and competency: the practitioner does not get to declare their own care safe. That judgement belongs to the person receiving it.
What this means for organisations
Four implications — not just individual practice
If cultural safety must be examined at the organisational level — not just the individual — what does that actually require? The paper sets out four implications.
Post-reading questions
Apply the argument in your own organisational context
These questions ask you to apply and evaluate the Curtis et al. argument in your own organisational context. Expand each one, write your thoughts, then reveal the guidance.
Most Australian healthcare organisations currently operate somewhere on the cultural competency spectrum — and most lean toward the cultural awareness or cultural sensitivity end. Signs that your organisation is in cultural competency territory include: training that focuses on facts about Aboriginal and Torres Strait Islander history or customs; one-day workshops without ongoing accountability; a completion certificate that is treated as the endpoint. Signs of movement toward cultural safety: training that asks staff to examine their own biases and assumptions; accountability mechanisms tied to patient-defined outcomes; explicit acknowledgement that institutional racism is a structural issue requiring structural responses. The paper is useful here precisely because it gives you a vocabulary to diagnose where your organisation actually sits.
Most healthcare quality systems measure what is easy to measure — wait times, readmission rates, complaint volumes. Patient-defined cultural safety requires something harder: creating the conditions in which Aboriginal and Torres Strait Islander patients can genuinely say what safe care feels like for them, and building feedback loops that reach leadership. Practical starting points include co-designing patient experience surveys with Aboriginal and Torres Strait Islander community members; establishing community advisory groups with real decision-making power; and separating cultural safety feedback from general satisfaction scores so it has its own visibility and accountability. The critical question the paper poses is: if cultural safety is determined by patients, who in your organisation is listening?
This question is designed to make abstract theory concrete. The language audit activity in this module exists precisely because of what Curtis et al. document: language choices in organisational communications are not neutral — they signal which framework an organisation is actually operating in. "Working with diverse populations" signals a cultural competency frame. "Commitment to culturally safe practice as defined by Aboriginal and Torres Strait Islander peoples" signals a cultural safety frame. Most organisations use the former without realising they have made a choice. The goal of this outcome is to make that choice visible and deliberate — starting with you as a leader, and extending to the communications and systems your organisation produces.
This is the question that connects the evidence base directly back to the learning outcome. If institutional racism is the primary driver, then the leader's job is not just personal development — it is structural reform. That means examining the policies, hiring processes, communication standards, complaint mechanisms and accountability systems your organisation operates. Personal cultural safety learning goals are necessary but not sufficient. The paper's recommendation is that organisations — not just individuals — be held accountable for culturally safe care. As a leader, including cultural safety in your own development plan is the start. Asking what structural change you are accountable for is the continuation. This module is designed to move you from the first to the second.
Language audit
Review four real-world communication excerpts
Below are four excerpts from common healthcare organisational communications. For each one, identify any language that could be exclusionary or culturally unsafe — then suggest an alternative. Use the "Show guidance" button to compare your thinking.
Consider: "Indigenous patients" positions Aboriginal and Torres Strait Islander people only as recipients of care — not as potential colleagues, leaders or applicants themselves. "Diverse patient populations" can imply that non-Aboriginal patients are the default. A stronger framing acknowledges cultural safety as an organisational commitment, not just a patient interaction skill. For example: "We are committed to culturally safe practice for Aboriginal and Torres Strait Islander peoples and actively seek to increase the representation of First Nations staff at all levels."
Consider: Placing the burden of cultural education on the Aboriginal Health Liaison Officer — and only during NAIDOC Week — positions cultural safety as an event rather than an everyday practice. It can also labour Aboriginal staff with additional emotional and cultural work without recognition. A stronger approach embeds cultural safety into routine communications and distributes the responsibility for learning across the whole organisation, not just during designated calendar events.
Consider: The absence of any prompt for cultural safety learning goals sends the implicit message that cultural safety is not a professional expectation — it is optional. At Level 1, this outcome asks you to include cultural safety goals explicitly in your own and your direct reports' development plans. Adding a prompt such as: "Cultural safety learning goal: Describe one specific action you will take in the next 12 months to advance your cultural safety practice" changes the structural expectation.
Consider: "All types of patients" implies a default patient type from which others deviate. "Responsible adult" can carry paternalistic overtones, particularly for people whose family or community structures differ from a Western nuclear model. The interpreter framing may also inadvertently position language diversity as a problem to be managed. A more culturally safe framing centres the patient's preferences: "We want your visit to be comfortable and clear. You are welcome to bring a support person of your choosing. Please let us know if there is anything we can do to communicate more effectively with you."
Your responses are not saved or submitted. This exercise is for your own reflection.
Go deeper
Click each question to expand and record your thinking
These questions move from personal practice to organisational accountability. Expand each one and record your thinking.
Check your understanding
3 questions — no pass or fail, just reflection
Three short questions to help consolidate what you have read. There is no pass or fail — this is a chance to test your own understanding before you finish.
Module 1.2 complete
Professional Practice for Cultural Safety — Level 1 Foundation
Well done on completing 1.2
Cultural safety is a living practice, not a certificate. The Level 1 outcomes are intentionally personal and relational — what can you do right now, in your own sphere of influence?