Why Cultural Intelligence Must Be a Core Competency in the NHS

Real Consequences of Cultural Misunderstanding

When the UK began recruiting nurses from the Philippines in the early 2000s, hospital managers quickly encountered a culture clash. In Filipino culture, it’s normal for family members to provide emotional and practical care at a patient’s bedside. This contrasted sharply with UK expectations, where nurses are responsible for most care tasks and families are often less involved in hospital settings.

Filipino nurses found UK families’ detachment shocking. British staff misread Filipino nurses’ reluctance to step in as laziness or poor work ethic. Morale dropped, and managers found themselves with a workforce they didn’t know how to lead.

This example is not unique. Over its 77-year history, the NHS has addressed surface-level diversity – language, dress, and customs – but it has yet to consistently tackle underlying cultural values and expectations. That’s where cultural intelligence (CQ) comes in.

What Is Cultural Intelligence?

Cultural intelligence goes beyond awareness and inclusion training. It’s the measurable capability to relate and work effectively across cultures. CQ is made up of four levels:

1. Attitude

The foundation of CQ is an openness to difference. NHS professionals must be willing to recognize that their way of working is just one of many. A culturally intelligent mindset says: What’s normal to me might be strange to someone else…and that’s okay.

2. Awareness

Once open to difference, staff must begin to observe how culture affects expectations and behavior. Is a colleague’s indirect communication evasive, or just culturally appropriate? Is a nurse avoiding eye contact out of disrespect, or because it’s considered polite in their culture?

Awareness means pausing to interpret behaviors through a broader lens.

3. Knowledge

This is where tools like Worldprism™ from Country Navigator become invaluable. Worldprism™ is a cultural profiling framework that analyzes key dimensions like communication style, approach to authority, risk, time, and problem-solving.

By comparing your profile with an individual, team, or national culture, you can identify specific differences that could cause friction or misunderstanding.

4. Skills

The final level is application. It’s about adjusting your communication and behavior to connect with others better. For instance, if you know a colleague is risk-averse, you tailor how you present a treatment option. If a doctor tends to communicate implicitly, you double-check that patients fully understand their diagnosis or care plan.

These adaptations are not just about empathy, they improve clarity, reduce errors, and lead to better patient outcomes.

Inclusion Is More Than Diversity

True inclusion means leveraging differences to make teams more effective, not just more diverse. For example:

• A risk-taking nurse may challenge outdated practices and innovate care delivery.
• A risk-avoiding colleague might ensure standards are met and safety is prioritized.
• A direct communicator is likely to ensure clarity in emergencies.
• An indirect communicator may excel at managing sensitive discussions with families.

Different cultural styles can complement each other if you have shared understanding and intentional collaboration.

Structured Approaches Work

Cultural intelligence isn’t guesswork. Two proven models help teams approach cultural difference with clarity and structure:

Worldprism’s 3R Framework

1. Relating – How we interact with people and teams

2. Regulating – How we interact with processes and structures

3. Reasoning – How we interact with problems and challenges

By exploring these categories of three dimensions each, teams can create shared norms, reduce conflict, and align expectations.

The second model aims to support application of culturally intelligent skills, supporting CultureFlex – the ability to adapt your style in an appropriate way.

ABCDE Adaptation Strategy

• A – Adapt: One person adjusts to another’s style. Common in patient care.
• B – Blend: Both parties move toward each other. Useful in long-term teams.
• C – Co-create: Teams collaboratively build a shared culture. Ideal for high-stakes collaboration.
• D – Deny: Ignoring cultural differences may be unavoidable in crisis but comes at a cost.
• E – Enforce: Leaders impose a specific approach. Sometimes necessary but requires strong communication and emotional intelligence.

Cultural Curiosity Is a Skill

Improving CQ requires developing the following:

• Listening with awareness: Recognizing your own cultural filters and interpreting others’ behavior through their lens.
• Critical thinking: Understanding that different thinking processes, for example, linear vs. circular, can reach equally valid conclusions.
• Tolerance for ambiguity: Being comfortable not having all the answers immediately.
• Humility: Acknowledging that “normal” is subjective, and your way isn’t always the best.

In one culture, eye contact signals trust; in another, it’s disrespectful. In the UK, it’s acceptable, even encouraged, for patients to challenge doctors. In others, the doctor’s word is final. These are not minor details. They shape everything from diagnosis to compliance to satisfaction.

The NHS Is Already Global

The NHS employs staff from 214 nationalities. That’s 21 more than the number of United Nations member states. And that’s just national culture. Age, religion, gender, profession, and socio-economic background also shape workplace expectations.

If every team in the NHS developed just a baseline level of cultural intelligence, the impact would be enormous:

• Faster decision-making
• More transparent accountability
• Higher staff engagement
• Improved patient communication
• Better care outcomes

Cultural intelligence isn’t a “nice to have.” It’s an operational necessity for an organization as large, diverse, and critical as the NHS. Cultural intelligence training through tools like Worldprism™ and Country Navigator provides measurable ways to improve collaboration, leadership, and patient care. For an NHS facing increasing pressure and growing diversity, CQ isn’t just a solution—it’s a strategic imperative.

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