When professional and cultural identities collide: working in a multicultural health team in NZ
Supervisors:Dr Davinia Thornley
Today's world can be described as a globalised environment. Globalisation is the process of increased interconnectedness among countries and what makes globalization possible is the ever-increasing capacity for and efficiency of how people and things move and communicate, most notably in the areas of economics, politics, and culture (Stief, 2018). This could mean growth and prosperity for each country; however, this is not a reality and we find ourselves competing to attract the best and/or attract migrants to fill skill shortages within our own environments.
NZ has immediate and long-term skill shortages in many areas including health and social services and actively recruits migrants from overseas to fill these shortages (Immigration NZ, 2017). The Organisation for Economic Cooperation and Development (OECD) shows NZ has the highest proportion of migrant doctors in the OECD and one of the highest for nurses (Zurn & Dumont, 2008; Badkar, Callister & Didham 2008). The challenge for NZ is that it is competing with other countries in the OECD who are also recruiting for practitioners in health categories (Dumont, Zurn, 2007; Hawthorne, 2014; Cumming et al., 2014; Freeman-Greene, 2015; Gorman, 2012).
It is therefore in NZ's interest to not only attract but also retain quality skilled migrants in the health category for NZ's economic growth, stability, and for safety for those being served within the NZ health system. However, the overall retention rates for migrant health practitioners is less than optimal (Hawthorne, 2014; Cumming et al. 2014; Nana, Stokes, Molano & Dixon, 2013; Walker & Clendon, 2012; Callister, Badkar & Didham, 2008). Furthermore, it could be argued that NZ has the responsibility to assist migrant practitioners to understand the expectations and skills needed for working in a NZ health context, as well, to assist NZ practitioners on how to work with culturally diverse colleagues, to assist with overall retention.
NZ will continue to recruit health practitioners, and while it is important to acknowledge the policy of the current governing party, Labour, is to upskill and educate NZ citizens to fill some of these gaps (Labour, 2017), this is going to take time and will not address all shortages. Whereby NZ has traditionally recruited from countries with similar cultural values and professional identities, for example, United Kingdom (UK) and Europe (Phillips, 2015; Trlin & Watts, 2004), this is very different today. In 2014 for example top source countries for 'essential skills and 'skilled migrants' workers were Philippines, India, UK, Fiji, China, and South Africa (MBIE 2015). Most of these source countries do not share the same cultural values (House, 2004; Schwartz, 1992; Hofstede, 1980; Tompanaars, Hall, 1981) and thus have different expectations on how to interact and communicate in a social and professional capacity. Because of these value differences migrant practitioners may come with very different expectations of how to interact and communicate within a NZ health context, which could lead to difficulties around communication, safety, fulfilling legal obligations in health, interpreting policies, and colleague demotivation. It is therefore vital to determine how differences in cultural and professional identities create challenges and understand the adverse (and positive) effects of these on both NZ and migrant colleagues.
This research proposes to address the gap in current literature regarding the influences and resulting consequences of differing professional and cultural identities on communication and interaction in the culturally diverse health workforce in NZ.
• Identify values dimensions of power distance, individualism, communication context for NZ GPs to gain a point of reference for identifying host and migrant values gaps.
• Identify communication and value differences between NZ and migrant GPs and how these differences effect interaction between colleagues, and individual motivation.
• Identify how GPs define themselves as a professional, whether these are defined differently, and how they impact communication and interaction amongst GPs.
• Identify strategies used to overcome cultural and professional identity differences.
Two groups will take part in this research – Research Group 1 - 500 NZ GPs and Research Group 2 - up to 15 migrant GPs and up to 15 NZ GPs. Research Group 1, will act as the control group to measure current values and communication styles of GPs in NZ, will be a random sample and complete one anonymous questionnaire distributed electronically.
Research Group 2, is the main research group, and will be recruited through the researcher's networks, snowballing and advertising. Data collection from this group will include completing the same questionnaire as Research Group 1, as well as an in-depth interview. The researcher will know this group, because of face-to-face interviews, and therefore ethical considerations such as confidentiality and vulnerability of participants need to be addressed.
The study will use both quantitative and qualitative data collection. The quantitative data, the questionnaire, will be analysed using statistical analysis; collecting and exploring the data to discover the current underlying patterns and trends. It is proposed the qualitative data will be analysed using thematic analysis; identifying patterns of meaning across the datasets, coding and theme development.
It is hoped that the results and strategies identified by this research can then be used to inform orientation programmes to provide a framework to assist migrants GPs to integrate into the NZ workplace and assist NZ GPs to work effectively with migrant colleagues. Ultimately, it is anticipated that such a framework will directly improve retention rates in NZ for both migrant and NZ GPs and promote the safety of people being cared for by these practitioners.
Teaching and Tutoring:
Guest Lectures: School of Population Health – University of Auckland (2012, 2013, 2014)
Previous Lecturing: Unitec, Auckland – Bachelor of Communication – Event Management
Current Lecturing: Auckland Institute of Studies – Business Administration Programme: Cross-cultural Behaviour and Negotiation
2007 2nd Annual Internal Communication Summit – Cross cultural communication
2008 3rd Annual Internal Communication Summit – Creating a cross-cultural internal communications strategy
2010 37th NZOHNA Conference – Cultural Diversity in Health and Safety
2010 Advanced Negotiation (2 day training) Asia Business Forum Singapore Pte Ltd
2010 NZICA Wellington seminar- Cross-cultural perspectives and communication
2011 12th International Mental Health Conference, Australia – Culture and Cultural Competency training.
2011 VNT (Visiting Neurodevelopment Therapy Association) Conference 2011: Careful Connections – presenting *CALD -WDHB
2011 Auckland School Caretakers and High School Management Forum – Communicating Across Cultures
2012 Goodfellow Symposium 2012 – Culture and Cultural Competency
2012 TNP Seminar Series – Laws of Networking
2012 34th One Stop Update for the Accountant in Business – Art of negotiation; understanding key elements to help seal the deal
2012/3/4 University of Auckland, Therapeutic Communication Course guest lecturer – Communicating Across Cultures
2013/2015/2018 Administration for Schools Conference – Communicating with other cultures
2013/2014 Australasian Faculty of Musculoskeletal Medicine – Culture and Cultural Competency and Working with Migrant Patients (*CALD WDHB –½ day training)
2014 Excell Corporation seminars – Culture – how not to get lost in translation
2014 Stakeholder Communications and Community Engagement Forum – Chair 2014 – Tertiary Education Women's Leadership Summit – Chair
2015 Association of Dispensing Opticians of New Zealand (ADONZ) Conference Hamilton - Communicating Across Cultures
2007 to present CALD (Culturally and Linguistically Diverse) development team and trainer
2004 to present MBA Lecturer - Cross-cultural behaviour and Negotiation