Critical Incidents for Intercultural Communication in Health Care

The Critical Incidents for Intercultural Communication in Health Care project developed a resource that will increase the intercultural communication competence of health professionals in culturally diverse healthcare contexts and teams. The resource will also support internationally graduated health-care professionals recruited to work and live in Alberta.

Immigration, global economics and skilled nursing shortages have made the demographic profiles of hospital patients and staff in Alberta increasingly diverse and have created complex work and care environments. In the current healthcare environment, the cultural diversity of patients and staff challenges professionals in the field, both Canadian-born and foreign-born, to develop more multifaceted communication skills than may have been necessary in the past. To this end, in a variety of health care contexts, intercultural competence is becoming an increasingly essential skill for health care practitioners and providers.

Lessons learned

The research from the project, while designed to produce a resource for health care professionals and educators, did highlight a number of different issues within the health care field, its multidisciplinary teams, the increasing levels of diversity, and the challenges clinicians are facing with limited or no supports. Firstly, the communication challenges which arise between Canadian-born medical professionals and foreign-born medical professionals stem from seemingly disparate values and the way these values are demonstrated in behaviours. These challenges are real, and are not being addressed to the fullest necessary extent in the health care system. Secondly, through the research for the Critical Incidents for Intercultural Communication in Health Care project, the literature review, the conferences, and the pilot sessions, it became clear that the discourses around increasing diversity in health care tend to be one-dimensional. With their overarching commitment to quality patient outcomes and safety, the health professions have largely focused their intercultural efforts on one dynamic - that of the clinician/patient relationship - overlooking, in many instances, the increasingly intercultural demands of the clinician/clinician relationship.

In addition, the clinician/patient relationship has largely been defined as North American-born and -trained medical professionals attending to patients of diverse ethno-cultural backgrounds, when the current reality that is facing medical professionals is much more complex. The stories collected for the project point to the increasing prevalence of internationally educated medical professionals in the Canadian health care system and how this results in not only a much more complex picture than that of the past, but also implications for their ongoing professional competencies. In addition to these findings of the research stage of the project, clinicians in many of the workshops concurred almost unanimously with this evaluation of their field, and reasserted the importance of both the clinician/patient and the clinician/clinician dynamics for delivering quality care, and improving patient satisfaction. In sum, the Critical Incidents for Intercultural Communication in Health Care resource contributes a small piece to a much larger and growing need - one that needs to be addressed intentionally, and soon.


Critical Incidents for Intercultural Communication in Health Care Facilitators Guide

The Facilitators guide helps instructors use the Critical Incidents effectively in health education and training contexts. The guide outlines the critical incident methodology, background information on intercultural communication, and how to use the critical incidents as a facilitator. The Guide also outlines how to use Critical Incidents with the Reflective Intercultural Learning Cycle and other approaches to facilitating the development of intercultural communication competence.

Critical Incidents

Critical Incidents are tools for increasing understanding of human attitudes, expectations, behaviours, and interactions. In intercultural training, critical incidents are brief descriptions of situations in which a misunderstanding, problem, or conflict arises due to the cultural differences or where there is a problem of cross-cultural adaptation and communication. The critical incidents in this collection were gathered from interviews with a diverse cross-section of medical professionals in Edmonton, Alberta, Canada.

Other project information
Project time frame January 2009 - March 2011
Project team
  • Jake Evans
  • Todd Odgers
  • Cheryl Whitelaw
Project funder Alberta Employment and Immigration
Key project activities
  • Research and development of stories to create critical incidents. This resulted in a final compilation of 18 critical incidents.
  • Research and development of train-the-trainer materials, which resulted in a facilitators guide to accompany the critical incidents.
  • Set up and implementation of pilots involving approximately Canadian and internationally educated health professionals. 10 sessions were provided to 231 internationally educated learners in nurse and health care professional education programs as well as Canadian and established immigrant nurse educators and health professionals.
  • Evaluation of pilots, including participant and stakeholder feedback and revision to the critical incidents, the facilitator guide, and facilitation techniques.
  • Mentorship and training of one new facilitator in use of the resource.
  • Revision and publication of Critical Incidents in Intercultural Communication for Health Care resource.
  • Reporting and dissemination of project results and a published resource, through two conferences, college and community networks, and online list-serves.
Target audience Health professionals and health educators in the Canadian healthcare system
Number of people involved in project 260 people including:
  • 3 project team members
  • 26 participants in interviews and development activities
  • 231 participants in resource pilots