Culture is like an iceberg, according to Sue Plaster, director of diversity for Fairview Health Services. Outward appearances, food, ethnic celebrations - the things most people associate with "culture" - represent only about 10 percent of the total picture, Plaster says.

"We teach employees to look for the 90 percent, what's underneath the surface," she says. "What does somebody value? What are the things that to them are the really important priorities and how do they think that life works?"

That may mean asking how a co-worker expresses respect. It could be by gesture or tone of voice, according to Plaster. "It's about bond-building between two people with the goal of better serving patients and better teaming with each other," she says.

Fairview has put this "bond-building" into action through a program in which trained employees of various cultures act as "benefits tutors" to help other employees navigate all aspects of employment in the system. "It really is a major way of demonstrating that someone cares about you there," Plaster says.

The importance of language

In the healthcare workplace, language is also paramount, according to Twanya Hood Hill, director of organizational development and learning at Hennepin County Medical Center. "We have so many employees who are recent immigrants," Hood Hill explains. "So what we have started to do is offer English language learners an on-site course free of charge where they can just learn more English."

Fairview has also offered English and accent improvement classes as well as workshops that help listeners decode and understand accented English.

Don't be shy

Workers shouldn't feel shy about asking an employee to repeat something, according to Plaster. "Look at how they do it at Starbucks," she says. "You're ordering a latte and they repeat your order two or three times to make sure they get it right. How much more important is it in a work setting like ours where you take care of people, to clarify, clarify, clarify?"

Hennepin counsels new employees on cultural diversity on their first day of work and regularly conducts brown-bag lunch sessions during which a representative of a particular culture talks about that culture. "The ability to be culturally competent is really key," Hood Hill says. "What we say is, `if you don't understand, at least show respect.'"

Faith matters, too

Sometimes a sticky cultural issue revolves around religious practice, Hood Hill says. When Muslim employees were using restrooms near the hospital's chapel for ritual foot-washing before prayer, the housecleaning staff was having difficulty keeping the floor clean and dry. The solution: Respectfully asking the Muslim employees to dry their feet and the floor after washing.

"What we ended up with was a solution that was far more respectful of the culture - welcoming of the community, but also respectful to the fact that we need to maintain a safe environment," Hood Hill says. "I think the solution was a really good one."