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Cultural Competence in Healthcare: An Imperative, Not an Option

“The increasing diversity of the nation brings opportunities and challenges for health care providers, health care systems, and policy makers to create and deliver culturally competent services. Cultural competence is defined as the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients. A culturally competent health care system can help improve health outcomes and quality of care, and can contribute to the elimination of racial and ethnic health disparities.”

This conclusion, from a Georgetown University study entitled, “Cultural Competence in Health Care: Is it Important for People with Chronic Conditions,” well encapsulates the issue: Objectively, our nation is experiencing significant demographic change. Simply put, our country “looks” much different than it did 10, 20, or 30 years ago and will continue along its demographically diverse path, with such change dramatically evident to those of us who have been around for a while.

Healthcare in a Changing Society

Health care is invariably on the front lines of such change, with patients representing the full spectrum of America’s demography walking through providers’ front doors every day. It is axiomatic as well that virtually all the data and analyses line up together with the same conclusion as Georgetown University – “A culturally competent health care system can help improve health outcomes and quality of care, and can contribute to the elimination of racial and ethnic health disparities.”

The May 26, 2017 issue of Harvard Business Review is the latest to elide with the cultural competence consensus. Professor Olympia Duhart opines that to meet the health care needs of a diverse population, providers should embrace the benefits of cultural competence training.

Professor Duhart writes:

“This type of training is designed to reshape attitudes, beliefs, and practices in an organization to improve the delivery of services that meet the social, cultural, and linguistic needs of patients….

As medical professionals strive to improve health care delivery for patients, they should explore policies and practices that enhance treatment for people from different communities. Improved cultural competency enhances patient satisfaction and compliance. As care providers know, interpersonal interaction between the patient and the health care provider is an important factor in successful treatment. Greater intentionality around developing cultural competency can go a long way toward improving patient care and closing the gap between doctors and patients.”

Best Practices for Cultural Competence in Healthcare

Professor Duhart outlines three best practices as good starting places for providers on the road toward greater cultural awareness in health care. Her recommended practices are:

1.“Be creative and expansive about addressing language barriers. 

Eliminating language barriers is a critical first step in treating patients… Even the most thoughtful providers can jeopardize patient safety when language barriers make an initial assessment or diagnosis impossible. Doctors and nurses should also be aware of the special challenges that might arise when relying on medically inexperienced, bilingual family members or nonmedical staff to serve as interpreters; even people with good intentions can compromise health care delivery.

… Facilities should also pursue other steps to reduce the risk created by language barriers. First, commit to training all staff in identifying patients with limited English proficiency. Next, use plain language to communicate directives whenever possible. Additionally, employ models, drawings, and devices to demonstrate points. Finally, make sure bilingual health care information reflects the community in which you serve.

2.Be alert for, and responsive to, mental health challenges. 

When implicit bias and mental health challenges collide, it creates the perfect storm for misdiagnosis and serious health consequences.

… Access to proper care is often a challenge for the millions of Americans struggling with mental illness, but these hurdles are often more pronounced in communities of color. African-American, Hispanic, and Asian adults are nearly 35% less likely than their white counterparts to receive treatment for mental illness because of accessibility barriers.

3. Be mindful of stereotypes.

… Health care providers can minimize anxiety about negative stereotypes by engaging in explicit discussions about what can be done to ease patient stress, such as advising them to bring a friend with them to their appointment, or offering to write down complicated instructions. Even general changes can help, such as talking openly and up front with patients about the universal anxiety many of them feel about health care treatment, regardless of their background.”

The cultural awareness imperative will only accelerate. That is the objective conclusion from our population growth and demographics. Meeting the challenge of accommodating the many different people, languages, faiths, cultures, and national origins of America’s population is one of the core responsibilities of health care.

That challenge can be less daunting and more doable when providers are able to answer the question I pose to my Georgetown University School of Medicine students about working with culturally diverse patients: “What do you do?”

Answering this question confidently and knowingly when your patient looks differently, speaks differently, and acts culturally differently than you as the provider better enables the physician or nurse to do what she is trained to do – deliver quality health care, now with a substantial dose of cultural awareness to inform the process.

Read some of Bruce Adelson’s other blog posts to learn more about cultural awareness and developments in language access law, and be sure to contact us if you’re interested in improving your organization’s ability to work with diverse patient populations.

© Bruce L. Adelson, special for Bromberg.  2017 All Rights Reserved The material herein is educational and informational only.  No legal advice is intended or conveyed.

Bruce L. Adelson, Esq, CEO of Federal Compliance Consulting LLC is nationally recognized for his compliance expertise concerning many federal laws.  Mr. Adelson is a former U.S Department of Justice Civil Rights Division Senior Attorney. 

Mr. Adelson teaches cultural and civil rights awareness at Georgetown University School of Medicine in Washington, D.C.

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