Increasing Diversity in the U.S.: The Importance of Cultural Competence in Healthcare
The United States of America has been a kaleidoscope of cultures for hundreds of years. This has never been more true than it is today, as people from every corner of the globe continue to seek out a life in the U.S., whether permanently or temporarily.
The multicultural makeup of the U.S.-especially in metropolitan areas-presents special challenges for medical professionals, whose job requires relating to patients on a very personal level.
In urban areas it is not unusual for a doctor to have a diverse patient lineup-seeing a patient in the morning who recently emigrated from the Philippines, a multi-generational family of Indian descent later in the afternoon, and a tourist from China in the evening might be a typical day for some in the healthcare profession. Even doctors and nurses who work in rural areas will inevitably encounter people of various ethnicities and cultural backgrounds in their careers, especially as the U.S. countryside continues to become more ethnically and racially diverse.
Sensitivity, compassion, understanding, and acceptance of patients with different values, beliefs, and behaviors are essential qualities for those who work in the medical arena.
Cultural competence is the ability of healthcare providers and organizations to meet the cultural, social, and linguistic needs of their patients. Below, we'll explore why cultural competence is so important for the effective delivery of quality healthcare, and we'll look at how a lack of cultural competence can lead to poor patient satisfaction and outcomes, and frustration for both patients and healthcare workers. We'll also look at some of the ways healthcare facilities can attain cultural competence through in-house training and education videos for nurses, doctors, and other healthcare workers.
Ethnicity, Race, Nationality, Heritage, Identity, and Culture-What's the Difference?
Before we move on, we feel it's important to define the differences between some commonly confused terms-ethnicity, race, nationality, culture, heritage, and identity. Let's briefly look at them individually.
Ethnicity - Often confused with race, ethnicity refers to learned behavior and customs, and embraces the traditions that are part of one's geographic region.
Race - Defining race has generated its fair share of disagreement and controversy over the years, and many scholars today agree that race is a social construct.1,2,3 The word race has been used to describe a person's biological features, including skin color and tone, eye color, hair color, and even a person's tendency toward certain genetic diseases. Race is generally thought of as something that cannot be fundamentally altered (e.g. skin color, eye color, etc.). Some definitions of race have been debunked altogether, such as the notion that a single characteristic, gene, or trait may separate all members of a so-called race from others.4 The sensitive subject of race has led many organizations to give people the opportunity to opt out of indicating their "race" (e.g. Caucasian, African American, Latino/Hispanic, etc.) on patient/consumer information forms. A good rule of thumb for healthcare workers is that, unless a patient identifies with a particular race, don't make assumptions.
Nationality - Most of the time nationality refers to a person's country of origin (i.e., where they were born), but this doesn't necessarily mean that a person identifies with that place. A person who was born in Germany but emigrated to Italy as a very young child may consider his nationality Italian-he may speak fluent Italian and identify closely with Italian culture.
Heritage - Generally, heritage refers to the traditions and beliefs of a particular group, which is often based on place (nationality); but, much like ethnicity, a person may not necessarily identify with their family's heritage.
Identity - Simply put, a person's identity is what they identify with, whether it's a particular country, religion, culture, etc.
Culture - So, what exactly is culture-the heart of our discussion on "cultural" competence? While definitions vary to some degree, we can generally think of culture as encompassing a person's learned beliefs, thoughts, and behaviors, their values, customs, and traditions, their communication style, their views on relationships, and the different ways they interact with others. Culture is shaped by many things, including race, ethnicity, nationality, heritage, socioeconomic status, education, and other factors. Together, all of these influences are described as sociocultural factors, and they all influence the way a person interacts with the world. A culturally competent healthcare professional or institution must take into account all of these aspects of an individual to achieve cultural competence.
All of the factors above help make up each person's unique identity. The world is more globalized than ever, today; a trend that will likely continue. This is why cultural competence is so important-in healthcare and beyond. Let's explore cultural competence and its benefits.
Cultural Competence in Healthcare: Why It Matters
Earlier we defined cultural competence as the ability of healthcare providers and organizations to meet the cultural, social, and linguistic needs of their patients. Respect is at the heart of cultural competence-patients who feel their healthcare providers respect their beliefs, customs, values, language, and traditions are more likely to communicate freely and honestly, which can, in turn, reduce disparities in healthcare and improve patient outcomes.
There is much progress yet to be made in ensuring that all patients are treated with equal respect and dignity. Poor communication between healthcare workers and patients can lead to greater health disparities and lower levels of satisfaction with healthcare.
In fact, the data show that disparities in healthcare and dissatisfaction are more pronounced among racial minorities. According to a report by the Agency for Healthcare Research and Quality (AHRQ), African Americans, Hispanics, and Asians received worse care and had worse access to care than their non-Hispanic White counterparts. The report also highlighted language barriers as a significant contributor to disparities in care. For example, patients who speak Spanish at home were more likely than patients who speak English at home to report poor communication with nurses.5
levels of partnership with doctors, in particular, are less likely than other minority groups to feel that their doctor understood and respected their values and beliefs; they were also more likely to report that their doctor looked down on them. 5These findings send a clear message about the importance of cultural sensitivity in healthcare. Let's look at the benefits of cultural competence and how healthcare workers can employ culturally sensitive practices.
Benefits of Cultural Competence
Cultural competence provides many benefits for healthcare professionals and healthcare organizations. Social benefits include increased mutual respect between healthcare workers and patients, increased trust, and promotion of patient responsibility and empowerment in their own healthcare.
When patients feel heard and understood by their healthcare providers, they are more likely to participate in preventive health care and less likely to miss health appointments. This can reduce medical errors and related legal costs for healthcare facilities, and it can improve health outcomes for patients. Ultimately, a culturally competent organization can help reduce health disparities among patient populations-still a common problem today.
Barriers to Cultural Competence
A lack of diversity in the healthcare workforce and its leadership is among the leading barriers to cultural competence, contributing to racial and ethnic disparities of care.6 Poorly designed care systems that fail to meet the needs of all patient populations, and poor communication between providers and patients of different racial, cultural, and ethnic backgrounds are additional barriers.
Steps to Achieving Cultural Competence
Maximizing diversity is the key to achieving organizational cultural competence. Organizations should:
Hire and promote minority healthcare workers.
Establish or strengthen existing programs aimed at minority leadership development.
Develop a system for community and patient feedback where individuals can express concerns about their care and treatment.
Gather information about patients' language preferences, and ensure that patients have access to healthcare workers, and/or an interpreter, who speak their language.
Provide patients with health education materials and forms in different languages.
Establish an interpreter services program in healthcare facilities where there are significant patient populations with limited proficiency in English.
Institute a program that detects medical errors resulting from language barriers and other communication disparities.
Monitor racial and ethnic disparities using data, and institute quality improvement initiatives where needed.
Collect data on race/ethnicity and language preferences in order to better understand patient needs and improve care.
Healthcare workers must be informed about the cultural factors that influence people's health beliefs and behaviors, and they must be provided with the tools they need to serve a multi-cultural patient community. This can be achieved through in-house training, case study review, live interactions with patients, role-playing, and training and continuing education healthcare videos. Staff should be periodically assessed based on established standards, and success rates can be tracked from patient satisfaction scores and with healthcare disparities data.
When healthcare workers at all levels of care are given the tools and training they need to become culturally competent, improved patient satisfaction and outcomes are the inevitable result.