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Cultural Competence in Healthcare: Why It’s Important & How to Build It

It’s important to build cultural competence in healthcare as providers begin to focus on health equity and value-based care, according to experts.

Healthcare is undergoing a seismic shift, with the role of public and population health playing a bigger role in patient care than ever before. Core to that role is the increased focus on health disparities, health equity, and cultural competence in healthcare.

According to the National Prevention Information Network, a project within the Centers for Disease Control & Prevention (CDC), cultural competency is essential for cross-cultural work.

“Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations,” NPIN says on its website.

“'Culture' refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. 'Competence' implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.”

The concept of cultural competency has become critical as the medical industry confronts issues of healthcare disparities and health inequities. Health disparities run the gamut from racial maternal health disparities to gender-based disparities to ones affecting people living in rural areas. There’s also data showing that ethnic minorities and non-White patients face more social determinants of health than White patients.

As medical organizations face dual imperatives to advance health equity and deliver value-based care, cultural competence comes front and center. Although closing health disparities and promoting health equity is a multi-faced and multi-stakeholder effort, cultural competence serves as a bedrock.

What are the principles of cultural competence?

Healthcare organizations that are culturally competent have a few different factors in common, NPIN says on its website. By and large, these organizations have a defined set of principles, a positive and bidirectional relationship with the communities they serve, and the ability to adapt their understanding of community culture across different organization initiatives.

“Cultural competence is the integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes used in appropriate cultural settings to increase the quality of services; thereby producing better outcomes,” according to NPIN, which added emphasis.

Key pillars of cultural competence can include:

  • Clear efforts to understand community needs
  • A broad definition of culture
  • Acknowledgement of language interpretation needs
  • Continued learning among organizational leaders
  • Cultural competency training for staff members and clinicians
  • Cultural competency ingrained in organizational policies

Importantly, cultural competency also includes linguistic competence, according to the Georgetown University National Center for Cultural Competence (NCCC).

“The capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse groups including persons of limited English proficiency, those who have low literacy skills or are not literate, individuals with disabilities, and those who are deaf or hard of hearing,” NCCC says on its website defining cultural competence.

Organizations that value cultural competence tend to measure it by looking at some key performance metrics. Improving cultural competence should help the organization design policies that lead to better KPIs, after all.

An organization looking to cut missed or late appointments will have to embody cultural competency to effectively address this issue, NPIN offered as an example. Missing an appointment goes beyond a patient being careless; that patient may not have been able to obtain childcare during the appointment or access transportation, for instance.

Having cultural competence means the organization is able to recognize those needs in a community and design new appointment policies that take those challenges into account.

How can cultural competence affect patient care?

When cultural competency is not a part of a healthcare organization’s DNA, it can have negative consequences for patient experience.

In 2017, researchers wrote in the journal Patient Experience that language and cultural barriers got in the way of a good healthcare experience for patients who are immigrants.

For providers, language barriers can make them uneasy in their interactions as they question whether they are communicating in an understandable way. And for patients, lack of cultural competence can make them reticent to seek care or engage deeply with a provider.

“They are hesitant to seek care from Western physicians due to the experience of stereotyping by physicians,” the researchers said. “Moreover, lack of cultural awareness by physicians also affects communication with their culturally sensitive immigrant patients.”

Immigrant patients are also reportedly reluctant to engage using digital or connected health technology. In some cultures, a face-to-face encounter is the only appropriate strategy for seeking medical care. Immigrants largely do not like to engage via telehealth or secure messaging, the researchers found.

A 2018 study published in the Journal of Medical Internet Research found more of the same, revealing that cultural and language barriers keep patients and providers from forging meaningful relationships.

Through qualitative interviews of 19 patients speaking English, Spanish, or Mien, the researchers identified key trends that both build up and detract from the patient experience.

Although all of the study participants said they value a good patient-provider relationship and defined good relationships as including active listening and confidence, Spanish- and Mien-speaking patients reported some barriers.

“For the Spanish-speaking and Mien-speaking patients, speaking a language other than English added another layer of complexity and difficulty regarding basic interaction with doctors and staff, as well as interaction with residents specifically,” the team reported. “Patients described a general concern as to whether doctors and patients fully understood each other when having to work through an interpreter.”

Some clinician behavior helped. Clinicians who emphasized tone, used non-verbal cues, and attempted to speak the patient’s native language were viewed favorably during the study.

Nevertheless, these challenges are making it harder for some populations to achieve wellness. A concerted effort to build cultural competence at an organization level will be important as the nation continues to strive toward better population health.

Steps to achieving cultural competence

The first step to building cultural competence at a healthcare organization is to understand community health needs, the American Hospital Association reported in a playbook on the subject.

“The hospital or health care system analyzes demographic data to determine the composition of the local community and the hospital's patient population,” AHA wrote. “With this analysis, the hospital or care system can conduct microtargeting surveys to determine needs for the specific communities.”

From there, healthcare providers can engage with the community and then drive self-education of clinicians and staff members.

That provider education process will likely occur in stages, AHA advised. Organizations may start by outlining why providers need to build cultural competence. This process may include explanations about the changing demographics in the US and the risks associated with low cultural competence.

From there, organizations may review with providers how cultural competence shapes the way the organization will interact with society and with individual patients.

The final leg of provider education should include an outline of specific needs for certain demographics and lessons about cultural norms and sensitivity.

Importantly, a healthcare organization will need to embed cultural competence into its organization policies, NCCC asserted. In fact, this may be the most underdeveloped area of building cultural competence, the Center asserted.

Embedding these principles into organization policy will codify the organization’s mission and values; support providers striving for cultural competence in their own practice; set a metric to measure cultural competence in practitioners; and overarchingly institutionalize cultural competence.

Additionally, healthcare organizations may consider how they and their individual providers and staff members will self-assess, NCCC said. Per the self-assessments NCCC offers, the self-check should look at both cultural competence as a whole principle and at specific aspects of it, like linguistic competence.

Cultural competence is not a standardized medical skill; instead, cultural competence, by definition, is contextualized to the community an organization or clinician serves.

As the healthcare industry continues to see the outcomes of limited cultural competence, it will be essential for organizational leadership to create a plan to assess cultural competence at their organization and make a plan to educate staff members and codify that competence into policy.

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