Underserved National Education Call
June 5, 2007
“Incorporating Cultural Competency in Practices to Transform
Healthcare for a Multi-Cultural Population”
Presenters: Gerard Shu Tangyie, MD, MPH; Pamela R. Emmons, RN, BSN
SASH Healthcare, Nashville, TN
The healthcare delivery system in the USA is described as “fundamentally broken” and “structurally complex”. Despite the technological advances that have been accomplished to improve the health status of its citizens, there is still a perceived lack of understanding about our interactions with one another because of inherent socio-geo-political barriers that characterize our ways of life.
Culture can be defined as the shared traditions, customs, beliefs, history, values, norms, and behaviors that provide a group with a framework for:
; Defining themselves individually and collectively
; Interpreting their reality and events
; Setting a psychological orientation toward life
Culture influences the healthcare provider’s behavior as well as the patient’s views on health, disease and approaches to disease management.
Barriers, ethics, sensitivity of the provider, assessments, facts, and encounters are some of the factors which influence the environment in which healthcare services are delivered.
Cultural Competence: “A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency or those professionals to work effectively in cross-cultural situations” (Cross et. al. 1991).
Linguistic Competence: Providing readily available, culturally appropriate oral and written language services to limited English proficiency (LEP) speakers through such means as bilingual/bi-cultural staff, trained medical interpreters,
and qualified translators.
Cultural and linguistic competence can increase behavioral awareness, develop communication skills to enhance the patient-provider relationships, improve outcomes, and decrease health disparities which negatively impact particularly ethnic and racial minorities.
It is a general misconception that the physicians and nurses are the only major players in providing healthcare services. This misconception excludes the other vital members of the healthcare team.
This is an opportunity to emphasize the important role of customer service in the healthcare delivery system.
Every member of the healthcare delivery system should play a vital role in providing cultural and linguistic appropriate services. Customer service is
the interaction between the provider of a service/commodity and the recipient of that service/ commodity.
This interaction can positively or negatively impact the quality of care on the healthcare continuum from the time of entrance of the client into the system until the time of exit. The client’s interaction will be through many service providers such as the receptionists, medical assistants, social workers, case managers, phlebotomists, medical imaging technicians, pharmacists, billing personnel, nurses, and the physicians to name a few.
Cultural competency and linguistic appropriateness at each of these encounters calls for recognition by the healthcare provider of the person as an individual with tradition, customs, beliefs, history, values, norms, and behaviors who deserves to be recognized as such and treated with respect and dignity.
Cultural imposition is the tendency of healthcare providers to impose their culture on patients that they perceive as being “different” (alien). This cultural imposition can be expressed verbally or non-verbally in many ways including but not limited to the following: by tone of voice, gossiping, violating HIPPA regulations, facial gestures, looking with an “evil eye”, body language, various forms of ignoring, stalling and “tune you out” etc.
The outcome of a negative interaction with the patient is manifold including: disdain of the services, failed communications, incorrect diagnosis, lack of compliance with treatments and follow up visits, adverse complications, poor outcomes, and perpetuation of the “fundamentally broken” and “structurally complex” healthcare system.
Incorporating cultural competency in practices to transform healthcare for a multi-cultural population is a gigantic undertaking that requires positive input at all levels of the healthcare delivery system, beginning from the policy makers through the institutional leadership to the providers and all support staff.
The physicians and the nurses who are the major healthcare providers should be strongly encouraged to undertake capacity building on cultural competency and linguistic appropriateness and serve as positive change agents in their institutions. By so doing, they will provide the leadership that is desperately needed in their various healthcare settings as well as providing feedback to the policy makers.