Cultural competence: moving beyond sentiment

James Mason, Ph.D.
Executive director, culturally competent caregiving
Providence Health & Services, Oregon

A growing body of evidence confirms that understanding cultural differences not only is the right thing to do, it's the smart and necessary thing to do.

This is especially true in health care, where working within our patients’ cultural framework – their values, beliefs, language, customs or socioeconomic status – can mean the difference between life and death. The Joint Commission now requires hospitals to promote culturally competent care, and this year the Oregon Legislature passed a bill that allows medical boards to require cultural competence training as a licensing requirement.

Under health reform, many of Oregon's newly insured patients will be ethnic and racial minorities, and many more will be economically disadvantaged. Some may be disabled, elderly or from rural communities, and some will have non-mainstream beliefs around health and illness.

Federal reimbursement models are placing new emphasis on patient satisfaction, and health care is undergoing a dramatic shift toward managing patients’ overall health. Combine all these factors and patient-centered, culturally competent care becomes more important than ever.

So what exactly is cultural competence? It helps to understand some definitions:

  • Cultural awareness means acknowledging our differences without judgment.
  • Cultural sensitivity allows us to understand how culture shapes our patients' behaviors so we can adapt accordingly.
  • Cultural competence is a set of attitudes, practices, policies and structures designed to respect and accommodate diverse beliefs and values.

Health organizations, including Providence Health Plan, are promoting cultural competence not only because of the external forces noted above, but also because this purposeful approach brings the most benefit to our patients and members.

Acknowledging our patients' culture and belief systems helps to ease early access to care, increases treatment compliance and can prevent illness. Research on diabetes care, for example, found that patients who received interventions consistent with their values, beliefs and preferred way of getting information had significantly better outcomes than those who received standard interventions.

Health Care Chaplaincy offers a useful primer on specific religions and cultures – and how they influence behaviors in health care.

By understanding your patients – in all their diversity – not only will you improve your own cultural literacy and effectiveness, you'll improve the lives of your patients and, in some cases, your colleagues.

How to boost your diversity quotient

Asking questions related to a patient's culture, ethnicity, race, religion, economic status, sexual orientation or disability can be uncomfortable. Will the patient take offense? Will your intent be misunderstood? Because patients’ answers can unlock barriers, however, it's important to get past that discomfort. Here are some tips:

  • Openly acknowledge cultural differences.
  • Ask your patients to share their values and beliefs around health care.
  • Apologize up front and explain that if you say something wrong it's out of lack of understanding, not malice.
  • Level the power dynamic and allow your patients to teach you.
  • Build a “diversity Rolodex” of people you can turn to for cultural insights and advice.
  • Weave cultural competence into your practice's policies, behaviors and performance evaluations.