Cultural competency – “the ability to interact effectively with people of different cultures” – plays a critical role in ensuring that patients who are members of minority groups receive equal access to care. It’s an ideal providers should strive for, but often find difficult to achieve.
“There is strength in diversity, but there are also challenges,” explains Dr. Joseph Betancourt, Director of the Disparities Solution Center. "Research shows that if you have two patients in an emergency room where everything is identical…but they are just different races, the minority patient will receive a lower quality of care."
"Often,” Dr. Betancourt notes, “it is due to communication challenges."
Author Olympia Duhart, whose scholarship includes wok with “historically underserved populations, from Hurricane Katrina survivors to veterans with post-traumatic stress disorder (PTSD)” agrees. In a 2017 piece for the Harvard Business Review, Duhart provides a number of takeaways for healthcare organizations seeking to improve their cultural competency, including:
1. Recruiting and Training a Diverse Workforce
“Minority health care professionals are more likely to understand the needs of minority populations,” notes RJ Castillo in A Framework for Cultural Competence in Health Care Organizations. The idea that “providers should look like their patients” isn’t a new one, but it’s a goal that’s proved to be easier stated than achieved. Healthcare leaders looking to boost cultural competency should consider proactively recruiting from the local communities they serve, increasing the odds that shared experiences will improve understanding and communication.
2. Providing Cultural Competency Training
Duhart’s HBR piece recommends that all healthcare staff receive cultural competency training to help “reshape attitudes, beliefs, and practices in an organization to improve the delivery of services that meet the social, cultural, and linguistic needs of patients.” In their guide, Cultural Competency in Health Care, health insurer Cigna suggests that training cover areas like:
- Language barriers
- Cultural beliefs and practices
- Medical biases, conscious and unconscious, towards specific groups
- Variations in care access and quality
- Low health literacy
- Social determinants, such as socioeconomic status, education, and/or physical environment
- Individual characteristics such as age, race, ethnicity, sexual orientation, gender identity/expression, and disability status
3. Teach Staff to Help Eliminate Language Barriers Using Qualified, Professional Interpreters and Translators
Duhart notes that “eliminating language barriers is a critical first step in treating patients” and recommends that hospitals:
Train staff to identify patients with limited English proficiency. Providers can easily spot patients who speak no English, but may overlook those who speak some English (but not enough to navigate a complex medical scenario). It’s important for staff to understand that, when in doubt, using an interpreter helps protects the patient from potential misunderstandings and the hospital from potential liability.
Recognize the potential dangers of using unqualified interpreters, including:
Patient family and friends, who may be eager to help but likely lack both the interpreter training and the objectivity to do the job reliably and effectively.
Bilingual providers, who may speak both languages well but fail to understand best practices for meaning-for-meaning interpretation.
Non-medical staff, whose lack of knowledge of medical terminology and procedures may prevent them from effectively interpreting.
(These recommendation aligns with Section 1557 of the Affordable Care Act, which mandates the use of qualified interpreters in healthcare settings.)
Provide written materials in the languages of the community. A quality language services provider can provide hospitals with their minutes of interpreter utilization, broken down by language. A high volume of interpreter use for a particular language likely means it’s time to translate intake paperwork, consent forms, and discharge instructions (and perhaps the hospital’s web site) into that language as well to better serve the local patient population.
Want to learn more about improving cultural competency with a great language services program? Learn how Florida’s Lee Health worked with CyraCom to do just that.