Recently, I was training leaders of a Veteran’s Administration hospital on a patient communication tool designed to help healthcare workers connect with both the hearts and minds of patients and their families. As I was speaking, a nurse leader who was having a kind of “ah ha” moment approached me and said, “If we added cultural competence to this communication approach, we would further strengthen our connection with patients and their families and improve care.”
And she was right. Cultural competence, or the awareness of another’s social and cultural needs, is at the core of connecting to patients.
Consumerism, Compliance and Cultural Competence
Improving care delivery and access is a top priority in healthcare today. Cultural, economic and linguistic barriers prevent large segments of our population from obtaining safe, high-quality care. At the same time, with the steady and strong push towards consumerism, patients are taking charge of their own health and demanding to receive care in non-traditional venues that fit their lifestyles.
Cultural competence can help us respond to both access and consumerism while providing best-in-class clinical care and outcomes. By embracing cultural competence, the medical community can open access to consumers with diverse values, beliefs and behaviors while meeting their social, economic and linguistic needs.
Acknowledging these socioeconomic influences can be the difference between access to care and thus optimal safety, clinical outcomes and quality care for underserved populations. It can also be the difference between a patient who engages in self-care or one who is non-compliant or neglects their health. That said, although the term “compliance” is common, it is a conventional term that is inconsistent with the importance of collaboration and narrative medicine. When communication is tailored to a patient’s specific requirements, they are better able to make appointments, describe their symptoms, engage in financial planning, communicate proactively with their care teams and manage their own health in the long term. In this age of healthcare consumerism, patient compliance is evolving to an era of shared decision-making and informed choices. Cultural competence is key to this progression.
Cultural competence (another term used in this area is cultural respect) builds a bridge to other cultures and turns the dial toward safe, effective care that is also compassionate, kind and respectful. When providers acknowledge and honor cultural preferences, patients are more likely to share their full story, thus revealing essential nuggets of wisdom about their health and the challenges they are facing.
Often when the medical community attempts to make a personal connection with patients, they expect patients to look through their lens, accept their approach to medicine and healing, and follow their rules of engagement. Clinicians must be sensitive to the patient’s perspective, their culture and their desired path to wellness. When providers understand these factors, they are positioned to co-create a safe, effective care plan that honors the patient’s beliefs and preferences. For most medical professionals that is why they entered healthcare – to provide the highest quality care that results in the best outcomes for people in their communities.
An Experience in Cultural Competence
Some years ago, I led a small nonprofit research institute, innovation laboratory and multispecialty group practice founded by three nurses on the principles of relationship-centered care (RCC). A key premise of that team’s model was cultural competence.
In the community where I lived at the time, a large Native American population and others from various cultures chose not to access the healthcare system due to the cultural barriers they faced. In response to these concerns, the team implemented new cultural competence processes to bridge the health system’s way of doing things with the community’s cultural needs. The goal was to increase access to the right care in the right place and at the right time, defined by consumers in collaboration with the Western healthcare system.
The research institute brought together and credentialed traditional Native American and Western-medicine-trained healers into a healthcare community using principles referred to as the circle process. A methodology of collaborative leadership and shared decision-making helped these two groups develop trusting relationships with each other and with the patients and families in their care. As this trust grew, patients who needed physical, mental health, addiction and other services crossed between Western and traditional healing models to receive care aligned with their beliefs and preferences. Integrating these two practices was not easy, but it was impactful as it opened new and safe avenues of care for the community.
Kee Straits, Ph.D., articulated the challenges of creating bridges to culturally competent care in her piece, “Native American Traditional Healing: Information and Ways to Collaborate for Western Medicine and Mental Health Providers.” Our research institute considered the following points outlined in the article when attempting to break down cultural barriers.
Meet patients where they are and not where we want them to be. Take the time to learn about the patient’s and family’s culture, and don’t assume everyone from the same culture has the same belief system. Recognize that there is a cultural connection between physical, mental, emotional and spiritual health. Be open to understanding healing and dying preferences, and work with the patient and family to integrate these choices into their overall care plan.
Be aware of power differentials that can create distrust for the medical community. The majority of doctors in the United States are male, white and affluent – but many patients are not. Some patients may hesitate to seek care because of this disparity. Also, when these same patients choose to see a provider, they may feel anxious about discussing their health and lifestyle for fear of being judged or misunderstood. When providers promote an open, non-judgmental atmosphere, it encourages patients to communicate freely, leading to optimal care.
Listen carefully to patients. Dr. William Osler once said, “Listen to your patient; he is telling you the diagnosis.” As humans, we are programmed to listen to respond. The real impact is when we listen to understand. To do so, we must expand our view, focus on establishing a connection with each patient and family and be open to learning new approaches that are also safe and effective.
Cultural Competence is a Leadership Choice
The role of leadership in cultural competence cannot be overstated. As a leader, how can you implement this essential component of care in your organization?
- Set a clear vision for care and identify cultural competence as a priority. Learn about your community, their cultural backgrounds, their traditions and where they seek care. Identify disparities and act to close the gap. Go beyond collecting market data. Rather, become part of the community by engaging and serving all members. As an example, many hospitals have partnered with faith-based institutions to broaden their reach in the community.
- Build a culturally competent care model that meets the needs of the entire community. If traditional healing makes sense for your community, engage traditional healers. If your community has a large non-English speaking population, communicate with this group using their native language. Some years ago in Chicago, access was improved dramatically when care was provided in a barbershop, a favorite gathering place for African American males in that area. It was an innovative and engaging program to meet people where they are.
- Create more ways for diverse members of your community to become part of your institution’s workforce. To open your employee pipeline, consider networking with diverse professional and alumni associations, advertising in culturally appropriate media outlets and partnering with community colleges and high schools.
- Develop Patient and Family Advisory Councils (PFACs) to actively engage diverse members of your community and do so with a commitment to leverage their wisdom. This must not be a “check the box” activity but an authentic relationship built on trust as part of the organization’s strategy to reach everyone.
The goal is to improve care and outcomes for everyone in the community. To do so we must embrace diversity by honoring and respecting all cultures. When each member of our healthcare teams delivers culturally competent care, we can profoundly improve safety, quality and access for all.
Thomas Dahlborg, MSHSM has more than 30 years of leadership experience with a focus on patient engagement, research, quality improvement and innovation. He is often sought as an advisor for creating Patient and Family Advisory Councils (PFACs), improving patient engagement and delivering compassionate care.