High Costs of Poor Cultural Competency in Healthcare

Did you know that 18 percent of the U.S. population speaks a language other than English at home? The U.S. Census Bureau projects that by the year 2042 there will be no single ethnic or racial majority in the United States. By 2060, the Hispanic population is expected to more than double, the Asian population will double, the African American population will grow by more than 47 percent, and the non-Hispanic white population will be shrinking.

Research shows that a failure of the health care system to keep pace with the diverse cultural and linguistic preferences and needs of patients has contributed to widening disparities leading to increased medical errors, prolonged lengths of stay, avoidable hospitalizations, and over- and under-utilization of procedures. Per the Institute of Medicine report, Unequal Treatment, increased levels of cultural competency and enhanced patient-provider communication have the potential to improve the accuracy of diagnoses, prevent patient exposure to unnecessary diagnostic procedures, and enable providers to better obtain true informed consent. In addition, cultural competency training is known to improve the knowledge and attitudes of healthcare staff leading to greater patient satisfaction and quality scores, as well as fewer unnecessary hospital readmissions, all of which are increasingly associated with hospital reimbursement rates.

Equity of Care: A Toolkit for Eliminating Health Care Disparities

Equity of Care is a national collaborative partnership of The American Hospital Association, American College of Healthcare Executives, America’s Essential Hospitals, Association of American Medical Colleges, and Catholic Health Association of the United States for the purpose of eliminating health disparities. In January 2015, the group released Equity of Care: A Toolkit for Eliminating Health Care Disparities, which lists cultural competency training as one of three core areas needed for improvement. Within this area, the guide calls for:

• Making cultural competency training a mandatory part of orientation for all employees
• Including training on language services, family and community interactions, religious beliefs affecting healthcare, languages spoken by patients, and diverse health beliefs held by patient populations
• Continually assessing training to gauge success, while identifying opportunities for improvement

According to a report published by The Joint Commission, One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations, one of the challenges hospitals report is a lack of awareness among staff about the importance of cultural and language issues and how they affect patient care. To address this challenge and others, hospitals should provide training on a wide-variety of topics that include, but are not limited to:

• Changing populations of the U.S.
• Demographics of the organization’s patient populations
• Health disparities related to diverse populations
• Aspects of diverse cultures, such as languages, religions, spiritual practices, traditions, customs, beliefs, preferences and values
• How culture influences attitudes, behaviors and expectations related to health, medications, treatment regimens, healthcare, and healthcare providers
• Communication skills, such as teach-back, plain language, verbal and written instruction methods, interviewing, non-verbal communication and knowledge confirmation
• How and when to utilize interpreter services
• How to address confidentiality concerns
• How to meet diverse needs of patients with disabilities and/or cognitive or mental health impairments

Although staff need to be aware of common beliefs and practices of various cultural groups, it is important to avoid assumptions and stereotyping. Individual differences exist between groups and within them as well.

10 Areas To Consider During Care

Below are 10 aspects related to health, illness and death that vary among groups and individuals.

1. Illness Beliefs

• Is illness/health believed to be caused or controlled by God, spirits, supernatural forces, the environment, violations of rules or norms, mind/body imbalances, chance, hygiene, ritual practices or curses?

2. Consents

• What preferences exist for having others involved in the consent process?
• Who are the primary decision-makers?

3. Invasive Procedures

• Some cultures/religions may not accept invasive procedures.

4. Pain

• Are medications accepted?
• How is pain communicated? Some are reluctant to verbalize complaints, even for severe pain.

5. Visitors

• Some cultures feel strongly about having immediate and extended family, as well as community members, present around the clock. It can cause stress for the patient if asked to leave.

6. Terminal Illness

• May wish to include a spiritual or religious leader, family spokesperson or decision-maker in discussions.
• May prefer a doctor disclose prognosis to head of family who will determine whether to and when to tell the patient.
• May want to protect the patient from “bad news.” May believe negative thoughts could hasten death. Some cultures prefer to care for a person with terminal illness at home and are resistant to placement in a nursing home or other facility.

7. Dying Process

• What are beliefs about death and after-life?
• How do family members show grief and mourning?

8. Organ Donation

• Do religious beliefs prohibit organ donation?

9. Death—Special Needs

• Are rituals performed at the time of death or after death?
• How quickly will family members prefer the body be removed from the room? Some cultures prefer extended time with the body after death and others prefer immediate removal.
• Does a religious leader, minister, or priest need to be present?

10. Death—Body Care

• In some cultures and religious groups, a specific person is tasked with washing, preparing, and/or dressing the body after death.
• Some cultures prefer the face be covered immediately after death and others prohibit covering it.
• Religious protocols may require certain positioning of the body and rituals performed.
• Are autopsies accepted?

Final Thoughts

Cultural competence is an important component of health care delivery. There are many aspects of diverse cultures to consider when caring for various patient populations, especially for people with chronic conditions who frequently encounter the health care system. Cultural competency training can pave the way to better communication, greater patient satisfaction and ultimately improved patient outcomes. Want to learn more about bringing Cultural Competency and Social Determinants of Health training to your provider network?