By Jill Schwab and Tom Hendrich
“Cultural competence” is an oft-cited, oft-misunderstood concept. Simply put, a culturally competent system recognizes the vast diversity in health beliefs and behaviors, disease prevalence and incidence, and treatment outcomes for different populations. Increasingly complex facets of diversity present an opportunity for medical schools and teaching hospitals to leverage cultural competence as a strategic opportunity to enhance clinical care.
A landmark study of cultural competence by Betancourt, et. Al., in 2003 included this definition:
A “culturally competent” health care system is one that “acknowledges and incorporates—at all levels—the importance of culture, assessment of cross-cultural relations, vigilance toward the dynamics that result from cultural differences, expansion of cultural knowledge, and adaptation of services to meet culturally unique needs.”
Why does cultural competence matter? Don’t physicians practice medicine by focusing on clinical data, the presentation of symptoms, the analysis of facts? Yes, but practicing medicine means interfacing with the whole person in context with family, community, culture, and heritage. Cultural competence takes individual and socio-cultural factors into account in patient care.
The picture will only become more complex. By 2050, estimates indicate 90 percent of US population growth will come from minorities. Minorities are now a majority in 48 of the largest 100 cities and in five states, including California, Florida, and Texas.
With this increasingly diverse population, we see great disparities in standards of care. When the standards of care are analyzed for whites and minorities, minorities receive lower-quality health care than whites–even when insurance, income, age, and severity of condition are comparable. Why do such disparities exist, especially when physicians do their best to provide the best standard of care for patients based upon their need and situation?
Answers may lie in common misunderstandings that develop when working with patients whose background, experience, and even language are different from the physician’s. Although we can accurately assess the needs of a patient when language is a barrier by using interpreter services, navigating cultural differences can be much more challenging. How do we work with patients whose culture is skeptical about traditional medicine? How do we navigate informed-consent issues? “Working with patients of different backgrounds” is perceived as race, religion, and culture, but cultural competence extends to broader cultural differences.
When we evaluate the potential cultural competence impact for a broad number of patients, it’s easy to understand why challenges exist in providing an equal standard of care for all. How can physicians better provide an equal standard of care for all patients regardless of cultural background?
Two ways: First, make a habit of noticing and inquiring about cultural differences. When we open our minds to perceiving things in new ways, we learn new ways that patients may perceive their worlds. Second, learn about the opportunities that cultural differences can present. Educational offerings exist for building cultural competence, and how physicians can best treat patients from cultural backgrounds that differ from their own.
Cultural Competence is recognized as a key component of high-quality care at Christiana Care Health System in Wilmington, Delaware. We have acted to incorporate cultural competence and inclusion into both employee education and operations. This includes making the importance of “being inclusive” a piece of the annual operating plan, and conducting a cultural competency “snapshot,” an assessment based on the AMA CAT evaluation tool. Educational programs have bolstered these efforts, raising awareness of and sensitivity to the types of differences, and how appropriately incorporating those differences into the plan of care can augment positive outcomes.