What does it mean for health care providers to be culturally competent? You’ve probably heard something resembling this definition: Delivering care that respectfully meets patients’ social, cultural, linguistic, and religious/spiritual needs.
But what does cultural competence really
mean? That’s one of the topics we’ll discuss in our upcoming IHI Expedition: Improving Communication to Enhance Cultural Competency
(part of Passport to IHI Training
membership), which begins in March. Since what constitutes and influences culture can encompass so many things — including ethnicity and race, language, religion, sexual orientation, gender identity, socioeconomic background, age, immigrant status, and geography — maybe, for this post, it might be more helpful to talk about what cultural competence is not
Here are six myths we’ve encountered about cultural competence in health care:MYTH #1: You just need a good cultural competence seminar or training to become culturally competent.
It’s not a “one and done” kind of thing. It takes practice to shift how we think and how we process our perceptions of others. It takes time, for example, to learn how to ask questions in a way that allows people to share their perspectives as individuals.
Cultural competency begins first with learning about ourselves. What is my background? What are my beliefs? What assumptions — even well-meaning ones — do I have that might lead to misunderstandings or stereotyping? What preconceived ideas do I have about my own superiority to my patients — because of my education, income, status, etc. — that might unwittingly lead to arrogance and errors? Striving for cultural competency is a developmental process that is part of lifelong learning.MYTH #2: Cultural competence applies only to interactions with racial and ethnic minorities.
Have you ever heard someone say, “Our service area isn’t very diverse, so we don’t need to be culturally competent”? We often fail to recognize that every single person belongs to multiple cultural groups.
There is a tendency to focus on the external physical characteristics or those things that we can see or perceive, such as race and ethnicity, age, gender identity, and physical ability. However, our perceptions can be incorrect, and we will not understand what’s most important to patients until we make the effort to get to know them as an individuals.
We should also avoid assuming that people from what appear to be a homogeneous group or community are all the same. For example, someone’s first language might be English, but that doesn’t mean they can read the instructions for taking their new medication. A nurse may be part of the same ethnic group as her patient, but their generational difference might lead to her unintentionally cause offense if she automatically uses her patient’s first name without permission. MYTH #3: Being a person of color automatically means you’re culturally competent.
Don't automatically assume that persons from minority groups are culturally competent or are interested in becoming champions for these issues.
People of color are just as prone to stereotyping, making assumptions, or forgetting to treat people as individuals as anyone else. And people of color aren’t necessarily interested in this topic. Or they may be concerned about being pigeonholed. We shouldn’t leave the work of striving for cultural competence only to people of color. Health disparities affect our entire society. Our efforts should reflect that. MYTH #4: One person or team in an organization should be responsible for diversity and inclusion.
Designating an individual to oversee diversity and inclusion shouldn’t mean they’re the only person responsible. Just as people with “quality” or “patient safety” are not the only ones responsible for quality and safety in an organization, cultural competency should be part of every interaction with a patient or family. Regardless of whether one works in environmental services, as a parking attendant, as a security guard, or as CEO, every single person needs to treat patients with dignity and respect.MYTH #5: Cultural competence is too big to tackle.
It’s important to understand that striving for cultural competence doesn’t mean learning every single thing about every single culture. That would be impossible. Cultural competence is also not about political correctness or simply being more culturally sensitive.
Instead, it’s important to take a skills development approach. Build cultural competency by using fundamental communication skills so people have the right tools to communicate respectfully, effectively, and efficiently with others. If we look at the HCAHPS or CG-CAHPS survey questions, for example, we can really see the direct connection to cultural competency. Was everything explained in a way that the patient can understand? Was the patient treated with courtesy and respect?
These surveys are top of mind for most institutions, so work is likely already underway in our organizations to engage patients more effectively and respectfully. Learning how to ask open-ended questions, elicit patient and family perspectives, explain things (like discharge instructions) in clear ways, and check to ensure understanding helps improve the patient experience. Whatever we're doing to address language barriers, gaps in health literacy, and differences in communication styles contributes to developing cultural competence.MYTH #6: Addressing cultural competence is yet another thing I don’t have time for.
We’re already overwhelmed with having to think about patient safety, avoiding readmissions, population management, and improving patient satisfaction scores, etc., right?
But just as our work to improve our interactions with patients contributes to both better patient engagement and
cultural competency, it also helps us avoid errors and harm, reduces the likelihood of an unnecessary readmission, and increases our understanding of the people in our service population.
In other words, better cultural competence can help with all those other issues that are demanding your attention and help your organization achieve the Triple Aim.