Diversity Milestone 2 Cultural Competence in Healthcare
The population of the United States is extremely diverse. Many immigrants (both legal and illegal) come to America in search of the opportunities that America has to offer. These immigrants come from all over the world. They speak a wide range of languages and come from a diverse range of backgrounds. These are some of the most vulnerable members of American society, and many face healthcare inequity. Some people may lack formal education and rely entirely on their healthcare providers to make sound decisions. They have their own cultural beliefs and may be resistant to modern medicine. Healthcare providers and facilities have an obligation to be aware of these issues in order to improve the quality of care provided to all patients.
Cultural competence in health care refers to the ability to care for patients who have different values, beliefs, and behaviors. This includes adapting healthcare delivery to patients’ social, cultural, and linguistic needs (U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH), n.d.). The persistence of racial and ethnic disparities in health care access, quality, and outcomes has prompted a movement in health care to recognize and facilitate cultural competence.
Language and communication barriers can have an impact on the amount and quality of health care received (AHRQ, 2012). Approximately 60.5 million people, both foreign and native-born, spoke a language other than English at home in 2011. While the majority of these people could speak English fluently, approximately 25.1 million (41%) were considered to have limited English proficiency (U.S. Census,2013).
There is a legal obligation to provide language access in all federal program areas and activities, including health care (U.S. Department of Justice, 2015). Unfortunately, many healthcare providers are unaware of their responsibility, despite the federal right to language access for LEP patients in healthcare settings. Less than half (48 percent) of non-English speakers who needed an interpreter during a health care visit said they always or usually had one (Collins et al., 2002). When LEP patients are not provided with competent translators, they are severely disadvantaged. Communication issues are the most common root cause of serious adverse events reported to the Joint Commission’s Sentinel Event Database (AHRQ, 2012). Language barriers also contribute to patient dissatisfaction, poor comprehension and adherence, and overall poorer care quality.
LEP contributes to and exacerbates the negative health effects of low health literacy (Chen, Youdelman, & Brooks, 2007). According to Healthy People 2010, low health literacy is “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services for appropriate health decisions” (U.S. Department of Health and Human Services, 2000). According to the National Assessment of Adult Literacy, only 12% of adults have Proficient health literacy. To put it another way, nearly nine out of ten adults may lack the knowledge and skills required to manage their health and prevent disease (National Center for Education Statistics, 2006). Lower literacy rates are more common among racial and ethnic minorities. This is frequently due to cultural and linguistic barriers, as well as disparities in educational opportunities (HHS, n.d.). Choosing a healthy lifestyle, knowing how to seek medical care, and utilizing preventive measures all necessitate people understanding and properly applying health information. When information is not provided in a way that patients can understand, they are put at greater risk. It may impair a patient’s ability to read and comprehend prescription bottle instructions, health educational materials, and insurance forms.
People with low health literacy use more services designed to treat disease complications and use fewer services designed to prevent complications (Collins et al., 2012). As a result, these patients have a higher rate of hospitalization and use of emergency services. This higher use is associated with higher healthcare costs. Additional healthcare expenditures are expected to cost $32 to $58 billion, representing a 3 to 6% increase (Collins et al., 2012).
Culture influences how people communicate, comprehend, and react to health information. Health organizations and practitioners must understand and apply diverse populations’ cultural beliefs, values, attitudes, traditions, language preferences, and health practices in order to achieve positive health outcomes. Understanding the background of the community and patient population, the impact of cultural influences on care delivery, and the skills required by clinicians and staff to meet the needs of their patient population are the first steps toward becoming culturally competent.
Teaching providers how to practice culturally competent health care is a critical component of implementing it. Many attempts have been made to develop curricula for educating providers on cultural competence. Several healthcare organizations have led the way in developing programs to improve cultural competence. Unfortunately, these initiatives have been fragmented, and no standardized curriculum for cultural competence has been developed (Brach & Fraser, 2002). This means that education is inconsistent and varies greatly.
There are national initiatives that recognize the importance of culture and language in the delivery of health care. The United States has established National Culturally Linguistic Appropriate Services (CLAS) standards. Health and Human Services Department (HHS, n.d.). They are as follows:
Providing patients with understandable and respectful care that is consistent with their cultural health beliefs and practices.
Recruitment, retention, and advancement of a diverse workforce that reflects the demographics of the service
Ensure that ALL employees continue to receive education and training in culturally and linguistically appropriate service.
At all points of contact, offer and provide language assistance services, including bilingual staff and interpreter services, to each patient with limited English proficiency. Interpretation services should not be provided by family or friends (except on request by the patient).
Provide easily accessible and understandable patient-related materials and post signage in the languages of commonly encountered community groups. HHS (U.S. Department of Health and Human Services), d.
For many people, the inability to communicate in English is the most significant barrier to obtaining health information and services. Health information should be communicated clearly in the recipient’s primary language, using words and examples that make the information understandable.
Organizational accreditation standards have been modified to include cultural competence. Medical schools, for example, must now teach students how to understand how people from various cultures perceive health and illness and respond to various symptoms, diseases, and treatments. Students must also be able to recognize and address racial and gender biases in themselves, others, and health care delivery (Institute of Medicine (U.S.) Committee, 2004).
Culturally competent healthcare services strive to provide the highest quality of care to all patients, regardless of race, ethnicity, or cultural background. Healthcare providers and institutions must recognize the benefits of cultural competence and collaborate to ensure that all Americans can understand and use health information and services. A culturally competent healthcare system can help improve health outcomes and care quality while also helping to eliminate racial and ethnic health disparities.
References
Agency for Research and Quality (AHRQ). (2012). Chapter 1: Background on Patient Safety and LEP Populations. AHRQ.gov, Rockville, MD, Retrieved April 22, 2018, from /professionals/systems/hospital/lepguide/lepguide1.html
Brach, C., & Fraser, I. (2002). Reducing Disparities through Culturally Competent Health Care: An Analysis of the Business Case. Quality Management in Health Care, 10(4), 15–28.
Chen, A. H., Youdelman, M. K., & Brooks, J. (2007). The Legal Framework for Language Access in Healthcare Settings: Title VI and Beyond. Journal of General Internal Medicine, 22(Suppl 2), 362–367. http://doi.org/10.1007/s11606-007-0366-2
Collins, K.S., Hughes, D. L., Doty, M. M., Ives, B. L. Edwards, J. N., & Tenney, K. (2002). Diverse communities, common concerns: Assessing health care quality for minority Americans. New York: The Commonwealth Fund
Health Research & Educational Trust. (2013). Becoming a culturally competent healthcare organization. Chicago, IL: Illinois. Health Research & Educational Trust. Retrieved March 23, 2018, from http://www.hpoe.org/becoming-culturally-competent
Institute of Medicine (U.S.) Committee. (2004). Institutional and Policy-Level Strategies for Increasing the Diversity of the U.S. Healthcare Workforce. Washington DC: National Academies Press (U.S.).
National Center for Education Statistics. (2006). The Health Literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy. Washington, DC: U.S. Department of Education.
Rasu, R. S., Bawa, W. A., Suminski, R., Snella, K., & Warady, B. (2015). Health Literacy Impact on National Healthcare Utilization and Expenditure. International Journal of Health Policy and Management, 4(11), 747–755. http://doi.org.ezproxy.snhu.edu/10.15171/ijhpm.2015.151
Tetine Sentell & Kathryn L. Braun (2012) Low Health Literacy, Limited English Proficiency, and Health Status in Asians, Latinos, and Other Racial/Ethnic Groups in California, Journal of Health Communication, 17:sup3, 82-99, DOI:10.1080/10810730.2012.712621
U.S. Census. (2013). Language Use in the United States: 2011. (PDF) Retrieved from https://www.census.gov/prod/2013pubs/acs-22.pdf
U.S. Department of Health and Human Services (HHS). (n.d.). CLAS Standards. Retrieved March 23, 2018, from https://www.thinkculturalhealth.hhs.gov/
U.S. Department of Health and Human Services (HHS). (n.d.) Office of Minority Health (OMH). Retrieved March 23, 2018, from https://minorityhealth.hhs.gov/
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Question 
1) Cultural competence and diversity are often considered to have the same meaning in healthcare facilities. What is the difference between these two terms and their applicability in terms of healthcare professionals in various healthcare settings?
Diversity Milestone 2 Cultural Competence in Healthcare
2) Explain the unique circumstances under which the ancestors of most Black/African American people arrived in the Americas. Why is it important for health service professionals to understand this history?
3) Is Hispanic a racial or ethnic category? Explain. How might this impact the status of the African/Black group, for example, in terms of whether it is the largest or second largest minority group?
4) List the racial categories based on the OMB classification in the United States. Explain the geographic origins of the people designated for each of the categories. Why is it important for health professionals to understand cultural differences among and between groups?
5) A physical therapy office in “Little Haiti” in Miami, Florida is closed due to lack of funds. All patients’ appointments are routed to a nearby hospital’s physical therapy department in which the predominant population served is Cuban. List and describe a minimum of some steps you believe the department has to take to meet the needs of the patients from a culturally competent perspective.