Social determinants of health, such as working and living conditions and quality health care access, aren’t the same for everyone. Health inequities pose a serious challenge to the healthcare community, but healthcare providers have a powerful tool at their disposal: cultural competence. Cultural competence in health care addresses the disparities that people of racially and culturally diverse backgrounds often experience. It can ensure all patients get the care they need to live healthier lives.
Improving health equity and diversity facilitates better patient satisfaction and more favorable health outcomes. An Online Master of Health Administration degree (MHA) can provide the essential skills required to promote cultural competence in health care.
What Is Cultural Competence in Health Care?
Cultural competence in health care means delivering effective, quality care to patients who have diverse beliefs, attitudes, values, and backgrounds. This practice requires systems that can personalize health care according to cultural and linguistic differences. It also requires understanding the potential impact that cultural differences can have on healthcare delivery.
For example, race, socioeconomics, health literacy, and other factors can influence:
- How patients perceive symptoms and health conditions
- When and how patients seek care
- Patients’ expectations of care
- Patients’ preferences regarding procedures or treatments
- Patients’ willingness to follow doctor recommendations or treatment plans
- Who patients believe should participate in making healthcare decisions
- Patients’ ability to access care and resources
While cultural competence in health care initially referred to meeting the needs of people from distinctive ethnic and racial groups, it now also refers to meeting the needs of people with disabilities, those from diverse socioeconomic backgrounds, and members of the LGBTQIA+ community.
The Need for Cultural Competence in Health Care
Differences between healthcare providers and patients can affect communication. This can, in turn, impact both clinicians’ and patients’ decisions regarding treatment. For example, a clinician may misinterpret a patient’s silence as a lack of interest in receiving care. As a result, the clinician may not order a diagnostic test, when in fact the patient’s response reflected their notion of respectful behavior.
When healthcare providers fail to recognize the differences between them and their patients, they may inadvertently deliver lower-quality care. Cultivating skills that improve cross-cultural communication can play an important role in delivering equitable care.
Additionally, building teams with healthcare professionals who reflect the diversity of the patient populations served can also improve cross-cultural communication. Diverse teams have a wider cultural knowledge base that they can share with one another. This makes them likely to respond with empathy to the unique cultural needs of patients.
Language accessibility is also key. Language barriers can complicate communication between patients and providers, affecting the accuracy of a patient’s description of their symptoms or the provider’s explanation of diagnoses. Language barriers can also create unsafe and inappropriate situations in other ways.
For instance, clinicians may rely on children to serve as interpreters, putting young people in the position of telling a parent they have cancer. As another example, clinicians may rely on abusive spouses to interpret for the partners. Both situations pose significant problems.
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Why Does Cultural Diversity in Health Care Matter?
Numerous factors influence patients’ trust in their healthcare providers. Trust can be defined as the collection of patients’ expectations of, as well as their assuredness and confidence in, their doctors, nurses, surgeons, and other members of their healthcare teams. Cultural diversity in health care promotes health equity by acknowledging and representing as many populations as possible.
According to the Association of American Medical Colleges, there is ample evidence to suggest that patients in minority populations who are treated by doctors of the same race have statistically better outcomes than those treated by doctors of a different race. For example, Black patients fare better when they are treated by Black doctors. When patients feel as if their cultures and values are appreciated and understood, they develop more trust in their providers.
Creating more cultural diversity in health care improves the patient experience, as well. This is evident in patient satisfaction surveys. Patients asked to rate the care they receive from their doctors give doctors of the same racial and ethnic background significantly higher scores.
Combining Cultural Competence with Cultural Humility
Healthcare providers strive to develop a multicultural orientation to deliver culturally sensitive care and improve communication. However, even when healthcare professionals have a meaningful understanding of a culture, they still can’t predict the behaviors and attitudes of their patients simply based on their cultural backgrounds. That’s because people are unique, and their behavior and beliefs might not always reflect those of their cultures.
Given this, healthcare professionals must focus on building cultural competence and cultural humility. Cultural humility recognizes the limits of people’s knowledge of others. It also acknowledges that even people who have cultivated their cultural awareness can still have unintentional, unconscious biases about cultures other than their own.
Cultural humility involves an ongoing process of self-evaluation. Through exploration of and reflecting on their own beliefs and behaviors, healthcare professionals can improve their awareness of implicit biases and foster an approach to patients characterized by openness and curiosity about each new patient.
Goals of Cultural Competence in Health Care
Cultural competence aims to break down barriers that get in the way of patients receiving the care they need. It also strives to ensure improved understanding between patients and their providers.
The growing diversity in the U.S. population demands that the healthcare community expand its ability to address patient needs. Cultural competence offers a pathway and a framework to reach the goal of better health for all patients.
Culturally and linguistically appropriate services, or CLAS, respond to the individual preferences and needs of each patient. They also help improve health outcomes and decrease health disparities. According to the U.S. Department of Health and Human Services Office of Minority Health, the principal standard of CLAS involves delivering equitable care that is effective, understandable, and respectful.
Importance of Cultural Competence in Health Care
Cultural competence significantly benefits healthcare organizations and patients alike. It results in more patient participation and engagement, fostering respect and improved understanding, which can lead to:
- Increased patient safety
- Reduced inefficiencies
- Reduced care disparities
- Decreased costs
Improved Patient Outcomes
Cultural competence improves communication, which keeps patients safer. Clear communication allows healthcare providers to collect accurate medical information. It also encourages active dialogues in which patients and providers can ask questions, correct misunderstandings, and build trust.
Studies have shown that the absence of culturally competent care can lead to preventable mistakes and adverse events.
For example, a 2023 article published by BMC Medical Education noted that LGBTQIA+ community members have experienced unfavorable outcomes and adverse events due to their health professionals’ lack of cultural competence. The researchers reviewed hundreds of articles and studies, and they found that changing health professionals’ confidence and preparedness through cultural competency training often resulted in statistically significant improvements in outcomes.
Improved Patient Experiences
Healthcare environments that show an awareness of and respect for differences create more satisfying experiences for patients. When providers adjust treatments to meet patient needs and preferences, patients notice, and their overall experience improves.
If a healthcare provider uses medical jargon unfamiliar to a patient or makes assumptions about a patient because they use public health insurance, the patient may feel frustrated. Conversely, if clinicians show nonjudgmental openness in response to differences, actively listen, and make efforts to verify patients have understood them, their patients are more likely to feel satisfied.
Cultural Competency Education in Medical and Nursing School
Per a 2024 publication in the ASRA Pain Medicine newsletter, cultural competence in health care requires more than simple acknowledgment to impact health outcomes. According to the article, true cultural competence must measurably reduce disparities and improve clinical outcomes throughout a variety of contexts.
Many modern healthcare training programs introduce cultural competency training in their schools and residencies in an effort to make healthcare more inclusive. It is an essential part of medical school, nursing, and health administration degree programs as well as post-secondary training programs for certified nursing assistants (CNA) and surgical technicians.
Doctors, nurses, and others who are introduced to cultural competency training during their education provide more effective care to diverse populations, especially in underrepresented communities.
Examples of Cultural Competence in Health Care
The following examples of cultural competence in health care illustrate how healthcare organizations address cultural differences when providing care, even when obstacles and differences in perspectives exist. Consider the following situations:
Navigating a Challenging Birth
A pregnant farm laborer from Mexico arrives at an emergency room in medical distress. Doctors discover the patient’s placenta has separated from the uterine wall, making an urgent C-section necessary. The patient responds “yes” to all questions, though it appears they have little understanding.
After the C-section, doctors admit the newborn to the NICU because the baby is premature and has respiratory distress syndrome. The patient, their husband, and their mother, all indigenous, speak Spanish and no English. Spanish-speaking staff members try to get a clear history about the mother and explain the baby’s condition to the family, but communication is a challenge.
As the baby’s condition becomes tenuous, the family wants to bring in a traditional healer to cleanse the baby of its illness.
Culturally Competent Responses
In this case, cultural competence in health care requires securing an interpreter who speaks the patient’s native language. Only then can the healthcare providers take a thorough medical history of the patient, learn about potential exposure to pesticides through their work, and give the patient the opportunity to fully understand the medical conditions of both the mother and the baby.
Additionally, with an interpreter in place, healthcare providers can explain their medical perspective and engage the patient and their family in a conversation to understand their cultural perspectives and preferences in receiving care. Such a conversation gives the family a chance to express its desire to bring a traditional healer, as well as any other desires or concerns.
Once the medical team has better information and back-and-forth communication, it can recommend culturally appropriate care and negotiate a plan of action that everyone agrees on.
Adapting to a New Patient Population
A local hospital experiences an influx of orthodox Jewish patients as a newly established Hasidic community nearby grows. The hospital staff has little knowledge of the customs or traditions of this growing segment of the facility’s patient population.
However, the staff has already encountered:
- Situations of patients refusing to eat
- Complaints that visitors who couldn’t use elevators on Jewish holidays lacked access to stairwells
- Confusing exchanges when members of the orthodox community refused to shake hands with healthcare providers of the opposite sex
Culturally Competent Responses
The hospital invites representatives from the Hasidic community to meet with administrators and staff members to openly discuss traditions and customs potentially relevant to their health care. The hospital also asks the community representatives to explain their community’s specific needs.
In this way, the hospital gets ideas and suggestions about established solutions the community already has for dealing with customs, such as not using electricity on Shabbat. The hospital also learns of other customs, such as no physical contact between members of different genders.
Based on the conversations, the hospital proposes policies and procedures that can better serve the needs of the Hasidic patient population. It then discusses those policies and procedures with the community representatives to ensure the proposals are appropriate.
Respecting a Patient’s Choices
A severely ill 80-year-old patient learns that one of their heart valves has stopped working. To survive, they need surgery to replace the valve. The patient has a history of excessive bleeding. This will require doctors to perform blood transfusions during the surgery.
The patient is a devout Jehovah’s Witness. According to their religious beliefs and interpretations, the Bible does not allow any type of blood transfusion, so the patient refuses the surgery.
Culturally Competent Responses
The patient’s medical team engages the patient, their family, and trusted members within the patient’s religious community in discussions about the nature of the surgery and the risk that the patient might not survive without it. After the patient gets all the information and seems to understand all the risks, the medical team respects their choice to forgo the operation.
Promoting Cultural Awareness in Health Care
Promoting cultural awareness in health care involves helping people understand, respect, and appreciate the differences in other cultures’ languages, customs, belief systems, and behaviors. All healthcare providers — including doctors, nurses, and surgeons — must be aware of their own cultural biases and be open to learning and understanding other cultures.
Culturally aware providers can develop effective treatments that embody their patients’ beliefs and values, resulting in better health equity. Healthcare organizations must create an inclusive, safe, and welcoming environment that attracts providers from diverse populations. Just as providers must be sensitive to their patients’ needs, organizations wishing to diversify must be sensitive to the needs of their staff.
Some of the best strategies for improving cultural awareness in health care involve educating healthcare professionals, facilitating cross-cultural communication, and promoting mutual respect by avoiding stereotypical assumptions.
How to Improve Cultural Competence in Health Care
To meet the needs of all patients, organizations must learn how to improve cultural competence in health care. They can begin by implementing strategies that develop and improve cultural competence among healthcare teams.
Promote Awareness and Education to Improve Cultural Competence in Health Care
Promoting awareness and education plays a key role in improving cultural competence in health care. To develop cultural competence, healthcare professionals, including clinicians and healthcare administrators, need to identify their beliefs and build an awareness of their culture. This gives them a basis to improve their cross-cultural awareness.
Cross-cultural awareness makes healthcare providers more open to unfamiliar attitudes, practices, or behaviors. It also improves collaboration with patients and helps them respond with flexibility. Benefits of cross-cultural awareness include:
- Improved rapport
- Tailored treatment plans
- Improved patient attendance and compliance
How can healthcare organizations best promote cross-cultural awareness and other skills needed for culturally competent health care?
Cultural Competence Training
Cultural competence training teaches healthcare providers intercultural communication skills and helps trainees respond to cultural differences with greater agility.
Additionally, cultural competence training can help organizations uncover organizational policies or practices that act as barriers to different communities. Then, they can adjust them to ensure they meet the needs of diverse patients.
Accessibility Leads to Improved Cultural Competence in Health Care
Cultural competence in health care demands accessibility. Accessibility means ensuring that language, culture, race, and other such factors don’t become barriers to patients receiving quality care. How can healthcare organizations make health care more accessible?
Build Knowledge About the Local Community
Healthcare organizations should learn about the populations they serve. Collecting and analyzing demographic data and sending targeted surveys to specific communities builds important knowledge about local communities, which puts them in a much better position to meet patient needs and ensure accessibility.
In this way, a hospital may learn it needs interpreters in Korean or Farsi, or it may discover a large segment of the population requires Halal dietary options for hospital stays.
Surveys and community engagement can uncover other key information that enables healthcare organizations to become more accessible. For instance, community engagement may clarify the need for staff members familiar with Nepalese culture or the need to bolster a diabetes outreach program.
Recruit and Retain Diverse Team Members
Recruiting and retaining team members who accurately reflect the populations they serve gives healthcare organizations a clear advantage in their efforts to deliver culturally competent health care.
When patients encounter team members who look like them, speak their language, and share their culture, they tend to feel more welcome. Healthcare providers who share cultural similarities with their patients often have a greater capacity to communicate with them, understand their perspectives, and anticipate their needs.
Diverse team members can also share their insights with their colleagues, deepening everyone’s capacity to deliver culturally competent care.
Barriers to Cultural Competence in Health Care
Promoting cultural competence can present challenges. Some of the barriers to cultural competence in health care include:
Adequate Knowledge of an Organization’s Cultural Competence
To successfully address cultural competence, healthcare organizations need to first gauge their current performance. This involves answering questions such as:
- Where does the organization fall short in providing language accessibility?
- Where do care disparities exist within the system?
Without knowing where disparities exist, leadership can’t properly channel its energy and resources.
As such, healthcare organizations that value cultural competence must collect data about their patients’ races, language preferences, sexual orientations, ethnicities, etc., as well as track disparities. Patient surveys can also offer insight into an organization’s level of cultural competence.
With the right information, healthcare organizations can target areas to improve.
As an example, data might reveal an organization serves a larger number of patients from the LGBTQIA+ community than previously realized. This allows leadership to make sure it has enough healthcare providers with specialized knowledge in LGBTQIA+ health care.
Putting Cultural Competence Into Action
To put cultural competence into action, healthcare organizations must create an institutional framework that:
- Demonstrates culturally competent practices
- Cultivates cross-cultural awareness and communication
- Maintains a diverse workforce
Cultural competence in health care demands an ongoing commitment and multi-pronged approach. Healthcare organizations must build an infrastructure that supports activities and protocols that ensure culturally competent practices.
Additionally, organizations must weather pushback from staff members who may perceive cultural competence as limited to racial and ethnic diversity and already consider themselves culturally competent. In such cases, healthcare organizations can implement educational programs that broaden definitions of cultural competence.
Limited Resources to Support Cultural Competence
Realizing cultural competence in health care takes resources. Organizations must invest time, money, and leadership into developing the infrastructure required to make meaningful improvements to their cultural competence.
This means budgeting for, among other things:
- Linguistically diverse materials
- Interpreters
- Cultural competence training
- Diverse staff recruitment programs
Prioritizing cultural competence requires an investment from the organization, but it ultimately leads to better patient outcomes.
Promote Cultural Competence in Health Care
Healthcare administrators have an instrumental role to play in promoting cultural competence in health care. Their expert knowledge in organizational behavior, financial management, and information systems and analysis empowers them to build the infrastructures needed to support culturally competent systems. Explore how Tulane University’s Online Master of Health Administration equips graduates with the skills needed to develop culturally competent systems capable of meeting the needs of diverse communities.
Gain the Expertise to Become a Healthcare Leader
Pursue Your MHA Online at Tulane University
Recommended Readings:
Patient-Centered Care: Definition and Examples
An Organizational Chart in Health Care Explained
What Is Quality Improvement in Health Care?
Sources:
American Association of Medical Colleges, “Do Black Patients Fare Better with Black Doctors?”
ASRA Pain Medicine News, “Embracing Diversity: The Adequacy and Importance of Cultural Competency Education in Medical School and Residency”
BMC Medical Education, “LGBTQ+ Cultural Competency Training for Health Professionals: A Systematic Review”
BMJ Open, “A Study of the Nature and Level of Trust Between Patients and Healthcare Providers, its Dimensions and Determinants: A Scoping Review Protocol”
County Health Rankings, “Cultural Competence Training for Health Care Professionals”
Diversity Resources, “Why Is Diversity Important in Healthcare?”
Every Nurse, “Seven Steps to Become a More Culturally Sensitive Nurse”
Medical News Today, “What Is Cultural Competency, and Why Is it Crucial to Healthcare?”
Psychology, Cultural Competence in Health Interventions
The Enlightened Mindset, “Cultural Awareness in Healthcare: Benefits, Challenges and Strategies for Improvement.”
U.S. Department of Health and Human Services, National Culturally and Linguistically Appropriate Services Standards
U.S. Department of Health and Human Services Office of Minority Health, The National CLAS Standards
U.S. Department of Health and Human Services, What Is CLAS?