User:Wkinforocks/Cultural competence in healthcare

Cultural competence in health care refers to the ability for health care systems to demonstrate cultural competence toward patients with diverse values, beliefs, and behaviors. This process includes consideration of the individual social, cultural, and linguistic needs of patients for effective cross-cultural communication with their health care providers. The goal of cultural competence in health care is to reduce health disparities and to provide optimal care to patients regardless of of their race, ethnic background, native languages spoken, and religious or cultural beliefs. Cultural competency training is important in health care fields where human interaction is common, including medicine, nursing, allied health, mental health, social work, pharmacy, oral health, and public health fields.

The term cultural competence was first used by Terry L. Cross and colleagues in their 1989 monograph "Towards a Culturally Competent System of Care". However, it wasn't until almost a decade later when health care professionals began to be educated and trained in cultural competence. In 2002, cultural competence in health care emerged as a field and has continually been embedded into medical education curriculum since then.

Definitions
Cultural competence is defined as a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enables them to work effectively in cross-cultural situations. Essential elements that enable organizations to become culturally competent include valuing diversity, having the capacity for cultural self-assessment, being conscious of the dynamics inherent when cultures interact, having institutionalized cultural knowledge, and having developed adaptations to service delivery reflecting an understanding of cultural diversity. Accordingly, organizations should include these elements in all aspects of policy making, administration, practice, and service delivery.

Cultural competence is often used interchangeably with the term cultural competency.

Health care system
A health care system, sometimes referred to as health system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations. A culturally competent health system not only recognizes and accepts the importance of cultural diversity at every level but also assesses the cross-cultural relations, stays vigilant towards any changes and developments resulting from cultural diversity, broadens cultural knowledge, and adapts services to meet the needs that are culturally-unique.

As more and more immigrants are coming to America, the challenges for American health care systems to meet the health needs of the increasing number of diverse patients are becoming very obvious. The challenges include but are not limited to the following:
 * Sociocultural barriers
 * Poor cross-cultural communication
 * Language barriers
 * Attitudes toward health care
 * Beliefs in diagnosis and treatment
 * Lack of cultural competence in the design of the system

Leadership and workforce
In response to a rapid growth of minorities population in the United States, health care organizations have responded by providing new services and undergoing health reforms in terms of diversity in leadership and workforce. Despite improvements and progress seen in some areas, minorities are still underrepresented within both health care leadership and workforce. To improve the weak minorities representation in leadership and workforce, an organization must acknowledge the importance of cultures, be sensitive to cultural differences, and establish strategic plans to incorporate cultural diversity.

According to the national survey of the U.S. health care leaders conducted by the search firm Witt/Kieffer, respondents viewed diverse leadership as a valuable business builder. They associated it with improved patient satisfaction, successful decision-making, improved clinical outcomes, and stronger bottom line.

To successfully recruit, mentor, and coach minority leaders in health care, it is important to keep these social science principles and cultural values in mind:
 * Branding - how health care leaders brand diversity in their organizations? Without inclusion, branding would not be complete
 * The concepts of self-categorization and "othering"
 * Lack of leadership commitment - diversity and inclusion should be an imperative of their organization
 * The compelling national demographics of health care leadership and workforce.

Within a culturally competent health care system, the leadership and workforce should reflect its diverse patient population so that patient satisfaction, favorable patient care outcomes, and health equity will be achieved while health disparities will be reduced.

Clinical practice
To provide culturally sensitive patient-centered care, physicians should treat each patient as an individual, recognizing and respecting his or her beliefs, values and care seeking behaviors. However, many physicians lack the awareness of or training in cultural competence. With the constantly changing demographics, their patients are increasingly getting diverse as well. It is utterly important to educate physicians to be culturally competent so that they can effectively treat patients of different cultural and ethnic backgrounds.

In response to the increasingly diverse population, several states (WA, CA, CT, NJ, NM) have passed legislation requiring or strongly recommending cultural competency training for physicians. New Jersey is a very diverse state in population. In 2005 New Jersey legislature enacted law requiring all physicians to complete at least 6 hours of training in cultural competency as a condition for renewal of their New Jersey medical license, whether or not they actively practice in New Jersey. Physicians' responses to this CME requirement varied, both positively and negatively. But the overall feedback was positive towards the outcomes of participation in and satisfaction with the programs.

In order to provide culturally competent care for their diverse patients, physicians should at the first step understand that patients' cultures can influence profoundly how they define health and illness, how they seek health care, and what constitutes appropriate treatment. They should also realize that their clinical care process could also be influenced by their own personal and professional experiences as well as biomedical culture. Dr. Like pointed out in one of his articles that "in transforming systems, transcultural nurses, physicians, and other health care professionals need to remember that cultural humility and cultural competence must go hand in hand."

Medical education
The critical importance of training medical students to be future culturally competent physicians has been recognized by accrediting bodies such as the Accreditation Council on Graduate Medical Education (ACGME) and the Liaison Committee on Medical Education (LCME) and other medical organizations such as American Medical Association (AMA) and the Institute of Medicine (IOM).

According to the LCME standard for cultural competence, "the faculty and students must demonstrate an understanding of the manner in which people of diverse culture and belief systems perceive health and illness and respond to various symptoms, diseases, and treatments." In response to the mandates, medical schools in the U.S. have incorporated teaching cultural competency in their curricula. A curriculum mapping search on cultural competence in the curriculum of Rutgers University's Robert Wood Johnson Medical School found that it was covered in 33 events in 13 courses. A similar search was performed on health disparities yielding 16 events in 10 courses covering the topic.

The cultural competence curriculum is intended to improve the interaction between patients and physicians and to assure that students will possess the knowledge, skills, and attitudes that enable them to provide high quality and culturally competent care to patients and their families as well as the general medical community.

Patient education
Patient-Physician communication involves two sides. While physicians are being encouraged or rather required to be culturally competent in delivery of quality health care, it would be reasonable to encourage patients as well to be culturally sensitive and be aware that not all physicians are equally competent in cultures. They need to communicate their concerns relating to their beliefs, values and other cultural factors that might affect care and treatment to their physicians and other health care providers.Only with effective communication and true understanding between the two parties can high quality care and patient satisfaction be achieved.

Language barriers
Linguistic competence involves communicating effectively with diverse populations, including individuals with limited English proficiency (LEP), low literacy skills or are not literate, disabilities, and individuals with any degree of hearing loss.

According to the U.S. Census in 2011, 25.3 million people are considered limited English proficient, accounting for 9% of the U.S. population. Hospitals frequently admit LEP patients for treatment. With cultural and linguistic barriers, it is not surprising that it is hard to achieve effective communication between the health care providers and the LEP patients.

In order to improve communication and mutual understanding, health care systems have used the professionally trained interpreters to help health care providers to communicate with patients whose English proficiency is limited. Studies have shown that trained professional interpreters or bilingual health care professionals have a positive affect on LEP patients' satisfaction, their quality of care, and outcomes.

The National Culturally and Linguistically Appropriate Services (CLAS) Standards in Health and Health Care developed by the Office of Minority Health (OMH) are intended to advance health equity, improve quality and help eliminate health care disparities. This is a very good resource for health care systems and organizations to follow to develop to be culturally and linguistically competent in the delivery of health care.

With the joint efforts of institutions, agencies,and health care professionals and the actions being taken at various levels, health disparities in the United States will be hopefully reduced.