Why Cultural Competency Matters in Hospitals

As the nation's population grows more diverse and hospital reimbursements are increasingly tied to patient satisfaction scores, clinicians must become more culturally aware.

Many Americans have experienced watching a foreign film and feeling like they missed something, whether it be the British political jokes in The Life of Brian or the nuanced treatment of the Spanish civil war in Pan's Labyrinth, something has been  lost in translation.

But what if what's missing is something more serious? What if what's missing is an important element of patient care?

As the nation's population grows more diverse, it's increasingly important to be aware of the influence of culture on everything from a patient's diet to attitudes about death and dying as we move to a patient-centered care model, says Joe Betancourt, MD, director of the Disparities Solution Center at Massachusetts General Hospital in Boston. He is co-founder of Quality Interactions, an organization that seeks to spread cultural competence in healthcare.

"There is strength in diversity, but there are also challenges," says Betancourt. "Studies have shown that greater difficulties in communication lead to poorer patient experience, lower adherence, and ultimately, worse outcomes."

HR, he says, is in the perfect position to make decisions that can lead to a more culturally aware and competent hospital. Unfortunately, this is an uphill battle for healthcare workers to fight.

"Research shows that if you have two patients in an emergency room where everything is identical—they have the same income, the same insurance, are both dressed professionally, but they are just different races, the minority patient will receive a lower quality of care."

"Often, it is due to communication challenges," Betancourt explains.

1. Understanding What Lies Beneath
Patients aren't always as forthcoming as clinicians would like them to be, and cultural differences can be a factor, especially when a clinician isn't aware of a patient's culture. But even United States natives can have problems communicating with medical staff.

As a Boston local, Betancourt sees many second-generation Americans of Irish decent. "They will often provide short answers of 'yes, Doctor, no, Doctor,' because they don't want to disappoint the physician." He explains this is a cultural holdover their parents brought across the Atlantic with them. In these cases, Betancourt is certain to ask the patient multiple questions to ensure that they understand what he has told them.

Another example: Patients from Appalachia may be hesitant to disclose information pertaining to domestic violence or substance abuse. These are life-threatening risk factors a culturally insensitive clinician might miss.

2. They're Right Under Your Nose
One strategy is to hire locals who speak the language and understand the culture.

"It takes effort to go out and look for [culturally aware] people and identify them," says Betancourt. "Maybe this is not the person with 'best' resume—but think holistically about what the candidate brings to your organization and the healthcare experience," he suggests.

Hospital serving members of a specific culture likely already have members of that group working for them. Some may be frontline workers and as members of the community, they understand the unique problems their peers face and their unique language and way of life.

Employee development programs can be helpful in engaging and retaining culturally competent employees who have an insider's view into a hospital's patient population.

3. Good Listening Skills
Clinicians don't have to be local or a members of a minority group in order to be culturally competent—what they need most is a questioning and open mind. "Being culturally competent means having the skills and tools to communicate with anyone, regardless of their background, or your own," says Betancourt.

It's vital to ask questions and find out what aspects of a patients' life create obstacles for them in getting and staying healthy, he says.

An example Betancourt uses is asking overweight patients what barriers they face to exercise. If asked in an understanding, open way, the physician might learn that the patient lives in a neighborhood where it is not safe to walk at night—or possibly even during the day.

"In this case, we ask them, 'how can you do this in your community,' says Betancourt, saying that some suggestions he's received from patients over the years have included taking the stairs rather than the elevator when at work or home and taking walks at lunchtime. "We try to mitigate the negative impacts of their environment," explains Betancourt.

Cultural competence is not just a nice thing to have. "Physicians and nurses today need the skills to communicate with anyone, of any background," says Betancourt. Maybe the next foreign film they see will seem a bit less foreign.