Cultural Competency in the Healthcare Industry - Research Paper Example

Cultural Competency in the Healthcare Industry of the Institute Thesis ment: The interpersonal communicatiSon between healthcare providers and the patient or their families is one of the core components of healthcare. The quality of healthcare afforded to the patient depends to a large extent on the information exchanged between the patient and the medical team. In short effective communication, to a large extent, results in effective patient care and management. Outline Introduction Globalization and multiculturalism Recognizing diversity in patient-provider relation Cultural competency will help to eliminate communication errors Need to improve literacy, linguistics skills, and cultural knowledge Support Statistics on multiculturalism Heterogeneity in patient-provider population Standards and Models on cultural competency Improving language barriers Healthcare literacy Use of interpreters Conclusion Need for cultural competency Alleviation of potential medical errors due to lack of proper communication Introduction The globalization phenomenon is mainly attributed to increasing rate of immigration of people from one country to another. This has resulted in formation of ethnical and culturally diverse groups of population within a country. The current multicultural setting has posed one of the biggest challenges to the healthcare industry which is better equipped in handling a mono-cultural population (Cote, 2014). Hence the increasing diverse population has necessitated the need for development of intercultural competence by the healthcare industry. For an industry that is already reeling under financial problems these cultural and language barriers are posing additional difficulties (Anand & Lahiri, 2009). Addressing cultural diversity in a healthcare setting should include several facets apart from race, customs, beliefs and practices. The healthcare industry encounters people with several diversities which may include gender, age, disabilities, political views, socioeconomic status, various occupations and other demographical aspects (Campinha-Bacote, 2003). Thus all these diversities should be considered in the patient-provider relationship. It has thus become imperative for them to overcome the present challenges and adopt suitable practices that would help to eliminate cultural, language and communication barriers and medical errors that could result from them. Increasing literacy among the general population would also help to meet this end (Campinha-Bacote, 2003). The following sections aims to address the need for creating a culturally competent environment in healthcare as it would help both the patient and the provider achieve their desired result. Globalization and Multiculturalism statistics The increasing globalization has emphasized the need for intercultural competence especially in the field of healthcare (Cote, 2014). The term healthcare provider encompasses all the individuals working in a healthcare organization who are responsible for the provision of immediate care to the patient and others who have a client-provider relationship with the patient. While physicians, physician assistants and nurses are responsible for patient care; ward secretaries, pharmacists, and those in the administrative departments have a working relationship with the patients 8. Cultural incompetency between the patient and the healthcare provider may arise due to several reasons such as their comfort level, lack of understanding about the functioning of the physician or the healthcare system, patient’s fear of disregard of their personal beliefs by the physician, differences that may arise during the treatment phase (Anand & Lahiri, 2009). In short patients who are sick would at times be unable to concentrate on interpersonal communication and on the other hand physicians would not be able to spend more time with their patients due to time constraints or unwillingness 8. The presence of a culturally diverse group of population in the healthcare industry is evident from various statistical projections. In America alone, which is home to one of the largest multicultural population, African American and Latinos/Hispanics account to 12.4% and 14.8% respectively; Asian Americans account to about 4.4% and native Indians account for 0.8% according to a 2006 Census Bureau report. Among these about 19.7% of the population speak more than 30 different languages apart from English. With the median age of the global population poised to increase to 39 from 28 and the population growth in developing countries expected to rise by six times, this could eventually lead to large-scale migration of people from diverse backgrounds from the developing world to developed countries. Among this heterogeneous population the Asian Americans, African Americans and Hispanics are more likely to encounter cultural and communication problems (Anand & Lahiri, 2009). In the US, studies have also shown that non-white populations suffer from higher incidence of diseases and mortality rates compared to the white counterparts. Statistics reveal that the age-adjusted mortality rate for African Americans is 61% more compared to whites and that women belonging to this minority population receive lesser prenatal care and their children are 2.5 times likely to die in the first year or suffer from malnutrition. Similar reports have emerged for the other minority populations in the US. All these differences have mainly stemmed from racial, cultural and ethnical differences along with their lower socio-economic status and lack of access to other facilities such as health insurance, education and employment 7. Such a situation has necessitated creation of a culturally competent environment. Providing culturally competent care to all irrespective of race, cultural and ethnical background and other differences is an ongoing process which cannot be limited to a few events. CLAS standards and the Campinha-Bacote Model on cultural competency In order to address the issue of cultural competency, the United States Department of Health and Human Services released a set of national standards termed CLAS which is the acronym for Culturally and Linguistically Appropriate Services. These standards have been put forth to address the issue of inequality meted out to culturally and ethnically diverse people by the healthcare industry (Campinha-Bacote, 2003). Several models have also been proposed to explain the concept of cultural competency in healthcare. One of the models for understanding cultural competence has been provided by Campinha-Bacote which serves as a framework for the concept and teaches caregivers to become culturally competent. According to this model culturally competent care can be achieved through cultural awareness, cultural knowledge, cultural skill, cultural encounters and cultural desire (Cote, 2014; Campinha-Bacote, 2003; Campinha-Bacote, 2002). According to the model explained by Cultural awareness is about self-analyses and exploration about an individual’s own cultural background and identification of any existing prejudice notion and bias against any culture or ethnical group. Such awareness would help people to overcome any inherent stigma or notions about other cultures and would prevent them from imposing their cultural beliefs and practices on others (Campinha-Bacote, 2002). In addition, Campinha-Bacote in her model clearly distinguishes between cultural sensitivity and responsiveness. While the former is only about awareness of the various cultures, the later involves incorporating the values and beliefs of specific cultures into the treatment afforded to the corresponding patients (Anand & Lahiri, 2009). Apart from learning about one’s own culture it is also important to gain sufficient knowledge about various other cultures as caregivers would be able to provide culturally competent care when they gain more knowledge about the diverse cultural and ethnical groups whom they are likely to encounter. They would be able to understand the patient’s perception of the illness and its management. In addition knowledge about cultural diversity will also enable healthcare providers to learn about the incidence and prevalence of specific diseases among specific ethnic and cultural populations. In order to meet this end they should also be willing to develop their skills while accessing the physical, biological and physiological variation of patients from diverse cultural backgrounds and collect the relevant details without hurting their cultural or ethnical sentiments. The cultural assessment process as defined by Leininger is “a systematic appraisal or examination of individuals, groups and communities as to their cultural beliefs, values and practices to determine explicit needs and intervention practices within the context of the people being served” (Campinha-Bacote, 2002). Continuous encounters with culturally diverse populations will help them to directly engage with patients from different cultural backgrounds and such interactions will help them change any existing beliefs about a particular culture and develop a more refined attitude towards individuals from different cultural backgrounds (Campinha-Bacote, 2003; Campinha-Bacote, 2002). For instance in some cases patients who have deep faith in God, and hence might avoid taking medication for fear that it would amount to lack of faith in God. If the patient is suffering from a serious condition, this lack of knowledge about the patient’s faith by the concerned physician might even lead to the death of the patient. However, when the provider is well aware of such beliefs, they can offer appropriate counseling to the patient and arrive at a solution in the best interest of the patient (Anand & Lahiri, 2009). In the case of language barriers during such encounters, healthcare providers may take the help of well-trained interpreters in their communication process. In such cases care should be taken to use interpreters with sound knowledge about the terminologies and disease conditions. If they lack the above it will eventually result in miscommunication leading to collection of wrong data from the patients during the assessment process (Campinha-Bacote, 2002; Schyve, 2007). In addition to the above healthcare providers need to have a genuine interest and be able to accommodate and adjust to the differences and learn to show humility towards their patients. The following diagram provides a visual analogy of the Campinha-Bacote model (Campinha-Bacote, 2002). Figure 1. The Process of Cultural Competence in the Delivery of Health Care Services (Campinha-Bacote, 2002) As evident from the above diagram all the five parameters that contribute to cultural competence are interrelated and hence healthcare providers need to address all the five elements in order to achieve cultural competence. This particular model proposed by Campinha-Bacote has been recommended for all areas within the healthcare industry including clinical, research, management, policy development and for training and education purposes. This model can be taken as a guiding framework to meet the requirements of cultural competence. Lack of cultural knowledge and the ability to deal with such patients can contribute to stress and anxiety among healthcare providers. Studies have shown that improving cultural competence has been linked to lesser stress or anxiety levels among healthcare providers as they would be confidently able to deal with their patients and in addition also help to relieve patient stress due to exposure to a new cultural environment 8. Improving on Language barriers and healthcare literacy Communication forms a vital link in the patient-healthcare provider interaction. Statistics has shown that among the minority population only 75% of the people have English as their first language, while 26% and 22% of Hispanics and Asians require an interpreter to communicate their healthcare problems (Briggance & Burke, 2002). Beginning with the patient explaining their condition to the physician and followed by data collection, explaining the test results to the patient and their family to the final discussion about the course of management of the disease, communication in both written, oral and in recent cases electronic methods constitute an important part of the treatment process. This process of collecting as well as disseminating information to the patient about their condition form the core of information management between the patient and the provider. This process requires effective communication between the concerned people in a language which is best understood by all concerned (Briggance & Burke, 2002). In the absence of effective communication, the care afforded to the patient is greatly affected as a result of errors. This could also lead to risks in the patient safety when left undetected. In places like the US, the heterogeneity of the patient population is not reflected among the medical fraternity. The percentage of non-white physicians and physician assistants and nurses is much lesser compared to their white counterparts. In such a situation, healthcare industry should strive to provide quality healthcare to all patients regardless of their diversity and should work to incorporate suitable changes in its practices and among the healthcare staff. Recruiting a collective workforce comprising of staff from mixed cultures could also help to alleviate problems of cultural competence (Briggance & Burke, 2002). Both language and cultural differences play a vital role in this information management process. When patients are not proficient in the language spoken by their physicians or when cultural differences lead to misinterpretation of words or sentences, it ultimately results in ineffective communication between the patient and the healthcare provider. In addition to the above, low healthcare literacy levels among patients with language and cultural differences as well as those who lack these differences could also lead to erroneous understanding of the medical problem. In many cases physicians who detect language and cultural differences usually resort to written communication if the patient can understand the same. But in cases where the patient is from a similar cultural background and speaks the same language as the physician, the absence of written and reading literacy can also result in incompetency. A study conducted by the Joint Commission, found that patients who lacked literacy suffered more severe adverse effects due to medical errors compared to the literate population. The employment of interpreters, especially in the emergency wards, has been found to be an effective means to overcome language related barriers. Experts believe that in order for these changes to be effective the entire work processes should be revamped in order to allow these changes into the system and any undesirable consequence should be identified and eliminated prior to implementation in a healthcare setting (Schyve, 2007). Conclusion In conclusion, the increasing multicultural environment has necessitated the need for developing cultural competence by healthcare providers. Several studies have proven that healthcare providers who are responsive and accommodative of all their patients irrespective of their age, gender, race, culture, ethnic, social, economic and political background will be able to establish better communication and rapport with their patients. This will eventually enable them to provide better quality healthcare to the society. Developing cultural competency is a primary requirement for all those who provide healthcare services to the community. It would help to alleviate medical errors that stem from problems in communication and in addition will also give the necessary confidence and assurance of the best possible treatment to the patients. References Anand, R., & Lahiri, I. (2009). Intercultural Competence in Health Care: Developing Skills for Interculturally Competent Care. In D. K. Deardorff (Ed.), The SAGE Handbook of Intercultural Competence (Ch. 23). SAGE Publications, Inc. Briggance, B. B., & Burke, N. (2002). Shaping America’s health care professions: the dramatic rise of multiculturalism. Western Journal of Medicine, 176(1): 62-64. Retrieved Nov. 30, 2014, from, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071658/ Campinha-Bacote, J. (2002). The Process of Cultural Competence in the Delivery of Healthcare Services: A Model of Care. Journal of Transcultural Nursing, 13(3): 181-184. DOI: 10.1177/10459602013003003 Campinha-Bacote, (2002). The Process of Cultural Competence in the Delivery of Health Care Services. Retrieved from DOI: 10.1177/10459602013003003 Campinha-Bacote, J. (2003). Many Faces: Addressing Diversity in Health Care. The Online Journal of Issues in Nursing, 8(1). Retrieved Nov. 30, 2014, from, http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume82003/No1Jan2003/AddressingDiversityinHealthCare.aspx Cote, Daniel. (2013). Intercultural communication in healthcare: challenges and solutions in work rehabilitation practices and training: a comprehensive review. Disability and Rehabilitation, 35(2): 153-163. Retrieved Nov. 30, 2014, from, http://www.irsst.qc.ca/media/documents/PubScientifique/Revues-journals/2014-03-Cote-Intercultural-Communication-oa-en.pdf. Schyve, P. M. (2007). Language Differences as a Barrier to Quality and Safety in Health Care: The Joint Commission Perspective. Journal of General Internal Medicine, 22(2): 360-361. Retrieved Nov. 30, 2014, from, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2078554/ Ulrey, K. L., & Amason, P. (2001). Intercultural Communication Between Patients and Health Care Providers: An Exploration of Intercultural Communication Effectiveness, Cultural Sensitivity, Stress, and Anxiety. Health Communication, 13(4): 449-463. http://www.iupui.edu/~c482web/documents/PDFs/Ulrey%20&%20Amason.pdf. Read More