Health professionals are becoming increasingly aware of the need to provide health care services that are respectful and responsive to cultural and linguistic needs in order to meet the increasing cultural and linguistic diversity of this nation. Educational institutions for health professionals have therefore been asked to include cultural competency training at all levels of curriculum and training programs. Current gaps in existing cultural competency training programs for health professionals include failure to adequately address health care access and language issues and to achieve longitudinal integration of issues of culture into the curricula. In addition, the impact of cultural competency training on student attitudes, beliefs and behaviors toward persons of other cultures as well, as patient outcomes, has not been adequately evaluated.
A study through the National Center for Cultural Competence provides an initial look at evidence of outcomes, well-being, costs, and benefits of promoting cultural and linguistic competence. A full report can be found here.
- Definition of cultural competence
- Definition of race, ethnicity, and culture
- Need for cultural and linguistic competence
- CLAS in Healthcare - The 154 National Standards
- Clinician's self-assessment and reflection
Cultural competence is a set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals that enables effective work in cross-cultural situations. The word “culture” refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values and institutions of racial, ethnic, religious or social groups. The word “competence” implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors and needs presented by consumers and their communities.
The American Association of Medical Colleges recommends that a socio-cultural definition of race be used in order to be consistent with the latest research on causes of health disparities. Here are links to acceptable definitions:
- American Anthroplogical Association Statement on "Race"
- A statement that represents generally the contemporary thinking and scholarly positions of a majority of anthropologists on race.
- Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity
- Federal government: Office of Management and Budget. Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity. Federal Register Notice. October 30, 1997.
- Statement of The American Sociological Association on The Importance of Collection Data and Doing Social Scientific Research on Race
- The American Sociological Association statement on race.
- A Glossary for Social Epidemiology
- Krieger N. A glossary for social epidemiology. J Epidemiology Community Health 2001;55:693-700
- American Medical Student Association's Race, Ethnicity and Culture in Health Action Committee
- The Race, Ethnicity and Culture in Health Action Committee addresses minority student issues and serves as a support network for their culturally diverse AMSA membership. It is a source of education to all students regarding health-care issues in communities representing people of color. They also provide a forum for discussion through a quarterly newsletter and listserve.
- Reactions to Race Questions
- See Module 12 in Behavioral Risk Factor Surveillance Survey.
- The American Association of Physical Anthropologists: AAPA Statement on Biological Aspects of Race
The following links address the need for cultural and linguistic competence in healthcare:
- Culturally Competent Healthcare Systems: A Systematic Review
- Anderson LM, Scrimshaw SC, Fullilove MT, Fielding JE, Normand J, Task Force on Community Preventive Services. Culturally competent healthcare systems: a systematic review. Am J Prev Med 2003;24 (3S):68-79.
- Strategies for Improving Minority Healthcare Quality
- Agency for Healthcare Research and Quality. Strategies for Improving Minority Healthcare Quality. Report/Technology Assessment Number 90. AHRQ Publication No. 04-E008-02, January 2004., Rockville, MD.
- More information on Language Access Resources
The National Standards for Culturally and Linguistically Appropriate Services (CLAS) Standards in Health and Health Care is a template released by the Office of Minority Health in March 2001 to ensure cultural competency in healthcare organizations. Accreditation of hospitals and medical schools will be based in part on adherence to these regulations and guidelines.
For updates on the National Standards for Culturally and Linguistically Appropriate Services please visit The Office of Minority Health from the US Department of Health and Human Services.
The 15 standards are organized by varying stringency levels:
- Mandates are current federal requirements for all recipients of federal funds (Standards 4, 5, 6, and 7).
- Guidelines are activities recommended by OMH for adoption as mandated by federal, state and national accrediting agencies (Standards 1, 2, 3, 8, 9, 10, 11, 12, and 13).
- Recommendations are suggested by OMH for voluntary adoption by health care organizations (Standard 14).
Culturally Competent Care
1. Health care organizations should ensure that patients/consumers receive from all staff members, effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language.
2. Health care organizations should implement strategies to recruit, retain, and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area.
3. Health care organizations should ensure that staff at all levels and across all disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery.
Language Access Services
4. Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency, at all points of contact and in a timely manner during all hours of operation.
5. Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.
6. Health care organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services (except on request by the patient/ consumer).
7. Health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area.
Organizational Supports for Cultural Competence
8. Health care organizations should develop, implement, and promote a written strategic plan that outlines clear goals, policies, operational plans and management accountability/oversight mechanisms to provide culturally and linguistically appropriate services.
9. Health care organizations should conduct initial and ongoing organizational self-assessments of CLAS-related activities and are encouraged to integrate cultural and linguistic competence-related measures into their internal audits, performance improvement programs, patient satisfaction assessments and outcomes-based evaluations.
10. Health care organizations should ensure that data on the individual patient's/consumer's race, ethnicity and spoken and written language are collected in health records, integrated into the organization's management information systems and periodically updated.
11. Health care organizations should maintain a current demographic, cultural and epidemiological profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area.
12. Health care organizations should develop participatory, collaborative partnerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and patient/consumer involvement in designing and implementing CLAS related activities.
13. Health care organizations should ensure that conflict and grievance resolution processes are culturally and linguistically sensitive and capable of identifying, preventing and resolving cross-cultural conflicts or complaints by patients/consumers.
14. Health care organizations are encouraged to regularly make available to the public information about their progress and successful innovations in implementing the CLAS standards and to provide public notice in their communities about the availability of this information.
15. Communicate the organization’s progress in implementing and sustaining CLAS to all stakeholders, constituents and the general public.
Identifying one’s own biases is an important step in assuring that quality of care provided is not hindered by a patient’s ethnicity, culture, or race. The following are some tools for self-reflection and assessment for not just healthcare professionals, but anyone interested exploring their underlying attitudes and beliefs:
- A Physician's Practical Guide to Culturally Competent Care helps to explore cultural competency in healthcare through looking at engaging cases. Registration is open to physicians, physician assistants, nurse practitioners, pharmacists, and all healthcare professionals.
- Culturally Competent Nursing Care: A Cornerstone of Caring cultural competency training for nurses.
- Implicit Association Test (IAT) is a series of short tests on a wide array of topics that include, race, religion, and sexuality.
- Here you will have the opportunity to assess your conscious and unconscious preferences for over 90 different topics ranging from pets to political issues, ethnic groups to sports teams, and entertainers to styles of music. At the same time, you will be assisting psychological research on thoughts and feelings.
- The Cultural Competence Health Practitioner Assessment
- Developed by the National Center for Cultural Competence.
- Here you will find self-assessment tools for organizations and practicing physicians.