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As populations shift and global migration increases, the number of different cultures and languages faced by healthcare providers will continue to expand. Understanding how to successfully deliver healthcare to patients of diverse cultural, sexual and socioeconomic backgrounds is now mission critical to achieving positive patient outcomes.

A world in flux

According to the IOM Global Trends 2015 Fact Sheet, the number of international migrants worldwide was the highest ever recorded, reaching 244 million people. Here in the United States, the 2010 census shows a changing and more diverse population as well. Just over one-third of the U.S. population reported their race and ethnicity as something other than “non-Hispanic white”, a 29% increase since 2000.

This transformation of the world’s cultural map puts one point ‘front and center’ for providers; when an individual’s culture is different from that of the physician or healthcare organization, it will complicate the relationship and potentially interfere with the delivery, understanding, acceptance and adherence to care.

So how are healthcare providers supposed to become culturally competent in sexual orientation, socioeconomic status, faith, profession, tastes, disability, age, race and ethnicity? The answer lies in observation. When providers practice acute observation of each patient, discomfort and confusion are noticed. That generates questions about the discomfort that can lead to important fact finding, increased understanding and more successful care.

What then, is the most effective training for providers?

Self-reflection. That may sound contrary to the norm considering that healthcare professionals are trained in evidence-based medicine and data based research, but it’s the reality. Manuals and classes may be part of the training, but until providers are aware of their own perceptions and preconceived ideas about different cultures, they cannot identify and rectify them when interacting with a patient. A recent issue of The Health Care Manager journal published a study saying “Cultural competence is learned over time and awareness, skill and knowledge are essential competencies that must be gained by healthcare providers, and especially for nurses.”

If cultural competency isn’t learned, patient care suffers. The American College of Obstetricians and Gynecologists (ACOG) says:

“Many cultural groups, including gay and lesbian individuals; individuals with disabilities; those with faiths unfamiliar to a practitioner; lower socioeconomic groups; ethnic minorities, and immigrant groups receive no medical care or are grossly underserved for multiple reasons. Lack of cultural competence of health care providers is one of the reasons these groups receive inadequate medical care.”

So what can culture affect when it comes to patient care?

According to the Centers for Disease Control, fact finding essential to correct diagnosis and appropriate patient care includes:

  • Description and communication of symptoms
  • Perceived causes of illness; understanding of infection, transmission, and contacts
  • Health-seeking behavior
  • Understanding of disease process, treatment expectations, and decision making
  • Interaction with the health care system and health care professionals
  • Attitudes towards helpers and authorities; reluctance to reveal contacts
  • How a person identifies and describes their contacts

ACOG gives a great example regarding a patient’s concern over medical tests. Here are 2 ways in which the scenario could play out:

Original: An elderly Chinese woman is asked by her physician to go to the laboratory to have blood drawn for tests. She takes the laboratory slip but does not get the tests, nor does she return to see that physician.

Culturally Sensitive approach: The primary care physician orders laboratory tests on his patient, but notes the woman’s hesitation and asks her why she is worried. She tells the physician that she believes that blood taken from her body will never be replenished and she is weak already. The physician spends time explaining how blood is replaced and the importance of the tests. The patient has the blood tests as the physician requested.
It’s an understatement to say that it is a complicated world. However, it seems that when it comes to cultural competency, simple human decency and sensitivity to another’s life goes a long way toward deciphering their world and its impact on effective healthcare. Ask your patients how they are doing. They will tell you, and teach you how to communicate with them in a way that makes everyone better.

When a patient has the opportunity to tell you how they feel about their care, they feel empowered, and acknowledged. Using HCXP for rounding and point of Care (POC) collection of feedback data, allows patients to do this. The result is a better patient experience and that ultimately leads to a better HCAHPS scores and a greater reimbursement. Find out more at HCXP, creator of a five point, 5 Star rating system for all in house satisfaction questionnaires and one comparison/benchmark reporting system.

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