Short-Term Strategies for the System
Although short-term solutions are often viewed as “masking” the problem, there are many for cultural competence in healthcare that are important far beyond the present. Many measures that serve the solution in the short-term also must remain in the long-term in order to ensure success. In fact, Georgetown University’s Health Policy Institute has identified several imperative measures that attempt to make up for current shortcomings for equality in healthcare treatment:
1. Provide interpreter services
As observed in the documentary World’s Apart, sometimes communication is a major contributor to inadequate and unfair treatment in healthcare. The documentary shows the case of a man named Mohammad Kochi who turns down chemotherapy treatment for his stomach cancer because by the way his translator describes it to him, it seems to go against his religious and spiritual beliefs. However, months later his daughter is concerned by the failure to treat her father and discovers that in large part it was due to a lack of communication because of a language and cultural barrier. This is all too common of an issue that is exacerbated by some hospital and physician failures to provide interpreter services.
2. Recruit and retain minority staff
The clear best way to provide fair treatment to all types of people is to recruit all types of people onto the staff. A survey by the Center for Substance Abuse Treatment even “showed serious disproportion between the demographic backgrounds of clients and those of treatment staff.” This lack of representation handicaps healthcare providers from treating diverse groups fairly. The best way to cater to all groups is to have a staff that is demographically representative of the population that they serve. This would result in increased trust by the patient and certainly fair treatment of the patient throughout their experience in the healthcare process.
3. Provide training to increase cultural awareness, knowledge, and skills
Even with a staff representative of the population, there is still always the possibility of a patient with cultural, religious, and spiritual beliefs that are not represented within a healthcare organization. Simply put, United States’ cities, especially Houston, are too diverse to be represented by a hospital staff of a couple hundred. Rather, the best way to approach this diversity is by creating a staff that is culturally aware. Research from the public health journal Medical Care, even found reviewed three individual studies that all showed the beneficial effect of cultural competence training, specifically in patient satisfaction. Thus, this training is imperative to any organization that hopes to provide equal quality of care to all individuals.
4. Incorporate culture-specific attitudes and values into health promotion tools
A study titled “Genetic Research and Health Disparities” explains that a lot of the inequity in the healthcare system is due to a lack of prevention, diagnosis, and treatment that results from racial and ethnic discrimination by the entire heatlhcare system. The study, that appears in The Journal of the American Medical Association, further explains that many exaggerate the influence of genetic differences between minority groups: which is true. However, a consumer health website that falls under the National Institute of Health still emphasizes the fact that some genetic conditions are in fact more common in certain ethnic groups. Thus, it is important that hospitals cater to their population and make these disparities known so that those affected can better protect themselves. By doing this, hospitals can build trust within their community, bringing them a step closer to providing fair treatment that ends the disparities in the healthcare system.
5. Coordinate with traditional healers
The World Health Organization works with member states to promote the use of traditional medicine in healthcare. Some of their goals for incorporating traditional medicine in healthcare are to “promote the proper use of traditional medicine by developing and providing international standards, technical guidelines and methodologies” and “to act as a clearing-house to facilitate information exchange in the field of traditional medicine.” Integrating traditional and modern medicine can be beneficial to patients, as traditional medicine offers a more holistic approach to treatment that includes spiritual and mental healing in addition to physical healing.
6. Use community health workers
Community health workers are defined by the National Heart, Lung, and Blood Institute as “lay members of the community who work either for pay or as volunteers in association with the local health care system in both urban and rural environments.” The advantage of community workers is that they live with and understand the community members that they serve. By using this valuable resource, healthcare workers can better work with and understand the unique environments and backgrounds of the community they serve, which results in enhanced communication and improved adherence to health recommendations.
7. Include family and community members in health care decision making
In a study published in medical journal Medical Decision Making, a sample of residents of Australia, China, Malaysia, India, South Korea, Thailand, and the USA were surveyed about their desired levels of family involvement in health decisions. The findings were that “respondents who valued relational interdependence tended to want their families involved,” which was a key finding in 5 of the 7 countries, and individual differences in culture determine whether a patient desires family involvement. Thus, generalizations should be avoided, but since a meaningful number of respondents in each country desired family involvement, it is reasonable to recommend that the inclusion of family and community members (who are considered as close as family in some cultures) in health care decision making should be widely considered by health practitioners.
8. Locate clinics in geographic areas that are easily accessible for certain populations
The National Rural Health Association reports that 77% of rural counties are considered “Primary Care Health Professional Shortage Areas” and 9% have no physicians at all. The Rural Health Information Hub reports that rural communities experience lower life expectancies and higher rates of diabetes, chronic disease, and obesity. It is apparent that populations in need of healthcare most are the ones who don’t have it. Hospitals and clinics must be established in these areas in order to reach marginalized populations who are neglected because of the geographic area they occupy.
9. Expand hours of operation
Some hospitals, like Davis County Hospital in Iowa, have expanded hours of operation in order to “provide healthcare during non-working hours for patients who find it hard to come in during normal business hours.” Especially for minority populations, taking time off to go to the hospital can be extremely difficult, as hospitals are open during working hours and many are not open on weekends. Some may wait days or weeks to visit, and some may choose not to visit at all. Expanding hours of operation would not only allow these workers to receive necessary treatment, but to allow them to visit a hospital or clinic sooner.
10. Provide linguistic competency that extends beyond the clinical encounter to the appointment desk, advice lines, medical billing, and other written materials
Even beyond hiring translators and minority staff, hospitals and clinics should extend cultural competency to other areas of communication to make a patient’s experience more comfortable, as the ability to communicate with healthcare workers is crucial to whether or not a patient chooses to make another appointment. A negative experience could deter patients from receiving the healthcare they need, so it is important to communicate clearly, in another language if needed, medical results, recommendations, bills, appointment times, etc.
Further Tools
You can find some videos and framework for sensitivity training modules for different types of doctors who serve different populations in an improvement module created by Harvard University. You can find more on tools under the tools tab.