The changing patient: Why culturally competent care is now more important than ever
May 1, 2018
CONTRIBUTOR
Laura Drucker Mueller
Essential Insights contributor, healthcare writer
Featured experts
Shoeb Sitafalwalla, MD
Vice President of Medical Management, Advocate Good Shepherd Hospital; Medical Director, Advocate Heart Institute’s South Asian Cardiovascular Center
Michael D. Brown, PharmBS
Vice President, Managed Services
Cardinal Health
Meet Meera: a 35-year-old South Asian woman living in the U.S. She's a vegetarian, a non-smoker, and has health insurance, but she's less likely to utilize healthcare services than her native-born peers.
Additionally, she's more likely to develop acute cardiovascular disease than other major ethnic groups in the country. She's also more likely to develop heart disease at an earlier age and has a one-in-three chance of dying from heart disease before the age of 65.
While Meera is a hypothetical patient, recognizing her inherent risks and unique life factors provides her with more patient-centered care. Caring for such diverse patients requires an approach beyond the basic acknowledgment of disease status or general health; it requires a deeper understanding of the patient. That’s where cultural competence comes into play.
Since April was designated as Minority Health Month, here's a deeper look at cultural competence and how it can be implemented in your organization.
Cultural competence and its benefits
Cultural competence is a method of reducing healthcare disparities by taking into account the social, ethnic, and linguistic factors that shape how a patient approaches his or her health. Across the nation, hospitals and health systems are getting better at incorporating it into their operations—but many aren't completely there yet.
Roughly 80 percent of hospitals educate their clinical staff on cultural competence during orientation, according to a recent benchmarking study by the Institute for Diversity in Health Management. And they're typically collecting demographic data that helps them better understand their patients, primarily data related to race, ethnicity, gender, and primary language. What they're tracking less are other key identifiers that define their patient, such as religion, sexual orientation, gender identity, and socioeconomic status.
“To really understand our patients, we need to have a level of insight that helps us understand who they are as individuals and how they conduct their lives," said Shoeb Sitafalwalla, MD, vice president of Medical Management at Advocate Good Shepherd Hospital in Barrington, Ill. (a Chicago suburb) and medical director of the Advocate Heart Institute’s South Asian Cardiovascular Center in Park Ridge, Ill.
Cultural competence has been shown to reduce disparities in care, yet it does more than that. It increases preventive care, increases cost savings by reducing medical errors and unnecessary treatments, and increases health service utilization. For patients and health systems alike, it decreases barriers to progress and helps facilitate trust, communication, and better care.
“It's about knowing people as they are, not just the language they speak," Dr. Sitafalwalla said. While knowing a patient's race and language helps providers talk to patients, it fails to account for the nuances that dictate how they might receive a message. Adapting that message is a large part of cultural competence; making sure patients not only hear what a provider is saying but fully understand it and can apply it to their lives.
Cultural competence in action
So let's return to our hypothetical patient, Meera. As a South Asian individual, Meera's increased risk of cardiovascular disease has long been understood, but it hasn't necessarily been addressed in an actionable way. That is, until recently.
Five years ago, providers at Advocate Lutheran General Hospital in Park Ridge noticed a troubling trend: young South Asian men and women, most in their late 20s and early 30s, were coming in to the emergency room with massive heart attacks. Hospital leadership knew about South Asians' inherently greater risk of heart disease, but they didn't know how to keep their South Asian patient population from ending up in the emergency room.
In response, Dr. Sitafalwalla helped spearhead the development of the Advocate Heart Institute’s South Asian Cardiovascular Center. Through transformative community outreach, clinical programs focused on prevention, and advanced data analytics, Advocate Health has been able to extend their reach in the South Asian community and affect outcomes at their roots.
Early results include a greater awareness in the community of the heart disease risk and even an average 22 percent reduction of sodium in the food of local participating South Asian restaurants, Dr. Sitafalwalla said. What’s more, he's confident this kind of immersive, wide-reaching cultural competence can be extended to other groups within the system's care population.
Becoming culturally competent
The first step in improving cultural competence is digging through the data. It's okay to ask the sensitive questions, Dr. Sitafalwalla said, like those about faith and sexual orientation. “Train your registration staff and your front line to ask these questions in a way that is not threatening or offensive, but rather shows compassion," he added.
Identifying questions are important beyond the emergency room, too. In the pharmacy space, better acknowledgement of a patient's cultural attributes is necessary for providing appropriate care.
“Tailoring the approach to a patient is going to lead to the best possible outcomes," said Mike Brown, vice president of Managed Services for Cardinal Health. “Our most important job as a pharmacist is communicating how a patient should take his or her medication, so we need to consider all factors of a patient to ensure we're doing that in the best way possible."
Chief among these considerations are a patient's preferred language and religion, since some religious groups can't take certain medications because of their ingredients. For example, in Islam, it is forbidden to use products that are alcohol, gelatin or pork based. So Brown recommends pharmacists know the clinical equivalents of medications that could be problematic when working with certain religious groups.
Taking the next step
Cultural competence is a three-pronged approach, starting with a community survey, followed by community engagement (sharing the survey findings with the community and then determining priorities) and staff education. (Read more in "Becoming a Culturally Competent Health Care Organization" from the Institute for Diversity in Health Management.)
Americans are more racially and ethnically diverse than ever before, and the U.S. is projected to be even more diverse in the coming decades. Organizations should make the move now to ensure they're providing more culturally competent patient care so patients like Meera can have better outcomes.