We wrote this article before the COVID-19 crisis seized our US healthcare system in its grip, but the pandemic has only made its message more important. Now is not the time to say we have more pressing concerns than addressing deficits in cultural competency in hospitals, for those deficits may cost lives moving forward.
As America becomes increasingly multicultural and racially diverse, US hospitals have begun to take steps to ensure that racial and ethnic disparities in treatment are closed. It’s well documented that people from disadvantaged and marginalized ethnic groups have significantly lower life expectancies than people from higher socioeconomic strata. These groups broadly encompass people of color, various ethnic and religious groups, and immigrants and refugees from developing or oppressed countries.
When medical and hospital care is needed, people in these groups often face great challenges in accessing care, not only for financial reasons but also because of profound language and cultural barriers. Well-intended and otherwise caring and competent health care providers too often simply lack the ability to communicate with diverse patients on their own level, either linguistically or culturally. This leads to frustration and misunderstanding on the part of both patient and provider.
For example, health care providers may misinterpret or be entirely unaware of how a patient’s religious beliefs, cultural taboos, or ethnic customs can affect their hospital stay. The provider may be suspicious of non-Western folk remedies and practices that the patient has great faith in, or may interpret a patient’s demeanor based on a long-held stereotype about the patient’s ethnicity. Religious prohibitions about male and female interaction can delay or hinder treatment, or patients of certain religious groups may refuse life-saving treatment in the belief that God will heal them or has prohibited the use of certain treatments.
In times of crisis, the need for empathy when working with other cultures is all the more critical, as most people entrench themselves in their beliefs, rituals and routines when threatened. What seems foreign to you can be a source of comfort to others in difficult times.
The road to misunderstanding is a two-way street though: a nurse or physician from a stoic, uncommunicative culture may interpret a patient’s expressed fear or pain as histrionics and delay appropriate action. Cultural differences can disrupt nurse/physician roles, as well, if, say, a physician from a more autocratic background ignores or demeans a nurse’s valid concern.
All of these factors have led hospitals to establish practices designed to improve communication among people of varying ethnicities with the aim of providing equal and effective care for all. It has become increasingly common for hospitals throughout North America to implement programs of “cultural competency” training for medical and nursing staff, as well as any other employee group that regularly interacts with patients.
Achieving cultural competency involves not only educating staff in broad-brush terms about language, customs, taboos, and restrictions of diverse cultures, but also encouraging more people from minority groups to enter health care professions — and hiring more minority professionals in hospitals. Several studies have shown that people from minority, ethnic, and non-English speaking groups prefer to interact with health care providers whose backgrounds are similar to theirs, who have grown up with and understand their cultures and customs.
Cultural competency shouldn’t stop with the front-line, patient-facing staff in a hospital. It’s essential that top-level administrative officers — the “C suite” and board — also reflect diverse backgrounds and ethnicities. Currently, diverse leadership from the top down is lacking. An AHA Institute for Diversity in Health Management survey showed that only 11% of executive positions and 14% of hospital boards were minorities — but 32% of hospital patients were minorities.
While much remains to be done, much has been accomplished to better serve ethnically, culturally, and linguistically diverse hospital patients. That same AHA survey showed that:
- 79% of surveyed hospitals provide clinical staff orientation about language and cultural factors affecting patient care of diverse patients and provide continuing education throughout the year.
- 40% of those hospitals have formal guidelines for incorporating cultural and linguistic competence into their strategic plans.
These are signs of positive developments in the continuing effort to overcome racial and ethnic disparities in hospital care. The COVID-19 pandemic will very likely force many healthcare organizations to reevaluate how operate—how can we be better prepared for another situation like this, what can we do to improve outcomes for all patients. Hopefully these questions will spur further action and progress on the issue of cultural competency in nursing and healthcare.