“I’d prefer it if my provider understood my needs as a human being not as an identity” the patient, a woman identifying as LGBTQ+, lamented as we discussed her perceptions of communication within a healthcare setting.
She’s not alone.
I’ve had similar discussions with dozens of patients and surveyed hundreds across different racial, ethnic, and gender identities, to name a few. The common thread in all of my conversations with patients is the desire to be understood as a human being.
The human element is what is missing from cultural competency models and frameworks that are used in healthcare. This omission is troubling seeing as many health systems and individual providers rely upon cultural competency education and training not only to ensure that care given meets the patients’ needs and preferences but also addresses health disparities.
Cultural competency is critical to providing high quality, compassionate healthcare, but perhaps it’s time we think outside the box and retire the term cultural competency in favor of people competency?
Cultural competency isn’t new and it isn’t improved
Cultural competency originated in the healthcare industry decades ago as the medical community recognized the powerful influence that culture has on health and well-being, so providers must identify, consider and integrate a patient’s individual beliefs, values and preferences into clinical decision making to alleviate health disparities (Purnell, 2014).
So, cultural competency isn’t new.
As the field of cultural competency has evolved, many definitions, frameworks and models have been developed and utilized so there is no standardized approach to cultural competency education and training. This high degree of variance is the root cause of many flaws in the field. Here are some key concerns with cultural competency in practice:
- Cultural competency leads to stereotyping: historically, education and training programs have become an array of “do’s” and “don’ts” that incorrectly prescribe how a patient should be treated on the basis of their particular ethnicity, national identity or language preference (Betancourt, 2004)
- Cultural competency is too provider centric: most cultural competency research concentrates on the provider’s evaluation of their own levels of competency and gives little consideration to the patient’s perspective (Futrell, 2014)
- Over-emphasis on evidence based practice: by treating cultural competency education the same as other topics in academic medical training does cultural competency a disservice as there is over-emphasis on evidence-based practices which can lead a provider to become skeptical or not engage in the culturally competent approach to patient communication and care despite the fact that many studies do show cultural competency leads to improved, intermediate health outcomes (Kleinman and Benson, 2006)
- Providers lack confidence: providers are often apprehensive and lack the confidence to ask patients increasingly personal questions in fear of being too intrusive, but it has been noted that provider confidence plays a prominent role in the provider’s ability to deliver culturally competent care (Jeffreys, 2015)
And, cultural competency isn’t improved.
What can we do better?
Think outside the box.
Ridding ourselves of rigid labels, categories and decision making aids is a necessary first step. The heavily prescribed approach of “If the patient identifies as X then the provider must Y” misguides the provider by allowing for assumption making about the patient versus allowing the patient to share with a provider who they are and what’s important to them.
We need to create education and training programs that empower providers by helping them identify the right questions to ask patients and when not only about their physical symptoms but also about the social determinants of their health.
By giving the patient the time and space to share information about themselves we accomplishing many things simultaneously: allowing the provider to gain more confidence in asking questions that aren’t specific to the patient’s physical health alone; moving away from the provider centric approach to cultural competency; reducing stereotyping by having a dialogue between provider-patient versus the provider working off a checklist or decision aid; and determining how better care can be provided through gaining new, non-biomedical information about the patient and tracking health outcomes as a result of (hopefully) more personalized treatment plans!
Should people competency be the new cultural competency?
Agree? Disagree? Tell me what you think!
Betancourt, J.R. 2004. Cultural Competence: Marginal or Mainstream Movement? New England Journal of Medicine. [Online]. 351(10), pp. 953-954. [Accessed 4 June 2017]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/15342800
Futrell, G.D. 2014. Using Perceived Cultural Competence as an Effective Measure of Culturally Congruent Care. Society for Marketing Advances Proceedings. [Online]. Pp. 77-78. [Accessed 16 June 2017]. Available from: http://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?vid=2&sid=d045ba93-2798-4b80-812e-c0e25d30a6e3%40sessionmgr104
Jeffreys, M.R. 2015.Teaching Cultural Competence in Nursing and Health Care: Inquiry, Action, and Innovation. 3rd ed. New York, NY: Springer
Pijl-Zieber, E.M., Barton, S., Konkin, J., Awosoga, O. and Caine, V. 2014. Competence and competency-based nursing education: finding our way through the issues. Nurse Education Today. [Online]. 34(5), pp. 676-678. [Accessed 30 June 2017]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24090616