Culturally Competent Care

Caring for diverse populations starts with culturally competent care. The theme of culturally competent care under the Office of Minority Health national standards on Culturally and Linguistically Appropriate Services (CLAS) is comprised of three standards:

• Providing care in a culturally competent manner
• Emphasis on recruiting and retaining a diverse workforce; and
• Availability of training in culturally and linguistically appropriate service delivery.

Take Action

In order to provide culturally competent care, a logical first step is to learn more about the cultural practices of the diverse populations served by your health care organization.

Did you know?

• In the Somali culture, the left hand is considered “impolite.” Providers are encouraged to use the right hand to offer food or medication to Somali patients.
• In the Hmong culture, farmers organize their activities around the sun up and sun down. Recent immigrants are unaccustomed to doing things at specific times. As a result, information about appointment times needs to be carefully explained.
• In the Russian culture, bad news is not given to the person who is ill or disabled. The family receives the news first and can then decide whether or not to tell the affected individual of their condition and prognosis.
• In Hispanic/Latino culture, the importance of familismo, a strong sense of family, suggests the well-being of the family prevails over the interests and necessities of individual members. Hispanic/Latino patients may include their entire family in making care decisions.
• In American Indian culture, time and silence may be used to maintain harmony.
  

Diversity in Minnesota

Minnesota's population is considerably less diverse than the overall US population. The state's non-white population was 14 percent in 2007 compared to 34 percent of the national population. Minnesota continues to become more diverse, as non-white populations grow faster than the white population. Thirty-six percent of the minority population in Minnesota is foreign born.

The Culture Care Connection - Diversity in Minnesota Fact Sheets help organizations and health care providers learn more about the background, religious and cultural beliefs, communication preferences, and common health issues of the predominant minority populations in Minnesota.

• African American
• American Indian
• Asian Indian
• Cambodian
• Ethiopian
• European American
• Hispanic/Latino
• Hmong
• Iraqi
• Russian
• Somali
• Vietnamese

The Culture Care Connection - DVD Training Series offers insights into the beliefs and norms of three of Minnesota’s prevalent cultures. DVDs must be purchased and include a facilitator discussion guide. CEU credit available.

• Hmong
• Hispanic/Latino
• Somali

Culturally competent care

Communication is essential to providing culturally competent care. Communication with patients from diverse populations can be inhibited by language barriers, literacy level, and cultural beliefs and practices. Data reported to the Joint Commission demonstrate that communication is one of the most common underlying root cause of sentinel events, a finding which is echoed in Minnesota’s own 2009 Adverse Health Events Public Report.

Of equal importance is the awareness and appreciation of culture and its impact on health care. Cultural understanding can play a unique role in diverse population’s decisions to seek health care services (University of Minnesota, 2000). Many health care organizations note that the lack of awareness among staff regarding the importance of cultural and linguistic issues and how they affect patient care presents a challenge in treating patients from diverse populations (Joint Commission, 2008).

Key strategies to improving communication and providing culturally competent care to patients from diverse populations include:

Using a patient-centered care approach

• Creating rapport by building relationships with patients and family members, asking them for their ideas, and asking them about concerns.
• Treating the patient as a person and orienting them to the care process.
• Tailoring care plans to the patient’s needs and preferences
• Making sure patients understand medical instructions by asking them to repeat them (also known as the teach-back method).

Learning more about health literacy

Health literacy is the ability to obtain, process, and understand basic health information and services to make appropriate health decisions.

• Limited health literacy isn’t a condition that makes itself easily visible, it depends on the context.
• Even people with strong literacy skills can face health literacy challenges, such as when they are not familiar with medical terms or how their bodies work; or they are diagnosed with a serious condition and are scared or confused.
• Health Literacy 101 presentation. The Minnesota Health Literacy Partnership has developed a presentation  to help providers and administrators learn more about health literacy. (34-slide PowerPoint)

Recruiting and retaining a diverse workforce

Developing a diverse workforce that reflects the community and patient population is one strategy recommended by the Joint Commission to foster the provision of culturally and linguistically appropriate care. While there are no studies that definitively address the association between the presences of a diverse workforce and health outcomes, consider this (HRSA, 2006):

• Increasing the number of racial and ethnic minority health professionals could provide a greater opportunity for patients from diverse populations to see a practitioner from their own racial or ethnic group. This may in turn increase adherence to treatment plans, ultimately resulting in improved health outcomes.
• Patients from diverse populations may distrust health care organizations that are managed by predominantly white health professionals. Recruiting and retaining a diverse workforce may increase trust and the propensity of patients from diverse populations to use services from those organizations.
• Greater diversity among health care organization employees at all levels may broaden the priorities of the health care delivery system. Employees from racial and ethnic backgrounds can provide input based on their own experience and advocate for policies and programs that meet the cultural and linguistic needs of diverse populations.

Organizations are encouraged to visit the International Institute of Minnesota’s Ethnic Resource Directory, a searchable database of organizations that provide among other services, job skill training and placement for foreign- and native born Minnesotans. Other tools, including a list of interview questions on the topic of assessing job candidate experience related cultural competence, are available through this Web site. More tools >

Training in culturally and linguistically appropriate service delivery

The provision of culturally competent care starts with an awareness of one’s own culture as well as an understanding of the needs associated with providing care to people of different cultures. With this knowledge in hand, organizations may begin to develop cross-functional strategies to change organizational practices, physical environments and communication practices at all levels and across all disciplines. It is for this reason that the Office of Minority Health suggests the provision of training and education as a standard toward achieving culturally competent care.

Of the various training resources available, few were developed with the needs of Minnesota's providers and the prevalent cultures of Minnesota in mind. Minnesota specific training resources >