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Today more than a third of Americans in need of medical care are not seeking treatment.

There are a variety of reasons why this occurs, including communication challenges, emotional factors, dislike of physicians and the healthcare system, denial, avoiding worry, embarrassment, practical barriers, and prior negative experiences, according to a well-referenced qualitative study from the National Institutes of Health. However, most of these issues could be addressed with the same solution that would make the healthcare delivery system more inviting: improving cultural competency among healthcare professionals.

What is cultural competency?

Cultural competency has its roots in social justice as it aims to provide a more equitable healthcare delivery system. Becoming culturally competent is a dynamic process involving leadership, medical professionals, administrative and technical employees, other stakeholders, and patients working together to create a climate of inclusion and acceptance.  It involves the ability to effectively relate to and communicate with people from diverse ethnic, racial, religious, cultural, economic, gender, age, linguistic, or social backgrounds.   

In the landmark report, “Toward a Culturally Competent System of Care,” researchers Terry L. Cross and Barbara J. Bazron, Karl W. Dennis, and Mareasa R. Isaacs first identified and defined a culturally competent system of care as one that acknowledges and incorporates – at all levels – the importance of culture, the assessment of cross-cultural relations, a continual expansion of cultural knowledge, and the adaptation of services to meet culturally unique needs.  

Culturally competent care for all

Cultural competency is a critical component in reducing healthcare inequities. A strong understanding of what cultural competency is, why it must be developed, and how to implement it throughout an organization can create a medical practice that focuses on the care needs of all patients while they are in a clinician’s office and even after they leave it. In its survey of U.S. hospitals, The Institute for Diversity in Health Management, an affiliate of the American Hospital Association, found that while 81 percent of hospitals educate clinical staff during orientation about how to address the unique cultural and linguistic factors affecting the care of diverse patients and communities, only 61 percent require all employees to attend diversity training. Doctors, nurses, EMTs, and those who deliver services directly to patients have been the obvious candidates for cultural competency training, but employees in IT, billing, collections, and other back office roles also contribute to patient care. 

Developing cultural competency for all healthcare workers and operationalizing culturally competent care for all patients must be a priority. It should be a requisite for every employee in the healthcare system, as it contributes to positive patient outcomes and begins to close the gap in healthcare equity. Cultural competency affects accurate diagnoses, adherence to treatment, good record keeping, and proper reimbursement for services. It has an impact on the patient-physician relationship and medical trust. In the United States, it has been estimated that the combined cost of health disparities and subsequent deaths due to inadequate and/or 

. Further, the lack of training and implementation of this “soft-skill” produced fear and frustration for patients and ineffective office operations, which negatively impact a healthcare provider or system’s ability to deliver quality care for all, as well as its reputation and financial standing.

Cultural competence benefits everyone

Cultural competence offers a wide range of benefits to the healthcare provider and community as well.

Increasing respect and understanding between the patient and provider, along with office and support staff, leads to a level of trust and responsibility for care that is mutually beneficial for all. Outside the office, it encourages community participation and involvement in health issues.

A culturally competent healthcare practice can improve data collection by communicating basic medical terms in the language a patient finds most comfortable and by being meticulously accurate with coding. This also boosts cost savings from a reduction in medical errors and can help eliminate frustration for patients and caregivers when they need to unravel disputes and/or denials from Medicare, Medicaid, and insurance company claims. When every staff member operates with professionalism as well as respect and understanding rooted in cultural fluency of the patients they serve, their actions reduce procedural misunderstandings, accidental overbilling, needless paperwork, and reimbursement issues.

Moreover, by incorporating diverse perspectives, ideas, and strategies into their operations, medical providers can improve efficiency, decrease barriers that slow payments for services, and cultivate better financial outcomes.  

Becoming a culturally competent healthcare organization

As more and more healthcare providers enhance their cultural competency, they provide proof that successfully treating and communicating with patients of every age, nationality, sexual identity, and gender can help those patients navigate the system and receive the care they need.

To help healthcare providers eliminate healthcare disparities, the U.S. Department of Health and Human Services has developed National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care. The CLAS Standards are intended to establish a blueprint for healthcare organizations to provide “effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.” 

Using CLAS as the foundation, here is a brief summary of tasks you can undertake now to move your practice toward excellence in cultural competency.  

• Commit to compassion, communication, and effective outcomes for every patient – a critical first step for having a culturally competent practice. Make culturally competent care a priority embedded in your operations, top to bottom, and front to back.  

• Internally assess your level of cultural competence and use CLAS to inform your cultural competency action plan. For example, Ultimate Medical Academy’s Health Information Technology curriculum includes a case study from a healthcare employer that uses their own Cultural Competency Plan combined with a CLAS Standards Matrix to ensure their services are accessible and culturally relevant.

• Bring into your practice people and tools that reflect the diversity of your patients so you and your team of healthcare professional may learn from one another and implement strategies, such as materials translated in several languages, gender neutral in-take questions, bilingual employees who provide interpretation via telemedicine, and, as your budget permits or through partnerships with local agencies, specialized trainings from consultants who are experts in cultural competence.

• Prepare healthcare employees properly during onboarding and orientation. Refresher training, role modeling, and management communications are required on an ongoing basis to engage staff to embrace what it takes to create the best outcomes for the diverse patients in their care.

• Review and revise your plans annually, and continually review and update your policy manual. Seek patient feedback via satisfaction surveys and actively incorporate suggestions into your cultural competency program. Involve your leadership team to demonstrate accountability and ongoing support.  

• Conduct an annual cultural competency staff development session for allemployees to ensure CLAS compliance. Even in smaller practices this is valuable. And as local demographics continue to change, keep finding ways to expand cultural awareness, sensitivity, and fluency for healthcare workers at every level to ensure positive patient outcomes.

Cultural competency requires an ongoing commitment and process

Healthcare professionals take on a responsibility and duty to care for the sick and partner to promote health and prevent illness. For a long time, bias in the healthcare system has been undetected, unintended, and/or unconscious, and the process for addressing these realities has been slow. As public and private healthcare institutions are realizing this to be a critical reality that affects the care outcomes of patients, healthcare providers and practices need to be prepared and able to care for those who have been traditionally unserved and underserved.  

The time to start is now. When the healthcare industry achieves cultural competency, healthcare workers throughout the system will be able to understand and appropriately respond to how their own cultural norms impact the way they view themselves, the patients under their care, and the health outcomes for all.  

Julene Robinson is vice provost of programs & academic affairs for Ultimate Medical Academy (UMA).  She is responsible for leading initiatives to monitor and improve program retention, graduation and placement metrics and to facilitate problem-solving and data-driven solutions to increase program health, curriculum viability, instructor performance, and student achievement.

Prior to joining UMA in November 2010, Robinson served as the regional executive director at the Florida Department of Education. Previously, she was vice president of programs at Bardoli Global, Inc.; the founder and principal of KIPP Houston High School; a Teach For America corps member, and a special education teacher.

Robinson has a Bachelor of Arts in American Culture from the University of Michigan and a Masters of Education from National Louis University.