Standard 1: Culturally Competent Care (guideline)
“Health care organizations should ensure that patients/consumers receive from all staff members effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language.”
Intent of the Standard
Standard 1 forms the basis for all of the content of the other CLAS standards. The intent of the standard is to ensure that all patients receive culturally and linguistically competent healthcare services. The standard concerns not only patient-facing staff members but also the entire range of managers, policies, and systems that underlie any clinical encounter.
Definitions of components
The 3 specific components of culturally competent care are defined as follows:
- Respectful care involves taking into consideration the values, preferences, and expressed needs of the patient.
- Understandable care involves communicating in the patients’ preferred language and ensuring that they understand all clinical and administrative information.
- Effective care results in positive outcomes for patients, including:
- Appropriate preventive services, diagnosis, and treatment
- Improved health status
Traditional healthcare beliefs and systems
Culturally competent care involves respecting each patient’s beliefs and cultural values regarding health, disease, and the efficacy of treatments. The World Health Organization (WHO) defines traditional medicine as “the sum total of the knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health, as well as in the prevention, diagnosis, improvement or treatment of physical and mental illnesses.” [World Health Organization. General Guidelines for Methodologies on Research and Evaluation of Traditional Medicine. Geneva; 2000. Available at: http://www.who.int/medicines/areas/traditional/definitions/en/index.html.]
Culturally competent healthcare services include:
- Investment in efforts to overcome cultural, language, and communications barriers
- Providing an environment in which patients from diverse cultures feel comfortable discussing their cultural health beliefs and practices while discussing diagnostic and treatment choices
- Involving members of communities being served in assessing the effectiveness of communication and care
- Encouraging patients to express their spiritual beliefs and cultural practices
- Becoming familiar with and respectful of relevant traditional healing systems and beliefs and, when appropriate, integrating them into treatment plans
Staff cultural and linguistic competence
Training and education in cultural and linguistic competence too often focus on an organization’s front-line staff members—eg, physicians, nurses, physician assistants, and so forth. A critical goal for Standard 2 is to ensure that every organizational staff member becomes equipped with the behaviors, skills, and attitudes that will empower them to work effectively with patients across all of the population groups that their facility serves. For example, if a staff member at the admissions desk exhibits behavior that is not culturally and linguistically sensitive at a patient’s initial point of contact with the facility, that patient could feel unwelcome and leave before even having an opportunity to interact with any member of the clinical staff.
Moreover, some healthcare organization staff members may not even think of themselves as “staff” and therefore do not appreciate the need for cultural and linguistic sensitivity. Others may regard themselves as culturally competent but in fact have an imperfect understanding of what is involved in cultural competence or feel that treating all patients in the same manner constitutes cultural competence. Therefore, healthcare organizations should recognize the need to support the cultural and linguistic competence of staff members at every level of the organization. Another important aspect of Standard 2 is that it is applicable not only to staff in facilities that provide direct medical care but also to those in other care settings, such as public health or prevention services.
Organizational Role in Ensuring Culturally Competent Encounters
Sound organizational and managerial supervision and infrastructure are critical to ensuring that all staff members provide culturally and linguistically competent interactions with each patient. Possibly the most important first step is that the organization must become put into place processes to develop a thorough understanding of the characteristics, attitudes, and practices of the communities that they serve. Based on the knowledge developed during this process, the facility should design services that address both general healthcare needs and those that are unique to the populations of their service area. The organization’s managerial staff should collaborate with physicians and other direct-care providers:
- To incorporate cultural sensitivity into each staff person’s day-to-day interactions with patients
- To make available culturally appropriate diagnostic tools, clinical guidelines, and health-education materials
- To require continuing education and training in delivering culturally and linguistically appropriate services
Additional organizational measures that enhance accessibility to healthcare services for members of diverse populations may include:
- Scheduling bilingual and culturally knowledgeable nurses at call centers to give advice to patients
- Offering longer clinic visits to patients who have challenging linguistic or cultural needs
- Providing larger patient exam and waiting rooms in facilities where multiple family members may be present to support patients
In the end, a healthcare organization’s management should take responsibility for assessing the cultural and linguistic competence skills of all staff members by conducting performance evaluations and requesting that patients assess their satisfaction with staff encounters.