1. Understanding and Implementing the CLAS Standards
Standard 3: Staff Education and Training (guideline)
“Health care organizations should ensure that staff at all levels and across all
disciplines receive ongoing education and training in culturally and linguistically appropriate service delivery.”
Education and Training in CLAS
Staff education and training may represent the single most important element in assuring the cultural and linguistic competence of an organization. At some point, virtually all staff members will interact with patients from different countries of origin, acculturation levels, and social and economic standing. Importantly, executives and managers should realize that “staff” includes not only the personnel employed by the healthcare organization but also its subcontracted and affiliated personnel.
In fact, staff training is cited as a key function in the Consumer Bill of Rights and Responsibilities, which was issued in 1997 by the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry. In addition to discussing the types of services and information that patients should expect to receive, this document provides practical suggestions for things that healthcare organizations can do to support those patient rights. One key suggestion is that provider organizations should offer “continuing education courses for providers to assure cultural and language competency” so as to inculcate among all staff members an understanding of “the significance of cultural attitudes on the effectiveness of health care.” [President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry. Consumer Bill of Rights and Responsibilities. Available at: http://www.opm.gov/insure/archive/health/cbrr.htm.] To further this goal, the AAMC, as mentioned in Module 1, has its Group on Diversity and Inclusion, which has issued a number of recommendations concerning the vital role of cultural competence training for the staffs of healthcare organizations.
Contents of cultural competence trainings
Healthcare organizations should either confirm that staff at all levels and in all fields have participated in ongoing education in CLAS delivery or should provide such education. This training should be based on sound educational (ie, adult learning) principles, include pre- and post-training assessments, and be conducted by appropriately qualified instructors. Training sessions should be relevant to the particular functions of the trainees and the needs of the populations that the organization serves.
Topics that could be covered during this ongoing educational process include:
- Effects of cultural differences between staff and patients on clinical and other encounters, including effects of the culture of US medical and other clinical training
- Elements of effective communication between staff and patients of different cultures and languages, including how to work with interpreters and telephone language services
- Techniques for resolving racial, ethnic, or cultural conflicts between staff and patients
- Healthcare organizations’ written language-access policies and procedures, including how to access interpreters and translated written materials
- Applicable provisions of Title VI of the Civil Rights Act of 1964, 42 U.S.C. §2000d, 45 C.F.R. §80.1 et seq. (including Office for Civil Rights Guidance on Title VI of the Civil Rights Act of 1964, with respect to services for (LEP) individuals (65 Fed. Reg. 5276252774, August 30, 2000)
- Healthcare organizations’ complaint and grievance procedures
- Effects of cultural differences on health promotion and disease prevention; diagnosis and treatment; and supportive, rehabilitative, and end-of-life care
- Impact of poverty and socioeconomic status, race, ethnicity, and sociocultural factors on access to care, service utilization, quality of care, and health outcomes
- Effects of cultural differences among patients and staff on health outcomes, patient satisfaction, and clinical management of preventable and chronic diseases and conditions
In the absence of current standard curricula or certification or credentialing processes for cultural competence, healthcare organizations can choose among several options to ensure that all staff members receive training in cultural competence. Some provider organizations may choose to develop and conduct the training in-house. Others may want to contract with an external consultant or organization to conduct in-service trainings. Community-based healthcare organizations may find that it is advantageous to coordinate with neighboring or related organizations to conduct joint trainings. Standard 3 intentionally allows organizations flexibility in how they handle the ongoing cultural competence training of their staffs.
For a more thorough discussion of the target audiences for training in CLAS standards, curricular contents, and the selection and assessment of individuals to conduct such trainings, please refer to Module 1 of this curriculum.
