N 512 Module 1 Assignment Diversity and Cultural Competence and Approaches to Multicultural Health Care
N 512 Module 1 Assignment Diversity and Cultural Competence and Approaches to Multicultural Health Care
As a starting point, it is important to define what cultural competence in health care is, since
it is toward this goal that training will be directed. There have been numerous attempts to
define this term, but perhaps the most widely accepted and useful definition is that given by
Cross, Basron, Dennis & Issacs in 1989 in their work at the National Center for Cultural
Competence, Georgetown University, which is adapted below:
Cultural and linguistic competence is a set of congruent
behaviors, knowledge, attitudes and policies that come together
in a system, organization or among professionals that enables
effective work in cross-cultural situations. “Culture” refers
to integrated patterns of human behavior that include the
language, thoughts, actions, customs, beliefs and institutions of
racial, ethnic, social or religious groups. “Competence” implies
having the capacity to function effectively as an individual or an
organization within the context of the cultural beliefs, practices
and needs presented by patients and their communities.
Perhaps one reason this definition has enjoyed such wide acceptance is that it succinctly
defines culture and competence in relationship to each other. Another reason is that the
definition is action, knowledge and skill-based. For many years the terms “culturally sensitive”
and “culturally relevant” have been used to describe quality care for diverse populations, and,
more recently, “culturally responsive” care has been used. These are all useful terms and
“cultural competence” includes them all. However, the notion of competence implies specific
kinds of perceptions, knowledge and skills that must be acquired and appropriately used.
Some people are a bit uneasy about using the word “competence” because it implies standards
for achieving mastery. Essentially, that is what it should imply, as it would when one strives
for competence in any field. The goal of cultural competence training for health care
professionals is mastery of specific knowledge and skills that increase their ability to provide
Why Do Health Care Professionals Need to be Trained in Cultural Competency?
The last 25 years have brought many demographic changes to the United States, intensifying
in the last ten years of the 20th century. Political and economic changes elsewhere in the world
have sent a massive number of refugees and immigrants to our country. We are, in fact, in the
middle of the largest wave of immigration the nation has ever known. We are also a polyglot
nation, and many people are limited speakers of English. Not only are there many languages,
but also there are many different concepts about health care.
Every culture has, interwoven into its basic worldview, beliefs about health, disease, treatment
and health care providers. People from the many immigrant cultures bring these beliefs, as well
as the practices that accompany them, into our clinics, hospitals and other health care
organizations. These often prove to be a challenge to health care professionals who have been
trained in the philosophy, concepts and practices of Western medicine.
Responding to this challenge, the Office of Minority Health in the U.S. Department of Health and
Human Services conducted a two-year study by a panel of national experts resulting in the
development of the National Standards for Culturally and Linguistically Appropriate Services in
Health Care, commonly called the CLAS Standards. Published in the Federal Register in
December 2000, the 14 CLAS Standards serve as a guide to quality health care for diverse
populations, and many health care organizations are following their guidance. Included among
the 14 standards is one that recommends that health care organizations ensure cultural
competence in their professional staff by offering them education and training in the field. The
CLAS Standards, along with an in-depth discussion of how they were formulated, are available
at www.omhrc.gov/clas.
Accreditation organizations, such as the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO), following up on these standards, are requiring that health care
professionals receive training in delivery of services to diverse populations, as are some state
contracts for Medicaid and Medicare. The Centers for Medicare and Medicaid Services (CMS)
are recommending that health care organizations with whom they contract for these services
provide culturally and linguistically appropriate care.
Additionally, as the state and federal government collected health status statistics and set goals
around the health of the nation, it became painfully clear that some population groups in
America suffer disproportionately from poor health, disease and limited access to health care.
Studies of the variance in disease burden and poor health across U.S. groups culminated in an
Institute of Medicine study and review document, Unequal Treatment: Confronting Racial and
Ethnic Disparities in Health Care, March 2002 (available at www.nap.edu). This document
discusses the various patient-based, systems-based and health care provider-based factors
that lead to unequal treatment in health care. Again, among the several recommendations
made in this study to begin to address and to resolve these disparities is to “Integrate
cross-cultural education into the training of all current and future health professionals.”
A Manager’s Guide to Cultural Competence Education for Health Care Professionals
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Numerous health care professional associations, such as the American Association of Medical
Colleges, American Medical Association, and the American Nurses Association have urged
professional schools to include attention to cross-cultural medicine and health care disparities
in their basic educational programs. Medical schools and residency programs as well as
nursing schools are responding to these recommendations by instituting classes and activities
designed to enhance the cultural knowledge and sensitivity of their graduates.
But what about the health care professional already out of school and in practice — the health
care professionals working in your organization? Health care organizations from health
management organizations and health plans to individual clinics and hospitals are seeking to
adhere to the accreditation requirement and CLAS Standards by providing cultural competence
training to their staff. Area Health Education Centers are mounting conferences and seminars
on the subject. Since the field is so new, however, managers and continuing education
organizers are often confused about what kinds of training exist and who offers high quality,
meaningful cultural competence education. This guide is designed for them.