The Single Most Important Thing You Need to Know About Diversity in Healthcare

“The essence of cross-cultural communication has more to do with releasing responses than with send messages. It is more important to release the right response than to send the right message.” – Edward T. Hall***

Imagine being in your early 20’s and going to a doctor for strange, dark, itchy marks that are appearing on your thighs and being told by this doctor, “Oh it’s nothing. It’s something that black women frequently experience. Don’t worry about it.” Now, as a black woman with a sister, close female cousins, a mother, several aunts, two grandmothers and several very close female friends who have never revealed nor displayed any such markings on their legs, what might you be thinking? Like most females, before going to the doctor, you asked your sister… the nurse… as well as your mother and a couple of other females what these dark spots might be. It was a mystery. Odd that something supposedly so common is unfamiliar to so many. So what made this doctor think these marks were common among black women, so much so that she felt no inclination to offer any treatment? What did this woman, do? She simply sought the advice of another doctor; one who was more experienced with treating women of color. The second doctor was not only experienced in caring for women of color but she was also familiar with the itchy marks on this patient’s legs… and she treated them!

The second doctor did not utilize her experience in caring for women of color to diagnose the spots. She used her medical expertise or familiarity with the malady to do that. What she did do with her experience caring for diverse populations, however, was speak to this patient with professionalism, compassion and a lack of stereotypic undertones in the process of rendering service.

Somewhere in the history of caring for others this physician made an assumption about African American women based on an encounter, an experience or something someone else may have told her. The result? Whether she realized it or not, she appeared insensitive or incompetent but worse than either of those, she lost a patient.

A Lack of Cultural Competence Compounds the Problem

Some healthcare organizations, police departments, mental health systems, education systems and others realize that if they serve customers they have to bridge the gap between worker lack of awareness and patron perceptions in order to provide superior service or mandated objectives. Unfortunately there are others who remain in the weeds, trying to figure out a better way to keep from doing anything different or inclusive. “Why can’t we just keep the old way of doing things, it works just fine?” they may say. The answer to the question, of course being, “The old way really did not work. It simply created a new problem we call disparities.”

Disparities are visible and typically significant differences or contrasts. The term is frequently used to describe an economic or social condition that’s considered unfairly unequal, as in racial disparities, health disparities, income disparities, gender disparities etc.

Practitioners with Inclusive Viewpoints Are Valuable Commodities

Everyone needs to see a medical professional at some point in their lives. How well or how poorly that visit is conducted can impact the frequency and success of future visits with that practitioner as well as others. Healthcare organizations have to drive inclusion home with healthcare workers as much as they do revenue generation, mortality rates, supply chain and medical errors. While many have caught on to the importance of workforce diversity, not all have recognized the necessity of cultural competence as an important component of inclusion. We cannot forget about the people we serve. Without them we have no business.

Cultural Competence Defined

Cultural competence is the ability to effectively interact with people from other cultures. In this evolving process, one continuously strives to work within the cultural context of another person or persons of a different cultural background, overcoming barriers to accomplish effective communication. Cultural competence is most definitely beneficial to individual growth and maturity but it ultimately helps to accomplish some of life’s most meaningful undertakings that are housed in systematic facets of society, such as judicial, corporate, educational, mental health and healthcare systems.

How Individuals Become Culturally Competent

An individual who is becoming culturally competent will find themselves developing and advancing through four stages of understanding that will yield culturally responsive interactions and ultimately produce culturally relevant interventions. These stages are a growth progression from Awareness, Knowledge, Skill and Encounter.

1. CULTURAL AWARENESS STAGE
Process of becoming sensitive to the world views of people from other cultures while also recognizing one’s own cultural norms, strengths and biases. It is recognizing and not denying that we all have a cultural background. It is acknowledging that while some may view their culture as a standard by which others should be measured, that is not the reality. When building cultural competence one is coming from the position of learning about another person’s culture and the recognition that all cultures have value.

2. CULTURAL KNOWLEDGE STAGE
When building cultural knowledge, the individual embarks on a process of gaining information and understanding about the world views and the actual belief systems of other cultures, such as beliefs about life, death, illness, relationships, child-rearing, family, money, religion etc. As this knowledge increases, so does the understanding of the challenges, joys and day to day choices and rationale faced by individuals from that culture. It opens up a world of understanding as to how and why people function the way they do.

3. CULTURAL SKILL STAGE
At this stage, one is learning “how” to obtain effectively and efficiently conduct a cultural assessment of an individual in order to provide more culturally specific service. So in a healthcare example, a health care provider must learn to extract meaning information from a patient in a very brief amount of time before the doctor sees the patient. The information obtained will be used by the doctor, to guide their discussion and examination and help them explore the patient’s concerns. It is therefore imperative that the initial health care provider and those following, are able to understand the patient’s conversation and cues, as information is being gathered. Questions and conversation may speak to issues of age, gender identity, eating etc. all of which necessitates the need for skill building in this stage of the process.

4. CULTURAL ENCOUNTER STAGE
This stage inspires individuals to move forward into engagement in cross-cultural interactions with individuals from diverse populations. Face to face encounters with real people are what validates the knowledge and skill that has previously been gained.

Avoid the Pitfalls of Inadequate Cultural Competence Development

One can never become overly confident in thinking that progression through these four stages warrants graduation from the school of cultural competence. It is a lifelong process that continues as we encounter new populations and new people. We must also take individual variations into account whenever we interact with individuals from other cultures, as well as our own.

Assumptions Lead to Stereotypes

It is very helpful to learn general characteristics of various cultures we may encounter and typically serve but we cannot lose sight of the reality that within every culture exists the individuals that make up that culture.

Another word for contempt is disrespect. Do not become overly confident with your perceived ability to “relate” to others that you become to familiar or friendly. Always be kind. Always be respectful. Always ask questions. Always listen to the answers.

2. Training is Required
An organization should never take for granted that individual practitioners or employees are going to learn cultural competence on their own or that it will just happen in the course of daily functioning. Training should be thorough, relevant and ongoing. It is not to be a one-time event nor is it a one size fits all. Training should be well developed and should be specific to the work being done.

3. Cultural Competence Development Must Be Supported
In order to support the effective development of cultural competence in staff and volunteers in any organizational structure, that environment should have ongoing diversity and inclusion initiatives in place. Training individuals without providing structural and institutional supports is counterproductive. This would incorporate management as well as budgetary support to implement and maintain this system of serving.

Closing Thoughts

Organizations are ramping up their diversity and inclusion efforts again, as they did in the late 80s and throughout the 90s. It often follows civil rights and social justice activism which raises awareness and consciousness to the needs and injustices that exist in our society. While the tide rises and falls, I can’t help wonder at what point we realize the fact that race, gender, age, culture and other differences are not going away. Because they are not going away, we have to effectively learn to incorporate working with them, for them and serving them now and in the future. It is not a start and stop operation but ongoing. Cultural competence is really a mandate for every industry and all organizational systems… if they want to be successful at what they do.

With that said, cultural competence should be a standard part of every educational program and every organizational training process along with diversity and inclusion. I recently took a look at a variety of content located on the internet. This included video and print resources. It was embarrassing as well as disappointing. I have definitely seen better days when it came to internet resources. It all reminds me of the refrain of a 1969 song by Friends of Distinction, “You’ve Got Me Going In Circles.” If what I saw on the internet in the form of cultural competence resources was what schools and healthcare practitioners have to work with today… well I would have to say, we haven’t learned much at all and we have landed right back where we started from. We have thus landed again at the impervious question, “Why can’t we just keep the old way of doing things, it works just fine?” And again I reply, “The old way really did not work. It simply created a new problem we call disparities.”

The single most important thing you need to know about diversity in healthcare? It’s the importance of Cultural Competence!

Best Regards!

C.

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