ascls_logo-300x199Many cultural groups, including gays and lesbians, disabled individuals, individuals with faiths unfamiliar to a practitioner, lower socioeconomic groups, ethnic minorities, and immigrant groups may receive no medical care or are grossly underserved for multiple reasons.  Lack of cultural competency of healthcare providers is one of the reasons these groups may receive inadequate medical care.1

Cultural competency is the skill of using multiple cultural lenses:

  • cultural awareness implies recognition of culturally unique behaviors
  • cultural sensitivity implies a recognition and accommodation of culturally unique behaviors.2

Cultural competence incorporates cultural awareness, cultural sensitivity, and cultural appropriateness but moves beyond, requiring a mastery of cultural knowledge, perspective, and behavior. Each healthcare professional must be aware of his or her biases and be willing to do what is needed to achieve cross-cultural efficacy of all patients.

For example, laboratory professionals must become skilled in communication with the patient populations served.  Effective communication is an integral part of providing equitable care, and language barriers significantly impact safe and effective health care.2  Because communication is a cornerstone of patient safety and quality care, every patient has the right to receive information in a manner he or she understands.  The Joint Commission now integrates linguistic and culturally appropriate care into its accreditation process and the ability to offer it is a mandate in awarding Medicare contracts to managed care institutions.3

Organizations providing care to a patient with limited English proficiency (LEP) face particular challenges.  Approximately 57 million people, or 20% of the U.S population, speak a language other than English at home, and approximately 25 million or 8.6% of the U.S. population are defined as LEP.3  LEP patients are at higher risk for adverse events than English-speaking patients.  English is a particularly linear language.  Americans give instructions with linear time markers such as “first do,” “then do,” etc.  Patients from some cultures in which stories or events are described by weaving in and out of a central theme or starting from a conclusion and working inward in a circular sequence toward an initial event may have difficulty complying with English instructions; e.g., properly collecting a midstream urine specimen.

Typical failures related to LEP patients that can occur in an organization are:

  • Use of family members, friends, and unqualified staff as interpreters
  • Provider use of basic language skill to “get by”
  • Failure to recognize cultural beliefs and traditions that affect care delivery, such as expression of pain, respecting authority, gender roles, and class biases

Developing cultural competence must be integrated into laboratory curricula as a component of providing patient-centered care.2  Educators and managers must be skilled and able to determine if students and laboratory staff are achieving cultural competency.  If laboratory professionals are serious about their desire to provide the best possible care to all patients, regardless of age, gender, ethnic origin, etc., it is essential that they become culturally competent.4

References:
  1. The American Congress of Obstetricians and Gynecologists Committee Opinion. “Cultural Sensitivity and Awareness in the Delivery of Health Care.”  May, 2011 (Reaffirmed 2013), No. 493. 
  2. Caskey, C. “Cultural Competency in the Laboratory.”  Clinical Laboratory Science.  Fall, 2002. 15(4) 200-203.
  3. Quick Safety. The Joint Commission.  Issue Thirteen, May 2015. “Overcoming the Challenges of Providing Care to LEP Patients.”
  4. Galanti, G. “The Challenge of Serving and Working with Diverse Populations in American Hospitals.” The Diversity Factor.