Implementing Cultural Competence in the Health Care Organization: Recommendations for Planned Parenthood Health Systems

Cultural competence in health care organizations is a way to extend to patients from every culture or ethnic background equal access to quality health care. Constant! y shifting demographics are changing the health care needs of communities; language and culture baniers have the potential to create enormous gaps in health care for members of racial and/or ethnic minority groups. This study explores similarities of culturally competent health care organizations and examines their keys to successful implementation. Leadership buy-in and self assessment as essential steps are explored and several models of delivery are reviewed. Baniers in this process are also examined and discussed and then recommendations on cultural competence implementation for private health care organizations are given. Specific recommendations are made to Planned Parenthood health services programs that can be extended to other health care organizations. Implementing Cultural Competence 3 On Sunday March 23, 2008, Kara Neumann, 11, died in her family's home in Wausau, Wisconsin. Her death was related to complications of undiagnosed and untreated type-1 diabetes. Her parents knew she was sick but not why, because she had not visited a doctor since she was three. They chose instead to put their faith in God and pray for the return of her health ("Child's Death," 2008). Would the child still be alive if the parents knew of a health care provider who would be able to understand their position on prayer and healing and was respectful of it? Introduction An increasingly diverse and multicultural society challenges health care organizations and providers to consider culture as it influences health. Health care providers across the country can conceive that culture and language may influence individuals' health, healing, and wellness belief systems. What may be less clear to these same providers is how illness, disease, and their causes are perceived by the patient and how treatment is given and by whom. Help-seeking behaviors and attitudes toward health care providers and how rights and/or protections are exercised by individuals from other cultures may be mystifying to health care providers, thereby creating an environment, as possibly seen by the patient, as one that is wrought with judgment. Whether it is perceived or real is of little consequence because to the patient it is the same. Every health care provider has his or her own biases which distort the lens through which they view their world. Furthermore in 2002, an Institute of Medicine report presented compelling evidence that "minorities tend to receive lower-quality health care than whites do, even when insurance status, income, age and severity of conditions are comparable". Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care is a comprehensive study of health disparities in Implementing Cultural Competence 4 the United States. "Although myriad sources contribute to these disparities, some evidence suggests that bias, prejudice, and stereotyping on the part of health care providers may contribute to differences in care" (Institute of Medicine, 2002). Because of this, organizations are looking at ways to increase cultural and linguistic competence among their employees and systems as a way for their providers to better understand how culture impacts health and how transcending these diverse beliefs can lead to equal access and quality health care (Ahmann, 2002; "Cultural Competence," 2001; Harlan, Lecture, 2007). Cultural and linguistic competence can be defined as the ability of health care providers and health care organizations to meet the social, cultural and linguistic needs of patients that present with diverse values, beliefs and behaviors (Betancourt, 2002). Cultural competence has been defined in multiple ways and is often described as having knowledge, awareness, and sensitivity to the meaning of culture and as respect for differences with a desire to learn. However the most common referenced definition across time and disciplines is "a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enables that system, agency, or those professionals to work effectively in cross-cultural situations" (Cross, T., Bazron, B., Dennis, K., & Isaacs, 1989). Why is this important? In 2000 31% of the population was identified as a racial or ethnic minority, and this is expected to increase to 40% by the year 2030 and to 50% by 2050 (US Census Bureau, 2000). Currently the United States Census Bureau ("Population clocks," 2008) estimates the population of the United States to be 303,768,485 people. In addition to ever increasing percentages, health disparities including diabetes, heart disease, stroke, drug and alcohol abuse, and cancer persist in racial and ethnic minorities (IOM, 2002). If there is any language or cultural barrier that prevents even one percent of the racial or ethnic minority Implementing Cultural Competence 5 population, over 940,000 people, from seeking, having equal access to or obtaining quality health care, the potential costs in terms of early morbidity and mortality would be great. "Failure to understand and manage social and cultural differences may have significant health consequences for minority groups in particular" (Betancourt, Green & Carrillo, 2002, p, V), Putting aside the issue of addressing health disparities and taking into account the increase in the population in general, becoming a culturally competent health care organization could become a must from a business perspective just by looking at the law of supply and demand. In a community where there is a large population of racial and ethnic minorities but few culturally competent health care providers, there is high demand and low supply. Providing culturally competent care to this population helps to increase the supply to meet the demand, and it increases the population base from which an organization could recruit patients as well as employees, thereby securing a larger portion of the market share of both. Providing a culturally competent environment internally provides a place where cross-cultural employees can contribute fully to the agency's overall success by offering their own experiences and perspectives (Van Ngo, 2000). Planned Parenthood Health Systems (PPHS) in Raleigh, North Carolina, through their self-assessment process, identified a significant need in their community. The Latino population was being underserved for reproductive health; based upon the results, the leadership of the Raleigh health center developed a plan to address this need. In an effort to fund this plan, PPHS applied for and received money that allowed them to expand their patient population and service provision ("Breaking Cultural Barriers," 2007). Providing culturally competent care allowed the health center to obtain funding that would have been inaccessible otherwise. Implementing Cultural Competence 6 Planning for cultural competence, which assures appropriateness of care to diverse populations, is a lengthy process that requires time, energy and resources from the stakeholders (board of directors, agency staff and leadership, clients, and community). Some organizations have done this successfully and completely and are considered models for the masses while some never get out of the planning phase. What keys to implementation did the first group possess and what barriers did the second group face?