Increased diversity throughout the health care field — among both providers and patients — can be an amazing opportunity to provide even more customized care. But this diversification also adds another layer of complexity to the physician-patient-caregiver team; communication with patients and their families in a respectful, compassionate and sensitive way is required to build confidence and trust. Effective communication is also essential to fully understand the patient’s health needs and craft an appropriate and meaningful care plan.
Health care professionals need to be mindful of not only ethnic diversity, but also differences in economic status, religious beliefs, weight, height, gender and more. Cultural beliefs have many dimensions, including decision-making styles, healing traditions, spirituality, expectations and assumptions about privacy/disclosure, status/hierarchy, socio-economic status and immigration status. Given this complexity, how do we equip our health care teams with the necessary skills to successfully navigate a plethora of culturally sensitive conversations?
The solution lies deeper than basic communication skills: It also involves reflective listening, accurate and efficient information gathering, joint-agenda setting, and recognizing the emotion of the patient and responding appropriately. It starts internally. Providers must be able to identify any underlying, existing personal biases and how those biases may impact interactions, the overall provider-patient relationship and, ultimately, clinical outcomes, safety and efficiency.
Here are some strategies for health care professionals to recognize and correct for biases to provide better care for all:
Concentrate on relationships
A key to delivering high-quality, safe and efficient whole-person care is a focus on meaningful relationships within each patient’s care team. Those relationships are also paramount to creating a culture of mutual respect, teamwork and trust — a culture focused on providing excellent care.
At the same time, we need to acknowledge the existence of health inequalities, personal bias and their connection to unequal quality of care. Building solid relationships is key to improving outcomes.
Unearth biases and assumptions
At the core of culturally sensitive communication is the need to develop a greater understanding and acceptance of beliefs that differ from one’s own. It is crucial to recognize that the personal and cultural beliefs of the health care professional affect decision-making and, therefore, patient outcomes, safety and efficiency.
As an individual or organization begins a cultural diversity journey, personal awareness work is often the first step. Professionals must become aware of biases and assumptions and how they affect relationships. Once members of the care team take their blinders off, they’re able to truly connect with patients and colleagues and to form cohesive teams.
Another effective step in the personal awareness journey is recalling one’s first memories of feeling different and the associated emotions. This can be a powerful exercise, providing valuable insight.
If a hospital or health care facility does not offer diversity and inclusion training internally, providers should seek continuing education courses — either in person or online — to enhance their service to patients and their families.
Practice inclusive communication techniques
It is impossible to anticipate every cultural belief and tradition a health care professional will encounter with patients over the course of a career. Therefore, it is important to be equipped with skills to understand patients’ cultural behaviors and environments, improve ethnic-specific knowledge of disease states and enhance trust among all members of the health care team.
To accomplish this, physicians and caregivers must learn to weave back and forth between the disease at hand (i.e., the differential diagnosis) and the illness at hand (i.e., the patient’s experience and his or her ideas of what is wrong and how to treat it). This will allow the physician or caregiver to obtain a more accurate history and develop a shared treatment plan — resulting in improved patient compliance, a sense of being valued as an individual, and mutual respect and trust between the health care professional and the patient.
Partner with interpreters
It would be remiss to discuss culturally sensitive communication and not consider the use of interpreters when language can be such a concrete barrier to communication. With increased diversity also comes the need for trained medical interpreters to obtain accurate historical information and communicate treatment plans in native languages. However, formal training on the appropriate use of interpreters in health care is somewhat limited.
Accurate interpretation requires no additions, no omissions and no changes to the story. The use of untrained interpreters, such as a patient’s family members or hospital office staff, increases the risk of an inaccurate history and, therefore, an inaccurate treatment plan. It is crucial that health care professionals seek out instruction on the appropriate use of interpreters and rely solely on trained medical interpreters.
To deliver excellent care and ensure the best possible outcomes for the patients and families we have the privilege of serving, it is crucial that those in the health care field fully understand the diversification of America, as well as our own biases and assumptions. Actively seeking opportunities to practice and improve culturally sensitive communication will go a long way toward connecting with patients who experience the American health care system differently.
William Maples, M.D., leads The Institute for Healthcare Excellence and is chief medical officer at Professional Research Consultants Inc. in Omaha, Neb. Before launching the institute, he was senior vice president and chief quality officer at Mission Health in Asheville, N.C.
The opinions expressed by the author do not necessarily reflect the policy of the American Hospital Association.