Begin Removing Barriers

CULTURAL COMPETENCE IN THE HEALTH CARE SYSTEM

The culture of the medical system in the United States has historically been male-dominated, Caucasian, heterosexual, pathology-driven, and science-based. Many lesbian, gay, bisexual, and transgender (LGBT) patients fear bias from a health care provider, which creates a barrier to optimal health care; the patient may provide incomplete medical information which may result in poor health outcomes. For example, a health care facility’s intake form may only list single, married, widowed, and divorced as options to indicate marital status. Should a lesbian in a committed relationship check single because she is legally regarded as being single? Doing so devalues her relationship and hinders disclosure. Right from the start, she lacks an opportunity to be open about her relationship. The form sends the message that her relationship and its implications for her health are things she may not want to share. Cultural competency starts even before the patient walks in the door of the health care facility.

According to the 1999 IOM report on lesbian health, cultural competence operates at two levels: the individual and the institutional. At the individual level, cultural competence is the set of behaviors, attitudes and knowledge that enable a person to interact effectively with people who are different from them. For example, it means knowing that Asian women tend to be more modest than Caucasian women and that, for them, remaining draped during exams might be even more important. Individual cultural competence means that one person knows how to communicate effectively with people who are different.

At the institutional level, cultural competence is a set of behaviors, attitudes, and policies that enable an organization to serve people of different cultures in respectful and appropriate ways. For example, it means changing intake forms so that the word “partner” is included instead of just “spouse” and/or allowing for gay men and lesbians in committed relationships to list their partners’ names. At the institutional level, it means that an organization is consciously set up to meet the needs of people from different cultures.

In the health care setting, culturally competent care is a comprehensive system of clinical practices, standards of care, and management policies that are wrapped up in an institutional philosophy that seeks to provide excellent care by being responsive to the cultural factors that influence the attitudes and behavior of every patient. Culturally competent care requires that providers be proficient in meeting patients’ needs within and across cultural lines.

The benefits of culturally competent care include:

• Increased access to services
• Improved prevention and early intervention
• Better communication and rapport
• More accurate diagnoses
• Improved treatment adherence and compliance
• More effective treatment outcomes
• Greater consumer satisfaction
• Increased patient retention
• More word-of-mouth referrals
• Reduced malpractice liability
• Cost savings
• Greater provider satisfaction

Cultural competence is a journey, not a destination. Individuals and organizations should always continue to learn about and improve on the ways they interact with others. Cultural competence is a skill that can be learned, one which requires ongoing practice and commitment.