Culturally competent health care

When new technologies are not available to all members of a society, they can exacerbate existing inequalities in the system of medical care. Currently the structure of the U.S. health care system is fundamentally flawed. Racial and ethnic disparities in health status and health care, more than 40 million uninsured, spiraling health care costs, and inadequate levels of culturally competent medical care are all evidence of this problem. 

Campinha-Bacote, J., The Process of Cultural Competence in the Delivery of Health Care Services, Transcultural C.A.R.E. Associates, Ohio (1998 and 1999). 

To deal with the health care dimensions of LEP, hospitals, clinics, and physician s offices must plan for and undertake a culturally competent response. The Rural Action Center, an initiative of the Department of Health and Human Services, defines cultural competence as... 

Tervalon, M., 8c Murray-Garcia, J. (1998). Gultural humility versus cultural competence A critical distinction in defining physiciantraining outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117. 

Barber, N., Rawlins, M., Franklin, B. D., Reducing Prescribing Error Competence, Control and Culture, Quality and Safety in Health Care, Vol. 12, 2003, pp. 129-132. 

Accepting responsibility for safety includes continuing the duty of care to a family with ongoing communication, truth telling, and offers of support from an outside expert. Communication is a core competency of the health care professional and a core duty in a safety culture. The duty for leaders is to try to maintain a healing relationship with patients even in the face of tragedy. 

Communication methods must serve all patients and families in the health care system if we are to achieve the Institute of Medicine s aims of safe, effective, patient-centered, timely, efficient, equitable care. Multicultural competence is not about tolerance or polite accommodation of differences (Chase, 1989, p. 36) but rather about awareness of and respect for cultural differences as evidenced in care that meets physical, emotional, and spiritual needs. This kind of care takes time and humility in addition to expertise. 

Use of interactive educational formats available to the worlforce for developing cultural competence. Educational dialogues and presentations that take place at new-employee orientations, conferences, department-specific presentations, grand rounds, and other venues can include discussion of cultural and linguistic factors in health care disparities, effects of cultural differences on the care encounter, and effective communication across languages and cultures (B. Kalanj, M. Khalif, and T. Culbert, personal communications, 2003). 

Arroyo, W. (1998). Immigrant children and families. In M. R. Isaacs (Ed.), Promoting cultural competence in children s mental health services. Systems of care for children s mental health (pp. 251-268). Baltimore, MD Paul H. Brookes. 

Cultural competency imperatives and mandates in school mental health clinical practices can be used to inform and drive the system. Until cultural sensitivity, relevancy of services, and cultural competency are fully understood and embraced, culturally appropriate services may be lacking for increasingly diverse communities within schools. An understanding and appreciation of services that culturally exclude contrasted to school-based mental health services that culturally include are highly relevant. What follows are a description of both exclusive and inclusive mental health practices and the author s stance of culturally responsive and effective mental health care in schools. 

Johnson, J., Mock, M. (June 21,2000). The foundations of cultural competence in mental health. Paper presented at the meeting of the Adult Children Systems of Care Conference, Santa Clara, CA. 

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