Keys to Creating Cultural Competence within Healthcare Organizations

As more and more healthcare organizations strive toward cultural competence, the importance of a diverse and educated workforce has never been more important. Meeting patients’ needs culturally, socially and linguistically requires caregivers who can connect with them.

“There's clear data that having your organization both reflect your community and that increased diversity leads to better patient outcomes and better healthcare,” said Elisa Arespacochaga, vice president, clinical affairs and workforce, American Hospital Association.

Carla Carten, senior vice president and chief diversity, equity and inclusion officer, Mass General Brigham, noted that healthcare organizations need to be strategic and intentional when working on cultural competence.

“There’s so much that can be done, that it is really easy to get overwhelmed with everything that could take place to make our organizations more accessible to our communities, and our communities more accessible to our organizations,” Carten said. “Especially through the lens of diversity, equity and inclusion.”

Achieving cultural competence in healthcare involves educating youth of all backgrounds about opportunities within healthcare, creating opportunities for career growth for those already working in the industry, identifying roadblocks within organizations, and training leadership.

Education and Opportunities in Healthcare

“I don't think this is something we're going to solve either quickly or using just one method,” Arespacochaga said. “I think there are a number of different activities that we need to be thinking about and helping organizations plan.”

To start, she advocates reaching out to young people who might be interested in healthcare, and talking to them about all the different types of careers available. 

“It's not just a nurse or a doctor and that's it. There's a whole city of jobs within a hospital or health system that could be appealing,” Arespacochaga said.

Besides helping school-aged children learn about careers in healthcare, she noted that there needs to be an educational effort for those already in the field about how to advance or change paths.

“How do we create opportunities so that those who are maybe in an entry-level position who want to pursue additional degrees, or additional training, or additional certification to move through a less of a career ladder and more of a career lattice within our organizations are able to do that?” Arespacochaga asked.

Carten agreed with the lattice analogy.

“Growth doesn't always mean like the next rung on a particular ladder, but being much more creative and understanding what are other ladders, what are other ways, what are other possibilities across the system,” she said.

Communication Is Key to Cultural Competence

Within healthcare organizations, effective communication and training is key to achieving cultural competence. Arespacochaga said that she encourages people to approach everyone with positive intent.

“I think one of the most valuable things we can bring to any table where we need to share information is that, that sense of positive intent and really being willing to share, and hear, and listen, and understand from each other,” she said.

Within her association, Arespacochaga said that sharing stories has been a huge help in moving forward in learning cultural competence.

“Being able to share what organizations have done either in their communities with different community partners, the outreach that they've done,” she said. “I think a lot of times people don't know what they don't know until someone suggests it.”

Carten added that in healthcare the art of storytelling is important, despite the industry’s heavy reliance on science, research and data.

“Without data and numbers, we can't measure effective change, but we need to be able to really develop our human language skills on how to take data and turn it into a narrative. Or start with the narrative and then support it with the data,” Carten said.

She noted that while teaching a health equity course she shared her own stories about how black people are treated differently when they go to the doctor.

“That was my story, but that story statistically replicates throughout the black and brown experience in healthcare. And those kinds of stories can open people's minds much more than if I have gone in just with the data of statistics of this, that and the other thing,” Carten said.

Identify and Name Roadblocks

When healthcare organizations encounter difficulties on the path to cultural competence, Carten noted that leaders should identify the roadblocks and name them.

“Find the people who are willing to listen and then have them help build that story of ‘This is the roadblock. This is how I need your allyship in addressing that this roadblock is real. It actually exists.’ And together you started building coalitions of bringing people together to identify the roadblock and then to identify ways of going around, or moving through, or finding a way of just removing that roadblock,” Carten said.

Arespacochaga said overcoming roadblocks can include recruiting people to your side through identifying the obstacle and providing details and data to support solving the issue.

“Then having that leadership buy-in and agreement to say, these are things that are not acceptable to the way we want the world to work and really getting everyone to agree that this is important, and we need to deal with it,” Arespacochaga said.

Keep Learning

Healthcare leadership can continue to educate themselves on cultural competence, which will then help them make better decisions for their organizations. Arespacochaga recommended taking a course that does a deep dive on implicit bias.

“I don't think anyone ever will get rid of the biases they have, but to understand them and recognize them when they're happening, and being aware of how you're approaching a situation, I think makes such a difference in your ability to really keep front of mind what it is you're there to do. And so that to me was one of the most powerful experiences we were able to do as a team here,” Arespacochaga said.

Carten added that diversity, equity and inclusion education should also include the communication piece, helping people develop the skills and abilities to have the necessary conversations.

Some questions leaders can ask of themselves about bias include:

• What are my implicit biases? How do I recognize them?
• How do I not shame and blame others?
• How do I not shame and blame myself?
• How do I not make myself an obstacle?
• How do I try to stay in a learning mode so I can artfully listen?

And even those in IT departments and informatics play a role in creating cultural competence within an organization by looking for trends, helping others understand the data behind them and finding ways to implement them in their organizations.

“In healthcare, you really can see the change that you can make in your community, in the health of your community, and the ability of people to connect with their families,” Arespacochaga said. “It’s just such a calling that I would hope that even, the IT professionals who might be more removed from direct patient care would see that this is an opportunity to really change how healthcare works.”