Cultural Competency Health Professionals Canada This paper discusses cultural competency for health professionals in Canada. Defining cultural competence for healthcare as respectful awareness of cultural differences, the importance of this perspective is discussed. Aspects of cultural competency, ranging from the purview of the healthcare insurance industry, to the perspective of the Canadian Nurses Association, are presented. Also, Rani Srivastava's 'Guide to Clinical Cultural Competence' is used to guide the discussion. Also, articles from scholarly journals are explored for the analysis.

Defining and classifying Cultural Competency

According to the United States National Institutes of Health (NIH, 2015), cultural competency, as applied to healthcare, 'enables providers to deliver services that are respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of diverse patients'. In another place it is defined as "a set of congruent behaviors, attitudes and policies that come together to enable a system, organization or professionals to work effectively in cross-cultural situations" (Srivastava, 2007). Using a question-and-answer format, with questions such as 'Can cultural competency make a difference?' The NIH guide explains that cultural competency is required for appropriate delivery of health care, and 'cultural competence is also critical for achieving accuracy in medical research' (NIH, 2015). The classic cautionary 'story' told to illustrate the importance of cultural competence concerns use of 'traditional and herbal medications and teas' by patients -- that may directly counteract and/or interfere with physician-prescriptions. The healthcare practitioner needs to be sensitive to, and aware of, cultural differences that might impact the patient's well-being, and be an important part of the patient/patient-family dynamic that must be considered.

Yet another perspective on cultural competence is found in The Healthcare Professionals Guide to Clinical Cultural Competence by Rani Srivastava (2007). This book can be counted among the leading works dealing with development of cultural competence with regards to a healthcare setting. Focusing on healthcare that is client-centered, this book offers an introduction to development of cultural competence. Ms. Srivastava's book begins by defining the concept of 'cultural competence' (vide infra), and from there moves into deeper levels of practical and theoretical aspects of cultural competence. Application of the concepts to clinical setting(s) and to different populations are also illustrated (Srivastava, 2007).

A stylistic comment: the Canadian and British authors in references herein use the word 'competence' where we 'Americans' would say 'competency'. They are used interchangeably throughout this work.

The Growth of Cultural Competency in Canadian Healthcare

Srivastava defines cultural competency as "The application of knowledge, attitudes, and skills that enhance cross-cultural communication and foster meaningful, respectful interactions with others." (Srivastava, 2009, p. 25).Cultural competency is an important strategy for improving quality and eliminating ethnic/racial disparities with regards to healthcare. This concept has increasingly garnered attention. In 2002, interviews were conducted with cultural competence experts from the government, academe, and managed care in Canada and globally, in order to understand their opinions pertaining to the field. Research findings were presented and current cultural competence trends were identified, with focus on healthcare practice, policy and education. The analysis shows that several stakeholders in healthcare are involved in the development of cultural competence initiatives (Betancourt et al., 2005). Still, motivations for making advances in cultural competence, as well as approaches adopted, differ based on goals, mission and spheres of influence.

Cultural competence can be seen as an important emerging strategy for addressing disparities in healthcare amongst stakeholders in academe, managed care, and government. It has caught the attention of policymakers in healthcare, healthcare providers, educators and insurers as a tactic for improving quality and eliminating ethnic/racial healthcare disparities. Cultural competence's goal is creation of a healthcare workforce and system that has the capability to deliver top-quality healthcare to all patients irrespective of culture, ethnicity, race or proficiency of language. Achieving this requires different healthcare sectors, with different approaches, leverage points and motivation to act and make progress in the field (Betancourt et al., 2005).

According to Srivastava, cultural competence is guided by "the shared and transmitted knowledge of values, beliefs, norms and life ways of a particular group of people that guides an individual or group in their thinking, decisions, and actions in patterned ways" (as cited in Srivastava, 2007, p. 14). Three practical explanations can be given for the emergence of cultural competence as a significant issue. First, as the United States (U.S.) and other countries globally, becomes more culturally diverse, healthcare practitioners will increasingly come across patients having a wide range of viewpoints with regards to health, normally shaped by their cultural or social backgrounds. For example,...

Their proficiency in English may be limited, and they might have different healthcare-seeking thresholds, or expectations regarding their care. Also, unfamiliar cultural perspectives may influence whether they follow providers' recommendations or not. Second, studies have depicted that communication between provider and patient is associated with patient satisfaction, adherence to medical advice, and effects on health (Betancourt et. al, 2005). Therefore, poorer outcomes in health may ensue when there is no reconciliation of socio-cultural disparities between providers and patients in clinical encounters. These barriers, ultimately, do not only apply to minorities but may only be more obvious in these instances. A landmark report from the Institute of Medicine (IOM) - Crossing the Quality Chasm- emphasizes the significance of cultural competence and patient-centered healthcare in quality improvement and elimination of ethnic/racial differences in healthcare (IOM, 2001).
Current trends in the health care field confirm these perspectives concerning cultural competence. For instance, health insurers like Aetna, Blue Cross and Blue Shield of Florida, and Kaiser Permanente have established cultural competence initiatives. Long-standing endeavors have been made by Kaiser Permanente, ranging from educational articles on cultural competence to complete "Centers of Excellence in Cultural Competence" that target specific population segments (Betancourt et al., 2005). Aetna began collecting data on ethnicity and race from its members, and devised 'culturally competent programs on disease management'. Aetna also mandated training in cultural competence for its in-house medical directors, case managers, and nurses. Florida's Blue Cross & Blue Shield has also taken on cultural competence initiatives, including in-house diversity training, as well as education in cultural competence for healthcare providers (Betancourt et al., 2005).

Furthermore, healthcare purchasing coalitions such as the National Business Group on Health have actively informed their members about ethnic/racial healthcare disparities and cultural competence. Accreditation agencies, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the National Committee for Quality Assurance (NCQA), have also been looking for opportunities to incorporate measures for tracking cultural competence and disparities (Betancourt et al., 2005). Overall, major developments have taken place in the cultural competence field ranging from healthcare insurers to healthcare purchasers, and including managed care policies. However, strong resistance still exists to investments in the field of cultural competence, because financing entities look for evidence supporting the possibility of costs savings and quality improvement. Organizations that have made investments in the field of cultural competence perceive themselves to be committed to equity, quality, and diversity issues. These organizations accept the possibility of increasing share of market by marketing these efforts.

Effect of Cultural Competency on Health Professionals in Canada

The patient population in Canada is diverse and increasingly so in recent times, requiring the professionals to be more alert to racial equality, cultural ethos and competent to discharge duties sensitively to ethnic concerns. In most of the cases that have been documented under improper treatment, there is little evidence of concerted racial discrimination or bias. The disparities arise out of common professional causes arising out of pressures of time. Such constraints cause an impulsive stereotyped response and lack of concentration causes "application error." Meaning the professionals fail to apply specific epidemiological data to the patient under consideration owing to pressures of multitasking. These are not directed cultural bias, instead a common occurrence in the harried medical profession where the physician or healthcare worker has a lapse of concentration and sensitivity to cultural consideration of the patient. (Geiger, 2001).

Health care quality suffers and disparities arise out of racial diversities. This fact is well documented. The solution to such issues is to improve the cultural competency of professionals and organizations in the field. 'Cultural Competence' is the ability of to discharge duties equitably across cultural Diasporas- interpersonal relations with patients and amongst the workers. Sensitization to cultural attributes and understanding the effect of such influences in interpersonal interaction and finding ways to attend to them is the way forward according to experts and commentators.

It has also been brought out in scholarly studies that the worst sufferers of discrimination in healthcare services are children. Minority and disadvantaged children carry most of the early childhood experiences into their adulthood and this primary aspect is reflected in their cognitive and educational outcomes as well. In addition to low income group and less privileged population, the same also applies to racial and cultural discrimination, leading to an overall negative in quality of life. (Grant, Parry, & Guerin, 2013)

Here it becomes important to define 'culture', as a proper understanding would…