Cultural Competency for Health Professionals in Canada

Defining and Classifying Cultural Competency

This paper discusses cultural competency for health professionals in Canada. Defining cultural competence in healthcare as a respectful awareness of cultural differences, the paper explores the importance of this perspective across several dimensions — from the purview of the healthcare insurance industry to the perspective of the Canadian Nurses Association. Rani Srivastava's Guide to Clinical Cultural Competence is used to guide the discussion alongside articles from scholarly journals.

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 formulation, 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, the NIH guide explains that cultural competency is required for appropriate delivery of health care, and that "cultural competence is also critical for achieving accuracy in medical research" (NIH, 2015).

The classic cautionary example used to illustrate the importance of cultural competence concerns patients' use of traditional and herbal medications and teas that may directly counteract or interfere with physician-prescribed treatments. The healthcare practitioner needs to be sensitive to, and aware of, cultural differences that might impact the patient's well-being and that form an important part of the patient-and-family dynamic that must be considered.

Another significant perspective on cultural competence is found in The Healthcare Professional's Guide to Clinical Cultural Competence by Rani Srivastava (2007), one of the leading works dealing with the development of cultural competence in a healthcare setting. Focusing on client-centered healthcare, the book offers an introduction to cultural competence development. It begins by defining the concept, then moves into deeper practical and theoretical aspects, with illustrations of how these concepts apply to clinical settings and different populations (Srivastava, 2007).

It is worth noting that Canadian and British authors in the relevant literature tend to use the word "competence" where American authors would say "competency." The two terms are used interchangeably throughout this paper.

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 and racial disparities in healthcare, and this concept has increasingly garnered attention. In 2002, interviews were conducted with cultural competence experts from government, academia, and managed care in Canada and globally in order to understand their perspectives on the field. Research findings were presented and current cultural competence trends were identified, with a focus on healthcare practice, policy, and education. The analysis shows that several stakeholders in healthcare are involved in developing cultural competence initiatives (Betancourt et al., 2005), though motivations for advancing cultural competence — as well as the approaches adopted — differ based on goals, mission, and spheres of influence.

Cultural competence has caught the attention of policymakers, healthcare providers, educators, and insurers as a strategy for improving quality and eliminating ethnic and racial healthcare disparities. Its goal is to create a healthcare workforce and system capable of delivering high-quality care to all patients regardless of culture, ethnicity, race, or language proficiency. Achieving this requires action across different healthcare sectors, each with different approaches, leverage points, and motivations (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 reasons explain the emergence of cultural competence as a significant issue. First, as countries become more culturally diverse, healthcare practitioners will increasingly encounter patients with a wide range of perspectives on health, typically shaped by their cultural or social backgrounds. Patients may describe their symptoms in ways that differ substantially from clinical conventions, may have limited English proficiency, or may hold different healthcare-seeking thresholds and expectations. Unfamiliar cultural perspectives may also influence whether they follow providers' recommendations. Second, research has shown that provider-patient communication is associated with patient satisfaction, adherence to medical advice, and health outcomes (Betancourt et al., 2005). When socio-cultural differences between providers and patients are not reconciled in clinical encounters, poorer health outcomes may result. A landmark report from the Institute of Medicine — Crossing the Quality Chasm — emphasizes the significance of cultural competence and patient-centered care in quality improvement and the elimination of ethnic and racial disparities in healthcare (IOM, 2001).

Current trends in the healthcare field confirm these perspectives. Health insurers such as Aetna, Blue Cross and Blue Shield of Florida, and Kaiser Permanente have established cultural competence initiatives. Kaiser Permanente has pursued long-standing efforts, ranging from educational articles to complete "Centers of Excellence in Cultural Competence" targeting specific population segments (Betancourt et al., 2005). Aetna began collecting data on ethnicity and race from its members and developed culturally competent disease management programs, while also mandating cultural competence training for its in-house medical directors, case managers, and nurses. Blue Cross and Blue Shield of Florida similarly adopted cultural competence initiatives, including in-house diversity training and education for healthcare providers (Betancourt et al., 2005).

Healthcare purchasing coalitions such as the National Business Group on Health have also actively informed their members about ethnic and racial healthcare disparities and cultural competence. Accreditation agencies, including the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the National Committee for Quality Assurance (NCQA), have been exploring ways to incorporate measures for tracking cultural competence and disparities (Betancourt et al., 2005). Despite these major developments, strong resistance to investment in cultural competence still exists because financing entities seek evidence of cost savings and quality improvement. Organizations that have invested in cultural competence tend to view themselves as committed to equity, quality, and diversity, and accept the potential for increased market share by marketing these efforts.

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