Health outcomes among ethnic minorities are noted to be worse compared to the general population. These disparities are associated with many factors including patient distrust of the health care system, ineffective communication with providers, and cultural differences (Misra-Herbert & Isaacson, 2012). The Office of Minority Health (OMH) developed the standards for Culturally and Linguistically Appropriate Services (CLAS) to address the language and cultural barriers to care (OMH, 2014). Three of the standards are discussed along with the level of organizational compliance. Recommendations for improving the application of the standards are also presented.
Standard on Diverse Governance, Leadership, and Workforce
The purpose of this standard is to diversify the leadership and workforce by encouraging organizations to mirror the diversity of the communities they serve. Leaders and employees of different cultural backgrounds have a lot to contribute in terms of knowledge and skills. Eliciting the ideas and perspectives of cultural minorities in the organization fosters innovation that will improve the level of cultural competence in service provision, achieve cost-efficiency, and reduce health disparities. In my workplace, 95% of nurses are Whites despite the Census showing that ethnic minorities, mainly Asians and Hispanics, compose 27% of the community. Hospital leadership is also 100% White. A human resource policy for the active recruitment of qualified cultural minority nurses is yet to be created.
Standard on Education and Training of Leadership and Workforce
Ethnocentrism which may manifest in prejudice and discrimination affects how health care professionals communicate with and care for patients (Singleton & Krause, 2009). Cultural competence is often something that professionals of the dominant culture do not possess and this standard highlights the need for education and training. Learning activities generate awareness of personal biases and expand individual worldviews to include knowledge of and respect for the health beliefs, values, and practices of others (Loftin et al., 2013). Policies reinforce culturally competent behaviors. There have been in-service educational activities for the nursing staff and providers regarding the cultural beliefs and practices of ethnic groups in the community as well as standard procedures when communicating with patients not proficient in English.
Standard on Print and Multimedia Materials and Signage
The purpose of this standard is to ensure language congruence. Signage in other languages allows patients who cannot read or understand English to navigate the environment. Likewise, print and multimedia materials in the patient’s language facilitate an understanding of his or her rights and responsibilities as well as health care information related to his or her medical condition. At present, our signage and most of the printed materials are in English, Spanish, and Chinese. However, many of our multimedia materials for patient education are available in English only and those with translations are in Spanish. As such, there are not enough materials for Asian but non-Chinese patients.
Recommendations
One recommendation is that commitment to workforce diversity should be manifested by human resource policies that promote the active recruitment, retention, and development of qualified cultural minority employees. For instance, there should be a Diversity Office with oversight from a Diversity Officer at the level of senior management. This office will coordinate efforts to increase diversity in leadership and workforce. It will also develop professional support systems for minority employees and counter all forms of discrimination.
At the level of clinical practice, it would be better to create a multidisciplinary committee that will spearhead cultural competence improvements. Efforts among different disciplines should be coordinated so that there are uniform expectations as to how each member of the team should care for ethnic minority patients. This will promote greater accountability as everyone is held to similar standards, and will also facilitate interdisciplinary communication regarding how best to respect cultural beliefs and practices.
The third recommendation is to address the lack of multimedia materials in more languages as needed by patients in the community. The materials assist in educating the patient about his or her illness and its management which increases compliance, a behavior that helps address health disparities. However, unlike Hispanics who speak variants of Spanish, Asian minorities come from different countries with different languages. Efforts should be done to locate and secure relevant materials in these languages such as from advocacy groups, the OMH, and other health care organizations.
References
Loftin, C., Hartin, V., Branson, M., & Reyes, H. (2013). Measures of cultural competence in nurses: An integrative review. The Scientific World Journal, 2013(1), 1-10. Retrieved from http://www.hindawi.com/journals/tswj/2013/289101/
Misra-Herbert, A.D., & Isaacson, J.H. (2012). Overcoming health care disparities via better cross-cultural communication and health literacy. Cleveland Clinic Journal of Medicine, 79(2), 127-133. doi:10.3949/ccjm.79a.11006.
Office of Minority Health (2014). National CLAS standards. Retrieved from https://www.thinkculturalhealth.hhs.gov/content/clas.asp
Singleton, K., & Krause, E.M.S. (2009). Understanding cultural and linguistic barriers to health literacy. Online Journal of Issues in Nursing, 14(3). Retrieved from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodica ls/OJIN/TableofContents/Vol142009/No3Sept09/Cultural-and-Linguistic-Barriers- .html
