Culturally and Linguistically Competent Care

June 8, 2018 | Ambulatory Care Risk, Quality, & Safety Guidance

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​​The United States is growing ever more diverse. In 2013, babies of ethnic or racial minorities became the majority among children younger than one year, and by the middle of the 21st century, non-Hispanic whites will no longer constitute the majority of the U.S. population, according to projections (Cohn). Similarly, the percentage of people speaking a language other than English at home has been increasing steadily, from 11% in 1980 to 21% in 2011. And because of concurrent increases in the U.S. population, the total number of people speaking a language other than English at home increased by more than two and a half times in the same period. (Ryan)

Religion, disability, immigration status, gender identity, and sexual orientation further contribute to the mosaic of diversity in the United States. As diversity increases, healthcare organizations must strive to serve patients and family members according to their cultural and linguistic needs. Federal, state, and local laws and regulations prohibit discrimination on certain grounds. Safety and quality, ethics, individualized and person-centered care, accreditation requirements, and liability are other major considerations. Cultural and linguistic competence can likewise affect health outcomes, patient satisfaction, and market share for the organization. See Race, E​thnicity, and Language in the United States​ for further discussion.

However, an individual's language and cultural needs are not always apparent, and ethnic and racial minorities are not the only individuals who may have such needs for organizations to address. For example, individuals may have religious dietary requirements, or they may not understand health information presented in English even if they otherwise speak English well. In the absence of a welcoming environment, some may hide their needs—for example, a lesbian couple may pose as siblings.

Therefore, as Joint Commission and many other organizations stress, cultural competence requires a person-centered approach to identifying the cultural and communication needs of all patients (Joint Commission "Advancing"). Similarly, organizations should consider how cultural competence policies and practices may apply to staff and should actively promote diversity among the workforce.

Because the cultural and linguistic makeup of individual communities varies greatly, healthcare organizations must assess the diversity and needs of their patients and the larger community. Then, they can develop and implement plans and practices that work best for them and the people they serve. Generally, a healthcare organization cannot simply adopt the cultural competence policy of another organization. Further, because the cultural composition of communities often shifts, organizations must periodically reassess their policies and practices.

This guidance article reviews the importance of cultural and linguistic competence in healthcare, safety and...

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