What is Cultural Competency?

Joseph R. Betancourt, MD, MPH, director of The Disparities Solutions Center at Massachusetts General Hospital, was asked during a recent interview with Physician’s News Digest how he defined cultural competency. He replied that he viewed it as basically an “expansion of patient-centered care,” which he said is characterized by the physician’s awareness of and agreement with “the need to be attentive to the health beliefs, values and perspectives of the patient.” Cultural competency, he said, pays “particular attention to social and cultural factors,” and is intended to “give the doctor a set of tools — questions and skills for negotiation – that they can incorporate into their history of present illness and shed light on what health beliefs a patient may have, what particular complementary or alternative medicine a patient might use, how a patient and their family might make decisions that may be culturally-based. Once that information is revealed, the physician could engage in a negotiation with a patient to improve outcomes.”

Dr. Betancourt is one of the leading figures in multicultural healthcare education, and he makes many interesting observations during the interview (practitioners really should read the whole thing). One of the most interesting was his contention that the field of cultural healthcare competency is not yet standardized, that many years of research are just beginning to bear fruit and their findings are being codified into official rules and practice. He noted New Jersey’s leading role in establishing cultural competency training as a requirement for licensure (see the June issue of MDNG: Focus on Multicultural Healthcare for more on this topic), a move that is being followed by several other states. The Think Cultural Health website has developed an interactive map that tracks the status of current and previously proposed cultural competency requirement legislation in the US. Specialty boards, too, are beginning to stress cultural competency; Betancourt said “questions in specialty board exams about racial and ethnic disparities and cross-cultural communication” are becoming more common. Even the fields of risk management and medical malpractice law are beginning to recognize the importance and value of promoting cultural competence; Betancourt claimed there are “medical malpractice companies across the country that are looking to give discounts for health care providers who have taken courses in patient-centered care, and hopefully soon in the area of cross-cultural communication.”

What do readers think about the current trend toward formalizing and institutionalizing cultural competency requirements? Will several hours of training and education make a difference? Have readers participated in such training already at their own healthcare facilities? Let us know what you think about this issue and what your experiences have been with cultural competency training and educational programs.

Additional Resources:

Cultural Competency in New Jersey: Evolution from Planning to Law

Why is there a Compelling Need for Cultural Competence?

National Center for Cultural Competence

The Office of Minority Health defines cultural and linguistic competence in the healthcare setting as “set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. 'Culture' refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups. 'Competence' implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs presented by consumers and their communities.”