Contributors: Beth Boynton, RN, MS and Lisette Martinez, MBA
Every patient and every provider has a unique story. Ethnicity, economic status, religious beliefs, weight, height, gender identity…all of these factors and more can play a role in how each patient and each provider experiences and interacts with the world around them. These differences add complexity in the provider-patient relationship — but they also add opportunity to grow and personalize the care experience. That personalization can lead to improved communication, trust, and ultimately, to better patient outcomes.
What is cultural sensitivity?
Cultural sensitivity, at a basic level, recognizes that people are different, without assigning any value to those differences. A culturally competent healthcare provider understands that a person’s unique experiences, beliefs, values, background, language, etc., all play a role in how patients perceive their healthcare service delivery, diagnosis and recommended treatment(s).
“Our culture influences many of our thoughts, behaviors, and feelings,” says Beth Boynton, RN, MS, a nursing consultant who helps healthcare organizations improve communication, collaboration, and culture. “How we feel about our bodies, what lifestyle choices we make, who we trust or not, what languages we speak, and even what happens to us after death are health-related cultural differences.If and/or when to seek help, who to seek help from, what information is safe to share with doctors and nurses, whether there is shame around pain or disrobing, or if it is acceptable to ask questions, are all examples of how culture shapes responses to illness and treatment.”
Why does cultural sensitivity matter?
The ultimate goal in healthcare is to improve peoples’ lives. Providing high-quality care requires that the provider and patient have a good relationship with a foundation of trust and solid communication. If cultural differences or biases create barriers, providers need to figure out how to remove them so they can be standing on common ground with the patient.
“The person in front of us is not like us, so there’s a disconnect — especially if it’s someone who may look different from you, speak different from you or have different beliefs,” says Lisette Martinez, MBA, chief diversity and inclusion officer at Yale New Haven Health.
Martinez works to create a more inclusive environment in the healthcare system, and strives to help healthcare providers fill the gaps by helping them understand how to best communicate and build trust with their diverse patients. The courses she leads for Yale New Haven Health equip healthcare professionals with communication tools so they know the types of questions to ask patients. “Whatever religion, whatever language, whatever culture, whatever gender identity, whatever mobility issues…we teach [the care providers] how to ask the correct questions to get to where [the patients] are in order to treat them the way they want to be treated,” she says.
Asking the right questions and removing biases can mean the difference between understanding and anger, sickness and health, and in some cases, life and death, as it was in a case study published on Dr. Geri-Ann Galanti’s website, “Understanding Cultural Diversity in Healthcare.”
Lamar Johnson, a 33-year-old African American patient, kept returning to the hospital with extreme headaches. The staff had labeled him a “frequent flyer” and considered him a “drug seeker.” Each time he came to the hospital, he was sent home with pain medication. One nurse’s instincts said there was more to the story, but “she saw his tattoos, observed his rough demeanor, and went along with what everyone else was saying.” Tragically, while she was taking him to get a CT scan, he herniated and died. He had a rare form of meningitis that was actually causing his severe headaches.
“If some of the staff had not stereotyped him as a drug seeker on one of his earlier visits, perhaps his life could have been saved,” the case study reads. “This incident left a lasting impression on Courtney [the nurse], who vowed never to judge a patient on his looks, and to trust her instincts, rather than let others influence her nursing care.”1
Can cultural sensitivity be learned?
Tragedies such as Mr. Johnson’s might be preventable with the right education. Unfortunately, traditional healthcare curriculum often neglects to address cultural sensitivity. Boynton says that these educational programs are full of clinical studies that leave little time for focusing on humanities. Despite this, care providers’ genuine compassion for their patients compels them to want to learn more to help their diverse patients.
That’s where experts like Boynton and Martinez come into play as they are helping current and future healthcare professionals improve cultural competence through education.
Although healthcare providers can’t be experts on every culture, they can improve interpersonal skills that can help them better communicate with, understand, and serve their patients. Two skills that Boynton and Martinez emphasize are asking the right questions and listening.
“I’m talking about beyond the kind of listening we do to assess heart or lung sounds or to check off boxes on a form about health history,” Boynton says. “The kind of listening that includes putting down our pens or computer screens and listening to what feels important or worrisome to our patients.”
Listening is key, but before you can listen you have to ask the right questions. To help healthcare professionals in their discovery to understand the patient’s point of view, Martinez utilizes “The 4C’s of Culture,” developed by Drs. Stuart Slavin, Alice Kuo and Geri-Ann Galanti.3
What are the 4C’s of Culture?
1. What do you CALL your problem?
2. What do you think CAUSED your problem?
3. How do you COPE with your condition?
4. What CONCERNS do you have regarding your condition?
The idea is to ask questions that aim to identify a patient’s perceptions of their condition and possible treatments, as well as the patient’s beliefs that may affect any course of action.
Curriculum such as “The 4C’s of Culture” can be included in virtually any education program, from a traditional classroom, to online education, to employer-sponsored training. To help narrow the focus of educational content, Boynton suggests reaching out to organizations that support minority groups at a local level, so that training reflects diversity in a particular community. At Yale New Haven Health, Martinez uses responses from cultural competency-related questions on patient satisfaction surveys to identify where improvement is needed — at the organization level and at the department level. Programs like these can ensure that when healthcare providers make it a priority to fit education into their schedules, they are learning relevant information that can immediately help them provide better care.
The terms, “cultural sensitivity,” “cultural competence,” and “cultural compassion,” have been recent hot topics, especially in healthcare. There’s something to be said for measurable results, but there’s also something to be said for simply doing the right thing.
Our world is not homogenous, and when someone needs care — no matter who they are or what their background is — healthcare providers must learn to overcome cultural barriers to help patients feel safe, understand their expectations and to provide the best care possible.
There is a lot of work to be done, but education is where it begins.
1 Galanti, Geri-Ann. (2019). Understanding Cultural Diversity in Healthcare: Case Studies. Retrieved April 1, 2019 from https:www.ggalanti.org/case-studies-field-reports/.
2 Branded Research. (2019). Healthcare and Cultural Sensitivity Poll, fielded February 9, 2019.
3 Galanti, Geri-Ann. (2019). Understanding Cultural Diversity in Healthcare: The 4C’s of Culture. Retrieved April 1, 2019 from https://www.ggalanti.org/the-4cs-of-culture/.