Cultural Competence in Healthcare – by Dr. Joseph Betancourt

To achieve organizational cultural competence within the health care leadership and workforce, it is important to maximize diversity. This may be accomplished through:
• Establishing programs for minority health care leadership development and strengthening existing programs. The desired result is a core of professionals who may assume influential positions in academia, government, and private industry.
• Hiring and promoting minorities in the health care workforce.
• Involving community representatives in the health care organization’s planning and quality improvement meetings.

To achieve systemic cultural competence it is essential to address such initiatives as conducting community assessments, developing mechanisms for community & patient feedback, implementing systems for patient racial/ethnic and language preference data collection, developing quality measures for diverse patient populations, and ensuring culturally and linguistically appropriate health education materials and health promotion and disease prevention interventions.

Systemic cultural competence programs include:
• Make on-site interpreter services available in health care settings with significant populations of limited-English-proficiency (LEP) patients. Other interpreter services should be used with smaller LEP populations or limited financial or human resources.
• Develop health information for patients written at the appropriate literacy level and targeted to the language and cultural norms of specific populations.
• Require large health care purchasers to include systemic cultural competence
interventions as part of their contracting language.
• Identify/ implement federal & state reimbursements for interpreter services.
• Use research to detect medical errors due to lack of systemic cultural competence.
• Collect race/ethnicity & language preference data for beneficiaries, members, & clinical encounters in programs sponsored by the government & private organizations. The data should be used to monitor racial and ethnic disparities in health care delivery, for reporting to the public, and for quality improvement initiatives.

Clinical cultural competence requires health care providers:

(1) be made aware of the impact of social & cultural factors on health beliefs & behaviors;

(2) be equipped with the tools & skills to manage these factors through training & education;

(3) empower patients in the medical encounter.

• cross-cultural training as a required, integrated component of the training and professional development of health care providers;
•quality improvement efforts that include culturally and linguistically appropriate patient survey methods and the development of process and outcome measures that reflect the needs of multicultural and minority populations; and
• programs to educate patients on how to navigate the health care system and become an active participant in their care.


Dr. Joseph Betancourt
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