Health Care in Context
To best serve patients, health care providers must be culturally responsive — and that requires system change.
By Danielle Brooks, JD
What defines cultural responsiveness? At its core, cultural responsiveness is about a commitment — a self- and organizationdriven commitment — to taking a dialogue-based approach to interactions with patients, network members and others in the community. This approach places the needs of the individual ahead of those of the provider, within a contextual understanding of social, economic, political and linguistic disparities.
At a fundamental level, health care organizations — both providers and payers — must communicate with patients and members in ways that respect and respond to their preferences, experiences and challenges. They must also work to identify their biases and recognize how these impact the delivery and quality of health care.
True cultural responsiveness means bringing sensitivity and awareness to patient interactions as well as humility when a clinician doesn’t know the answer to a patient’s question. It also means examining and address- ing unconscious biases. This multifaceted approach requires intentional commitment for it to be implemented successfully in the medical setting.
Physicians who are pressed for time and preoccupied with cases may forget to take a moment to connect with a patient. And doctors who train for many years to establish authority may feel deeply uncomfortable admitting uncertainty and may not recognize when their own biases affect care delivery.
Despite these challenges, prioritizing culturally responsive care is a moral and professional imperative, as evidence has shown that responsive care can improve health outcomes and help chip away at the racial, cultural, linguistic and ethnic health disparities that plague our country.
Today, racial and ethnic minority groups remain disproportionately affected by chronic illness. Health outcomes for some populations are worse than those for others, with discrepancies seen not only in the context of race and ethnicity but also in gender, gender identity, sexual orientation, immigration status, ability, economic level, primary language and even patient geography.
This must change. To start on the path toward providing culturally responsive care, health care professionals must first understand the communities they serve: Who are their patients? What is their experience in the health care system? Do they feel heard? What traumas have they experienced? What resources do they have available to them? What are they missing? What barriers are present? Are they experiencing provider bias? What historic and present discrimination do they experience, and how does that shape their interaction with providers?
As a provider, it’s important to seek out opportunities to connect with your community in honest ways. Reach out to the grassroots organizations whose workers are on the ground day-in and day-out. Invite them to have honest conversations; ask them for help in learning how to support their patient community. Find out if your patients have had negative experiences with medical professionals or insurers. Consider how you can address those experiences and make patients feel more comfortable. These connections must be frequent and genuine. That’s how relationships germinate and trust builds.
But listening isn’t enough on its own — you must also embrace data. Create metrics to measure whether your efforts are truly working. As the ubiquitous business maxim holds, if you don’t measure it, you can’t manage it. And once you detect disparities, act, learn from your actions and continually improve your response.
Cultural Responsiveness in Action
For a wonderful example of what can happen when clinicians commit to establishing close ties with their community and rigorously track their results, let’s look at a study by a group of researchers at Northwestern Medicine in Chicago. Doctors there noticed that when you examine the rate of cerebrovascular incidents geographically across the city, you see a huge increase in neighborhoods that are predominantly African American and Hispanic. But the spike in these areas couldn’t be scientifically explained.
The research team set out to understand the underlying issues. Through many discussions in the community, they realized that a lot of misconceptions surrounded stroke treatment. These misconceptions created a pervasive mistrust of medical professionals and — combined with cost and a lack of access to care — ultimately reduced the likelihood that these patients would seek prompt treatment.
In order to jump-start community education about the importance of going to the ER immediately when experiencing stroke symptoms, the researchers connected with the community pillars who were trusted sources of information: the preachers, the store owners, the teachers. They then trained these community leaders about the symptoms of stroke and the benefits of early treatment. The researchers also distributed flyers and pamphlets at community events in order to further spread awareness.
The team then examined area hospitals’ stroke registry data and the Chicago Fire Department’s ambulance records from before and after the yearlong stroke education program. It showed that more young people, men and African Americans went to the ER quickly when experiencing stroke symptoms than before the program. The data proved what the researchers saw anecdotally: People in those groups sought treatment sooner.
Culturally responsive care isn’t a passing trend. Our country is and has always been diverse, and in order to create true equity and improve outcomes, health care organizations must provide the highest level of care to every patient — with respect and in response to who they are and their experience.
As providers and payers, we must strive to meet people where they are and work on systemic issues that are entrenched in our systems. By seeking to match care to culture, we can begin to create a future filled with healthier individuals, vibrant communities and equitable societies. It’s time to get to work.
Danielle Brooks, JD, is director of health equity at AmeriHealth Caritas.
This article appeared in issue 2 (2020) of In Reach by AmeriHealth Caritas.