Friday, May 7, 2010

The Risk of Cultural Illiteracy

I went to a networking breakfast this morning at the Boston Center for Community and Justice on Diversity: Institutionalizing Diversity as a Business Strategy.

A very well done event with a number of business leaders committed to the integration of this thing we call diversity in a manner that connects like "traditional" business staples like lead generation, fulfillment, accounting, etc.

It is easy in meetings like this for the default to go straight to workforce representation conversations. Some commented on how some of their companies have gotten executives to fulfill diversity goals and it has increased representation. Others shared that the goals of representation are also tied development. That resonates with me, but it also falls short to me in a way, in that what development means and is are often much different than what those responsible for developing their people do.

There was one hospital COO there. She mentioned the ideas of health disparities (quality disparities) and cultural competence. I appreciated her commitment and candor about how far they have come and how far they have to go. Where I wished she could have taken the conversation was into an area that most organizations face on a regular basis: risk.

Now, while the idea of risk is one that most leaders have to face, they don't generally think about risks in terms of people not being able to relate to others in a manner that is in alignment with their needs. In healthcare the risks here are obvious. Just speak to any clinician who has had diagnoses compromised due to not having the ability to discern cultural cues. Cues that may have provided additional data for a diagnosis that could have prevented or at least mitigated further suffering on behalf of the patient.

In other industries, I hold that the risk of cultural incompetence and what I call "cultural illiteracy" (extrapolated from health literacy) is just as profound. In a global playing field of business, the stakes of cultural navigation matter more than ever before.

For many Americans, the lens of the world is narrow and generally has an insular focus. The risk here is that if we are not able to consider the globe as the business environment that we live within; and recognize that the norms of business are as diverse as the world is big, our ability to be competitive in this global economy is mitigated. This is not just true for people from the U.S., this is true for everyone.

Consider that we are all culturally illiterate in a way. Now, think about the risk of being illiterate in any other sense of the word.

Make it a great day!


Tanenbaum said...

Ignoring how a patient’s culture (and specifically religion) impacts his or her health decisions is definitely a risk. A person’s religion and culture can influence whether they choose to take certain medicine, receive a blood transplant or even just generally seek care. It is essential that health care professionals are trained in religio-cultural competence and hospitals and other health care settings make this training a priority. Then, doctors and nurses will be prepared to ask the right questions and get the answers they need, so they can treat the patient to the best of their abilities.

Anonymous said...

Very Interesting!
Thank You!

Anonymous said...

Yes, I agree. We are cuturally illiterate to some degree and in this day and age, we should be responsible and be pro-active in trying to minimize this risk. Each day at work when I care for a person of another significantly different culture, I feel like I'm gambling with their healthccare because I am not fully in tune with subtle signs that they may be conveying. I worry that I will miss something exptreemly important, all because I was not culturally competent. It is my personal goal to minimize this risk and bring myself one step closer to providing globally competent nursing care.

Dr. Patti Rose said...

I have written a book on this subject and it is entitled Cultural Competency for Health Services Administration and Public Health. I totally agree with the comment by Tanenbaum. May I suggest the reading of the above book. I think within it, you will find specifics that are very usefu. The book is available at:

Anonymous said...

After reading hundreds of pages in my nursing finance class, it is clear to me that the new health reform law will have difficulty evolving through a federal law unless it allows states to regulate the type of "basic health care" needed for particular cultures in society.
The concept of "basic health care" offered to all, is subjective, just as the idea of "religion of one's choice". The federal constitution allows for "Freedom in choice of religion", however, we also hear the rhetoric that this country was founded on a certain religious preference. Now we have become so demanding about public display of an individual's faith that we tear it down as it is an insult to us that have a different faith. Healthcare measures must consider cultural diversity when defining "Basic health care". This will be very complicated and must allow time to evolve within each state or region in society.

Anonymous said...

I defiantly believe that health care professional need to be educated about the cultural matters. Health care professionals need to be sensitive and take cultural differences into consideration when providing patient care.

Anonymous said...

I agree with Tanenbaum that health care professionals should consider the cultural aspect of the person as well as the religious aspect. As health care professionals, we are taught to give culturally competent care, on a holistic level, one individual at a time. The concept is similar to dating, developing new friendships, or getting to know someone. When people are at the beginning stages of a relationship, we get to know the person on many different levels such as personal (values and morals), cultural, and religious and according to the discoveries we, for the most part, adjust our behaviors accordingly. The same goes for health care professionals and the patients that they encounter. In order to deliver the utmost in quality care, then one must be culturally competent. For example, culturally Asians are known to nod agreeably and minimize pain; if these attributed behavioral cues are ignored then pain treatment could be delayed and other cues could be missed when treating the patient. Furthermore, being aware of attributed cultural behaviors can aid in building rapport with the client, which can further contribute to quality health care delivery.

Anonymous said...

I completely agree that culturally competent health care is very important. Language barriers and cultural beliefs can easily hinder the delivery of adequate nursing care. I think the United States is particularly challenged because we are such a melting pot of cultures. We need more providers of different ethnicities to help bridge the gap. However, here's my thought. Has anyone been hospitalized in another country? Was there a language barrier? What is the American culture to other countries? Do we get served a hamburger and fries on our meal trays?