Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches

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This report spotlights a diverse group of health care organizations striving to improve access to and quality of care for a growing minority and immigrant population. According to the report, these organizations are working to dismantle the cultural and communication barriers to quality health care through innovative programs that develop minority leadership, promote health system redesign, and train health care providers to better understand and manage the social and cultural factors that affect patients' health beliefs and behaviors.

In addition to highlighting these model programs, the study also provides the first comprehensive framework for health care organizations seeking to address cultural barriers in health care delivery. The report, Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches, was written by Joseph R. Betancourt, M.D., of Massachusetts General Hospital—Harvard Medical School, Alexander R. Green, M.D., and J. Emilio Carrillo, M.D., both of New York-Presbyterian Hospital—Weill Medical College of Cornell University. The Fund report follows from recommendations of the 2002 Institute of Medicine report, Unequal Treatment, highlighting cultural competence as part of a comprehensive effort to address racial and ethnic disparities in health care.

The authors conducted an extensive literature review, interviewed experts in the field of cultural competence, and conducted site visits in academic, government, managed care, and community health settings to explore programs in more depth. They recommend steps health care organizations can take to implement programs that take into account the needs of their own patient population, available resources, and the business case for improving care. The sites visited were: White Memorial Medical Center Family Practice Residency Program, Los Angeles; Language Interpreter Services and Translations, Washington State; Kaiser Permanente, San Francisco; and Sunset Park Family Health Center Network of Lutheran Medical Center, Brooklyn, N.Y.

The authors outline promising practices on three levels--organizational, systemic, and clinical--used by health care organizations to increase cultural competence. Organizational practices focus on hiring and promoting minorities in the health care workforce. Systemic practices include providing on-site interpreters in settings with high numbers of limited-English speaking patients and involving representatives of the community in quality improvement efforts. Clinical practices include integrating cultural competence into training for health care providers.

Facts and Figures
  • Minorities make up 28% of the U.S. population but only 3% of medical school faculty. Only 7% of all physicians are minorities.
  • At the San Francisco Medical Center, Kaiser Permanente established a department of multicultural services that provides on-site interpreters in 14 different languages and dialects.
  • The White Memorial Medical Center Family Practice Residency Program requires 30 hours of training in issues surrounding cultural competence.

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Publication Details

Publication Date:
October 1, 2002
Authors:
Joseph Betancourt, Alexander R. Green, M.D. and J. Emilio Carrillo, M.D.
Citation:

Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches, Joseph R. Betancourt, M.D., M.P.H., Alexander R. Green, M.D., and J. Emilio Carrillo, M.D., The Commonwealth Fund, October 2002

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