Cultural clues: the recent flurry to train health care providers for underserved areas has policymakers asking whether we need a more culturally competent workforce.

• Author: Hansen, Melissa
• Position: HEALTH CARE

For many state policymakers, having an adequate health care workforce is not just about numbers. It's about having doctors, nurses, technicians and assistants who can connect with patients in a way that improves their health and avoids costlier conditions.

The recent flurry of both state and federal activity to train health care providers for under-served areas has opened the door to policymakers who want a more culturally competent workforce--providers who recognize when cultural differences matter and can adapt their ways of communicating with patients accordingly. It sounds simple, but it's not.

Take, for example, an overworked doctor who diligently explains to a young immigrant patient exactly when and how she needs to take her medication, not realizing that his efforts are ineffectual because he really should be talking to the grandmother who controls and distributes all medicines in the household.

Or it could be an elderly gentleman who nods enthusiastically as a nurse quickly reviews instructions on which pills to take for each of his ailments, but who never mentions that his failing eyesight prevents him from distinguishing one bottle from another.

It's clear that the provider-patient relationship--and the communication between them--is very important.

In fact, a lack of understanding between providers and patients is thought to contribute to the estimated one-third of patients who do not adhere to prescribed medication regimens. This can lead to serious complications and more hospitalizations, that in turn, ends up costing the U.S. health system an estimated $100 billion to $290 billion every year.

The idea is that, until providers truly understand their patients' distinct cultures, languages, home lives and values--being "culturally competent" in wonk-speak--they will not be able to adequately and clearly communicate with them about their health or needed health care.

Cultural competence basically derives from the knowledge, skills and attitudes needed to help individual health care providers or teams understand--for an individual patient--what cultural factors might affect that patient's care and to use that knowledge to tailor medical instructions and guidance. It involves avoiding stereotyping and over-generalizing, and includes recognizing how personal beliefs, values and assumptions may guide communications and interactions with patients.

What Have States Done?

Having a more culturally competent workforce is a goal described...