Written by: Debra Stinchcomb, MBA, BSN, RN, CASC

As the U.S. population continues to become more diversified, greater emphasis is being placed on cultural sensitivity in health care — and rightfully so. For example, in 2016, the Affordable Care Act required covered entities to obtain the top 15 non-English languages in their state in order to post taglines. It was probably surprising to see how many languages are spoken in your region.

In fact, the Agency for Healthcare Research and Quality (AHRQ), which develops data needed to improve the health care system, reports the following diversity statistics:

Of the U.S. population, 21 percent speak a non-English language at home, while 9 percent have limited English proficiency.

Minority Americans are expected to make up more than 40 percent of the U.S. population by 2035.

Clearly, diversity among patients will continue to become more prevalent as time goes on. Ambulatory surgery centers (ASCs) must rise to meet the needs of their evolving patient base by becoming more considerate of their unique languages, ethnicities, cultures, and religions.

Cultural Sensitivity Initiatives

Many of you — if not all — have encountered lingual, cultural, or religious barriers when caring for patients. As these situations are likely to become more frequent, federal, state, and accreditation requirements have been developed aim at increasing cultural sensitivity. One such federal statute, known as the “Healthy People 2010” initiative, sets a goal of eliminating health disparities on any basis. Listed below are key phrases pulled from additional statutes that consider population diversity and aim to meet the Healthy People 2010 initiative.

Centers for Medicare & Medicaid Services (CMS)

Condition of Coverage 416.50 – Patient Rights:

    • The patient must be given rights verbally and in writing in a language and manner the patient can understand.
    • Patients must …. “be free from any act of discrimination or reprisal.”

Accreditation Association for Ambulatory Health Care (AAAHC)

Chapter 1 – Patient Rights:

    • Interpretation services are available.
    • Patients are treated with respect, consideration, and dignity.

The Joint Commission (TJC)

RI.01.01.01 EPs: 4, 5 & 6:

    • “… treats the patient in a dignified and respectful manner …”
    • “… respects the patient’s right to and need for effective communication.”
    • “… respects the patient’s cultural and personal values, beliefs, preferences.”

HR.01.04.01; HR. 02.02.01. EP: 3:

    • Documented orientation for employees and licensed independent practitioners (LIPs) includes “sensitivity to cultural diversity based on their job duties and responsibilities.”

Further Considerations

While the aforementioned statutes are commendable, providing culturally sensitive care within ASCs poses some unique challenges, including:

    • Less frequent patient interactions.As an episode-of-care facility, we only speak to patients pre-operatively and often see them only one time. Since we don’t know our patients as well as those that offer continuum of care this can make it difficult to know if we are meeting their needs and traditional ideas.
    • Sedated clients.Most of the time our patients are sedated, which can impair communication.
    • Unique preferences.It is virtually impossible to know the nuances of every culture, religion, and ethnicity. Furthermore, within each of these categories, people may have individual biases or prejudices.
    • Lack of standardization. Training courses are not standardized for orientation requirements

Enhance Culture Sensitivity

Despite its challenges, there are practical methods you can use to increase cultural sensitivity in your ASC. Below are a few simple ways it can be done.

EDUCATE STAFF APPROPRIATELY

  • Learn/share the beliefs and practices of patients in your area and how that may impact their care. For example, if an Amish patient is having a long surgery at your ASC, is a non-automobile an appropriate mode of transportation? What should that discussion entail?
  • Develop approaches that focus on increasing knowledge about various groups, typically through a list of common health beliefs, behaviors, and key “dos” and “don’ts.” This information provides a starting off point for health professionals to learn about the health practices of a particular group
  • Be aware of internal group differences and avoid generalizations (i.e., “All older Hispanics … ”).

PROVIDE LANGUAGE ASSISTANCE

  • Oral/Sign language
  • Translated documents
  • Interpreters or bi-lingual staff

RECRUIT MINORITY STAFFCOORDINATE WITH TRADITIONAL HEALERS

INCORPORATE CULTURE-SPECIFIC ATTITUDES AND VALUES INTO PROMOTIONAL HEALTH TOOLS

INCLUDE FAMILY MEMBERS IN THE SURGICAL PROCESS, AS APPROPRIATE

By incorporating these tips, you can help make your ASC more culturally sensitive. It’s imperative that you become more aware of the customs, values, traditional beliefs, and practices of patients in your area, as the need for cultural sensitivity is increasing in health care. By having such knowledge, you can treat those you may be caring for appropriately in our diverse society.

WANT TO LEARN MORE? Join Debra Stinchcomb for a free live webinar on cultural sensitivity on Monday, July 29, @ 11 a.m. PT / 2 p.m. ET. Register for the webinar here.