Articles

CULTURAL HUMILITY IN HEALTHCARE: WHAT IS IT AND HOW CAN WE APPLY IT?

Jesse Vazzano, Julia Lamb, Sanjeev Sah, & Brian M. Leonard

Over the past thirty years, cultural competence has become a familiar concept in healthcare to understand and meet the holistic needs of patients. However, what does cultural competence imply, and how do we know if we are competent in providing care that genuinely incorporates the culture of those we serve? These questions have prompted a conceptual shift in modern healthcare from cultural competence to cultural humility. Tervalon and Murray-Garcia proposed that the problem with using the word "competence" implies "a detached mastery of a theoretically finite body of knowledge" (p.117). In comparison, "cultural humility incorporates a lifelong commitment to self-evaluation and self-critique" (p.117). Furthermore, cultural humility implies a continuous sense of curiosity and a life-long approach to seeking and incorporating different viewpoints, values, and practices, as well as reflecting on our biases.

In the healthcare setting, cultural humility is observed through patient-centered and open conversations that reveal what is essential to each client. In this way, we gain insight into the unique strengths, beliefs, and barriers a patient might possess. While this work can seem labor intensive, a reflective conversation and culturally respectful interventions can significantly impact the patient's health outcomes and satisfaction with their care, particularly when compared to simply completing a demographic questionnaire (Bullard, 2022). Taking the time to learn from individuals served by the healthcare system about what motivates them to seek care and what prevents them from accessing care is vital to find avenues for equity. We can gain insight into factors that might force a patient to decide between filling a prescription or putting food on the table. As we adapt our approach and navigate under-developed systems to allow for integrating different cultures and beliefs more effectively, it is okay to be uncomfortable. Wherever we are, is a great place to start.

Expanding one's practice to include cultural humility can consist of individual acts of care or examining how a whole system of care operates. As a single care provider or small practice, one can take the time to speak with a patient about what is going on in their life, to identify significant changes, or ask about demographic information that may help inform care (i.e., religious beliefs and how active they are in their religious community, what part of town they live in, changes in a job, or other life events). For example, suppose a care provider notices a lack of prescription medication compliance. They've also identified that the patient lives in a part of the community that relies on public transportation or has a language barrier. In that case, there could be an opportunity to work with pharmacy providers that offer a free or reduced-rate delivery service.

On a larger scale, as a system, looking at how an interdisciplinary team can work together to provide care and services proactively may be more difficult but can incorporate more cultural aspects. This may include having a social worker conduct a pre-visit assessment that allows for collecting clinical information along with significant social and cultural knowledge. Then the social worker returns this information to the entire team (primary care, specialty care, nursing, etc.), summarizing what the patient has identified as important to them personally and in care, along with what they want and need from care. When the patient comes into their appointment, this can allow for a more patient-centered approach versus a series of questions and clinical reminders being completed. As a care team, being able to huddle before a patient's appointment is critical to this type of change in the system. It can proactively determine who will assist a patient with different needs. 

Modern healthcare is expanding beyond what was traditionally provided to incorporate a more holistic understanding of the social drivers of health and cultural humility. In this way, we ensure that our patients' basic needs are met so our communities can thrive. As an interdisciplinary collective, we can address the social determinants of health by working proactively and collaboratively with patients and communities to improve outcomes.

This article is the first of many supports and resources the CAHE Diversity, Inclusion, and Equity Committee will bring to CAHE members. We are excited to share more information in the upcoming months.

References

1. Barsky, A. (n.d.). Ethics alive! Cultural competence, awareness, sensitivity, humility, and responsiveness. What's the difference?. The New Social Worker. Link
2. Bullard, J. (2022, September 13.) Cultural humility improves patient experiences, health outcomes, hospital readmissions. RTI Health Advance. Link
3. Lekas, H. M., Pahl, K., & Fuller Lewis, C. (2020). Rethinking cultural competence: Shifting to cultural humility. Health services insights, 13, 1178632920970580. Link
4. Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of health care for the poor and underserved, 9(2), 117-125. Link