Today's patients are more informed than years past, thanks to advances in digital health, increased educational attainment, and the wide accessibility of information online. Providers are finding that shifting from an authoritarian relationship to a collaborative one can result in better patient outcomes.
Part of establishing a strong patient-provider relationship is building trust and empathy, which starts by understanding the world in which each patient lives. External forces, such as lived culture and social networks, have a significant impact on an individual's perspective. Working alongside community-based organizations to foster ongoing understanding and support is key to greater patient satisfaction.
Patient-provider relationships shift to partnership model
Jarrod: In a recent video, we talked about the face of healthcare delivery. Now let's talk about ways we can retool the system leading to better outcomes for all. A question I have for you, Francoise, is I've seen it suggested that the practice of being patient-centered requires providers to negotiate between two world views, being the patient and the provider. What do you think about that concept?
Francoise: The concept of cultural competence alludes to an understanding of facts about a specific race or an ethnic group to provide culturally sensitive care. When we think about cultural humility, it digs deeper into that concept. It enacts a commitment to developing ongoing knowledge about an ethnic group to provide tailored care based on a patient's unique cultural experience.
By exhibiting traits of cultural humility, providers and organizations can work together to eliminate those unconscious biases that often exist in longstanding frameworks, like our healthcare delivery system. Conscious and unconscious biases exist and can inadvertently lead to unjust treatment. Providers can work to engage in continuous self-reflective exercises to recognize any biases that they may have personally. Those biases need to be eliminated to deliver true, whole-person, patient-centered care.
From the patient perspective, providers can engage in meaningful conversations and actively listening to the patient to better understand the patient experience. Providers bring great medical preparation and knowledge to the table, but beyond that, patients bring a lot of valuable insight as well from their own lived, natural experiences. Patient-centered care is respectful, and uses individual preferences, experiences, needs, and beliefs to guide medical decision making in conjunction with the patient. Getting to the root of how a patient is thinking, how they're feeling and doing is key to serving patients in a patient-centric environment.
Jarrod: I totally agree, Francoise. You know, patient-centeredness requires putting the patient at the forefront of how care is delivered. It requires listening to the needs of the patient and coming up with these care plans that are both appropriate and attainable to the patient. So, patient goals that providers set with patients need to be sensitive to his or her lived experiences and culture. The goals should be targeted to fit their needs. Now, in cases where patients are more at-risk, it means that it might require allocating more resources to certain patients so they can overcome those risks and get to more equitable care. But the goals must be aligned so they are both culturally sensitive for the patient and attainable for the patient, and within reach so they can be more accountable to those goals that are set in place for them.
Culture and social networks have significant influence on healthcare system interactions
Jarrod: We've said culture can influence how individuals approach seeking healthcare. How is culture represented among the 5 factors affecting health equity?
Francoise: Culture plays a huge role in medical interactions and it's intertwined in all of the categories, to be quite honest. Cultural beliefs can influence how an individual consumes healthcare. It can influence how they feel about things like tests and procedures, blood draws, their preference in provider gender. It can influence how an individual approaches decision making and their beliefs about disease states and treatment. From a cultural perspective, often we lean on our communities that we know and trust to help direct us to arrive at the right decisions and seek care from someone who has a proven track record in supporting our community. On top of that, often communities seek healthcare providers who look like them and are already aware of their cultural norms and their cultural needs.
Organizations can do their part to help support their patients by making sure that their providers represent the community and are aware of some of the norms that are happening in their surrounding areas. Healthcare organizations are often the pillars of community, so having a presence in the community, such as, partnering with faith-based organizations, community organizations, supporting the community beyond just providing medical care is key to build buy-in with the community at hand.
When you think of things like the maternal health crisis, African American women are 4 times more likely to die during childbirth than their White counterparts. They are seeking providers who look like them, have a proven track record of successful deliveries, and are coming at high recommendations from their neighbors, friends, and faith-based organizations from a safety factor. African American women have been known to be scared to deliver babies given the maternal health crisis. Identifying this as a cultural need and helping to support that community is key to developing trusting relationships to provide sound medical care.
Jarrod: I totally agree. Something I think is overlooked when it comes to cultural humility is what you alluded to earlier—it's interwoven in these factors of social determinants of health. For example, the food that's celebrated by a certain culture, or a certain population of people, how it's prepared and eaten, is woven into one's culture, which have impacts on outcomes.
Let's also look at the social networks around people. If they are particularly around a group or culture of people, they're not experiencing other cultures and people. The social networks where we are brought up and how we are brought up are interwoven into our culture. All of that really impacts how we can experience these health outcomes. It's going beyond this individual level, to a more population-based level approach. And it's not at a specific point in time either. It's over the entire lifespan of one's life. Culture is built into us when we are born into our families, and it holds onto us throughout our entire life.
Cultural humility is an ongoing pursuit to understand patient needs
Jarrod: The third question I have for you is what role does cultural humility play in advancing health equity among healthcare providers?
Francoise: Embracing cultural humility is not a singular event. We can't check the box and say we have attained cultural humility. Individuals change, communities change, populations change. Look at the impact that the COVID-19 pandemic has had on healthcare overall. It has shone a spotlight on populations that are underserved or less advantaged than others, how they consume healthcare and their healthcare needs are different from various other areas where healthcare is robust and easily accessible. The healthcare landscape is continuously changing; that's where cultural humility enters.
By institutionalizing a partnership mindset with patients, providers are committed to learning from their patients about their cultures and how their culture affects them on an ongoing basis. If you look at certain demographic groups, COVID-19 had a huge impact, especially in the early days, on individuals who had Type 2 diabetes. Certain demographic groups are more susceptible to have complications or are at greater risk to developing Type 2 diabetes.
COVID-19 had a greater impact on those communities than others which don't have that same risk factor. As providers are able to gain a better understanding of patients' cultural needs, their concerns, and how it impacts their healthcare decisions, that understanding creates a space for evolving healthcare techniques and approaches, all within the care delivery system. That's the shift we are experiencing today. These efforts help to provide care that is not only high quality and culturally proficient, but it's equitable. Everyone is able to receive the same care and operate at their highest health.
Jarrod: I admire how the American Psychological Association described cultural humility: cultural humility opens doors to restoring or fixing power imbalances where none ought to or shouldn't exist. For example, historically, there's always been a power imbalance between the patient and provider with the patient deferring to the provider. But now, as the patients are more informed, that power balance is shifting, which is great.
There are other power imbalances that we see between races and ethnicities. Cultural humility will start to break down other power imbalances. Because we really must get to a place where the patient and the provider share power. Each person is unique with their own culture, diversity, and unique life experiences. We should all appreciate that diversity and uniqueness. Thank you everyone for joining us for the second video series on our discussion about health equity. We hope you watch the upcoming Part Three of our video series.