Creating equitable health systems is a complex task that demands patience and accuracy. Data can play a critical role in identifying the communities and services where an institution can improve and in tracking progress as changes are implemented. Data stratification and analysis can inform the work of training providers in more culturally sensitive practices.
To learn why cultural sensitivity leads to better outcomes and how to leverage your data to achieve these outcomes, read our conversation below. This is the final installment of our series of discussions concerning health equity. Catch up on Part One and Part Two. We also invite you to watch our conversation here:
Fostering cultural sensitivity within institutions leads to better health outcomes
Francoise: What practical or tangible benefits can a health system expect when evolving toward a more culturally sensitive organization?
Jarrod: I think there's lots of gains the health system can expect to see by becoming more culturally sensitive and humble. The biggest improvement we should expect to see is closing gaps in patient outcomes like maternal mortality, infant mortality, and premature deaths, such as homicidal-related deaths.
When we close these gaps and outcomes and become a more culturally humble society, we can begin to gain trust in the healthcare system and those delivering care within the system. We can also expect to see improvements in patient experiences. Patients who report negative experiences and are being treated differently or unfairly will hopefully reduce, and more patients will feel that their best interest is being kept at heart.
Furthermore, when the patient is more comfortable, they become more confident. And when you become more confident, you are expected to have greater engagement. I expect to see patient engagement much higher when the system is more culturally humble. When patients feel more comfortable, they're also more willing to share more about themselves, their experiences, health condition, and unique situations. Being humble to their needs and culture will inspire their confidence and willingness to share.
When a patient is more satisfied, comfortable, confident, and engaged, they can be more open. For example, when a provider understands the culture surrounding the types of food a person is intaking and its preparation, they can establish a care plan that is sensitive to this culture with the goal of creating healthy behaviors within that patient's culture. Notice I said a goal within, and not aside from, their culture. Patients are more apt to hold themselves accountable since the care plan wasn't forced upon them and wasn't designed in a way that was completely unattainable for them.
In a culturally humble society, goals that we set for patients must be realistic and appropriate for their specific conditions. No one wants to take the blame or be held accountable for not reaching a goal that was unrealistic in the first place. When patients are more engaged, we can expect them to take a more proactive role in their health and be receptive to behavioral changes. A culturally humble system also paves the way for increasing health literacy and self-management. I think more culturally sensitive health plans ensure that patients understand their care regimen, including the goals, advantages and disadvantages, risks, alternatives, and their role in the plan. This understanding, I think, will bring about the knowledge needed to self-manage their conditions and when and where to seek care when needed.
I believe cultural humility will also lead to high engagement with primary care, which is the gatekeeper to health and plays a major role in preventative health. Consistent primary care that is culturally humble can lead to better population health outcomes by way of early detection and diagnoses and avoiding costly, preventable acute episodes.
Improved patient experience depends on multiple factors
Francoise: You touched on the topic of patient experience. In some of the research I've seen, organizations are rebranding their patient experience departments as human experience. That lends itself well to exactly what you just shared considering all the demographic, cultural, and societal factors that impact patients beyond their time within the healthcare institution. Food, transportation, and socioeconomic status impact the way someone consumes healthcare. Recognizing how the whole human experience impacts a person's care can help support improved health outcomes for all patients.
With these benefits in mind, in your opinion, is it best to start small: to first change a program, process, or department? Or does sustainable change come from the adoption of an organizational mindset which shapes the behaviors and attitudes reflected in an institution's value system?
Jarrod: I think this is going to be a big change for the healthcare system, and it's going to be an incremental change. It's not going to happen overnight; it's going to require time and effort beyond training providers and other health practitioners. Training in and of itself is not sufficient. We can train providers to be more culturally competent, but to be culturally humble requires a provider's behavior change. The practice of cultural humility should be shared, but it would need to be embedded within the values and the mission of organizations or systems, and in the mindsets of those within those organizations and systems.
One critical piece that I think would help organizations adopting cultural humility is standardizing how data can be collected regarding disparities and social determinants of health. These disparities within systems and organizations must be defined and identified, and we must collect, disaggregate, and stratify data by demographics and other factors to identify opportunities for improvement and populations who might need more targeted and care-coordinated care. Population restratification and segmentation come into play. Even then, predictive analytics to identify populations who are at risk for adverse outcomes must be done equitably to prevent widening disparities. We don't want to widen health inequities. We want to close them by ensuring there's a series of validation studies to evaluate the performance of predictive analytics and predictive models across multiple populations and settings.
Data and data analytics are key, but it's only one piece of the puzzle. If we remember that we should treat others the way we would like to be treated, that mindset will start breaking down some of our unconscious biases and assumptions that are easily picked up by the person on the receiving end.
Francoise: Accountability to quality improvement and performance improvement based on the data stratification and some of the data stratification models is key. Additionally, we're seeing accreditation bodies, like the National Committee for Quality Assurance (NCQA) and CMS, add health equity to their accreditations. Whether it's data reporting or some of the accountable attributes, health equity will be an added lens in future iterations of various accreditations.
Jarrod, thank you again for joining me today and continuing our conversation on health equity. Thank you to everyone who has tuned in. For more information, please continue to connect with us at RTI Health Advance.