The first thing Aisha notices is the cold. It chills her to the bone and makes her shiver almost uncontrollably. Through parched lips she calls out for someone to turn up the heat, but all she manages is a raspy mumble. Her mind is vaguely aware of a rhythmic beeping, while at the same time a low murmur of voices signals the presence of humans nearby. Though comforting, Aisha suddenly realizes that she doesn’t understand a word that is being said. Flashes of an in-flight movie and colorful outdoor market dance before her eyes. The fog dissipates and memories start flooding back as a cold hand clasps her arm and a voice says in clear, if not perfect, Arabic, "alsayidat eayishat , taqul aldukturat kim 'ana aljirahat sarat ealaa ma yurami. sawf yarak maratan 'ukhraa fi ghurfatik qryban.” - “Ms. Aisha, Dr. Kim says that your surgery went well. He will see you back in your room very soon.”
Once in her room though, Aisha immediately senses that communication is going to be a problem. Nurses come in and out, inserting IV’s and changing her medication without giving her a glance or much less explaining what they are doing. When Aisha asks one of the nurses what medication is being administered, the nurse timidly backs out of the room waving her arms as if to indicate that someone else will be there shortly to explain. About 24 hours after the surgery, Dr. Kim said it was okay for her to eat and drink, to which she responded with a wide grin, after enduring hours of hunger. No sooner had Dr. Kim left than the nurses brought Aisha her lunch, a non-halal food.
This is not an uncommon occurrence for many international patients who travel abroad to receive care. While medical treatments offered by these programs may well be up to par with global standards, certain subtle events such as this mar the entire patient experience and keeps patients from ever coming back to a medical provider.
Cultural competency in healthcare can be defined as the ability of [hospitals or clinics] to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients’ social, cultural, and linguistic needs [1].
Cultural competency is especially important within the context of medical travel, where patients from different cultural backgrounds travel for healthcare away from their home. Cultural sensitivity and awareness breaks down barriers, reduces the potential for errors and ultimately promotes better outcomes. According to the National Center for Cultural Competence, “Cultural competence requires that healthcare providers and their personnel have the capacity to value diversity, conduct self-assessment, manage the dynamics of difference, acquire and institutionalize cultural knowledge, and adapt to the diversity and cultural contexts of individuals and communities served.”
In simple terms, a medical provider with an international focus must be able to successfully interact with patients from diverse cultural backgrounds.
Why is cultural competency important?
Hospitals and clinics operating in multicultural contexts can expect to interact with patients who will have different perspectives, expectations and practices regarding their health and wellness. It goes without saying that a lack of cultural competency often leads to misunderstandings, anxiety, and a poor overall international patient experience.
For a hospital that is expanding its services to reach international health consumers, it is important to learn about the traveling patients’ social customs and norms. Cultural differences may include verbal and nonverbal communication, spatial behavior, diet preferences, and even the way people view time.
Every culture has a distinct way of doing things, therefore expectations vary across cultures. For example, in some cultures maintaining eye contact during a conversation may be the norm, while in others it may be considered rude. North Americans in general tend to keep more distance between people when they are talking, compared to Latin Americans and people of Arab descent who are apt to talk just inches from each other (and gesture wildly). In many Latin American countries, it is not uncommon for doctors to hug patients or even kiss them on the cheek when greeting or saying goodbye, which would likely raise eyebrows in the U.S. or some European countries.
In most Middle Eastern countries, communication is also greatly nuanced on the genders of the people engaging in a conversation. While it is often commonplace or normal to find men or two ladies conversing in close proximity to each other or even holding hands, in Arabic culture, a man should not stand too close to a woman during a conversation, let alone hold hands. In many conservative Arab families, even a slight touch on a woman’s arm is considered inappropriate. It is safe to consider that most individuals of this culture follow this rule while communicating with them, unless explicitly stated.
How do we achieve cultural competence?
Achieving cultural competence and proficiency requires a deliberate effort on the part of medical providers to understand the cultural contexts of their target client and remodel their operations to accommodate those differences. The following strategies are critical to enabling a culturally-competent medical travel program.
Identify Cultural Nuances: Ensure that the values, beliefs, spirituality, language, diet and other preferences of the target populations served by the medical travel program are identified. This could be achieved through patient survey assessments or through direct questions about patient preferences.
Incorporate Diversity: Incorporate a diverse workforce reflecting the patient population to achieve cultural proficiency. Instead of staffing your hospital or clinic with people of the same cultural background, hire people from different cultural backgrounds, to help your team better understand cultural nuances and interact better with patients from similar backgrounds.
Language translations: Make language assistance available for patients from other countries to maintain the integrity of patient communications. Using a language line, for example, helps patients to understand their medical treatments and procedures, potential complications, risks, and post-treatment instructions in their own language. This limits medical errors and unnecessary miscommunications.
Staff training: Offer ongoing staff training regarding delivery of culturally and linguistically appropriate services. Your employees need to continuously learn and unlearn modes of communications and interactions based on patients’ varying cultural contexts.
Track Progress: You can only determine your cultural proficiency or competence through feedback from your patients. Does your staff tick the right boxes as it concerns interaction and communication along cultural lines? You can only find this out when you track the quality of care across racial, ethnic, and cultural subgroups.
Eliminating language barriers
Numerous studies have shown a strong correlation between language barriers and a poor patient experience or even bad healthcare outcomes. In one study in the Philippines, almost one fifth of the participating nurses thought that healthcare outcomes (i.e., nursing care, understanding patients' needs, communication, healthcare errors, having trust in nursing care and feeling satisfaction) were USUALLY or ALWAYS affected because of language barriers. A fourth of foreign patients in the same study reported communication difficulties and decreasing satisfaction, respectively, as usual or always experienced because of language barriers [2].
Communication discordance has been identified as the root cause of nearly 60% of serious adverse events reported to the U.S. Joint Commission’s Sentinel Event Database. Common adverse events reported include medication errors, re-admission for the same health problems, and prolonged hospital stay [3].
While it may not be feasible for all your staff to speak the languages of your target patient populations, you can implement various measures to reduce language barriers in your interaction with foreign patients.
- Hire on-site interpreters or bilingual clinical and non-clinical staff.
- Choose physicians who are comfortable speaking in your target market’s language
- Staff in charge of interacting with medical travel patients and prospects should have a good grasp of your target market’s language, both spoken and written.
- Use multilingual signage in hospitals or way-finding tools such as multilingual brochures with the layout of the hospital.
- Translation services including those of legally binding documents (e.g. consent forms, confidentiality, and patient rights statements, release of information, and applications)
- Access to media (e.g. television, newspapers, and periodicals) in multiple languages.
The benefits of cultural competence are far reaching
For every healthcare organization, more so a medical travel provider, achieving cultural competence and proficiency has enormous benefits in the growing interconnected society. Essentially, building this mastery helps to:
- Break down barriers in providing healthcare: Cultural competence builds patient trust and confidence. When a patient perceives that from interactions with nurses, doctors, and other staff, as well as diet choices, a health provider recognizes and values their cultural contexts, they are more trusting of the system and comply fully in all aspects of the care journey.
- Reduce the chance for miscommunication and errors: With communication concordance, for instance, patients are able to trust the medical encounter and provide accurate and complete medical histories, aiding proper diagnosis. Patients are also able to be more compliant with treatments as they understand treatments and treatment instructions in their preferred language instead of nodding while a nurse or doctor describes these things in a language they are not very proficient at.
- Promote better treatment outcomes: Better patient understanding drives better treatment compliance. Patients are very unlikely to comply with a plan or even feel driven to volunteer further medical histories and information if they do not understand what medical treatment they are receiving or if they feel they have been disrespected because of some events that come across as offensive to them.
- Create an improved healthcare provider–patient relationship: Once health professionals display cultural appropriateness when managing patients from different cultural backgrounds, then create an environment that makes the patient feel valued and recognized, and not just another clinical case.
- Improve business visibility: The happier and more satisfied international patients are with the quality of the patient experience in a medical tourism destination, the more referrals they will make to others. This snowballs into greater visibility for your brand.
As the world becomes smaller and people from different cultural backgrounds connect and transact, there Is a need for medical providers and medical travel businesses to recognize the cultural lines that distinguish people, and ensure they remodel their operations to accommodate these differences and boost their patient experience, thereby.
Global Healthcare Accreditation (GHA) helps organizations implement culturally competent care through its standards and best practices. For more information about GHA and its programs, click here.
References
1. CULTURAL COMPETENCE IN HEALTH CARE: EMERGING FRAMEWORKS AND PRACTICAL APPROACHES. Page 5. Joseph R. Betancourt, Massachusetts General Hospital–Harvard Medical School Alexander R. Green and J. Emilio Carrillo, New York-Presbyterian Hospital–Weill Medical College of Cornell University. Field report: October 2002
2. Sameer Al-Harasis. Impact of language barrier on quality of nursing care at Armed Forces Hospitals, TAIF, Saudi Arabia. http://www.me-jn.com/August%202013/language%20barriers.htm. Retrieved 10/26/14
3. Danielle de Moissac, Sarah Bowen; Impact of Language Barriers on Quality of Care and Patient Safety for Official Language Minority Francophones in Canada; Journal of Patient Experience; 2018. https://doi.org/10.1177/2374373518769008. Retrieved 11/20/22
