Quality of healthcare service provision

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Cultural Competency
Cultural competency training is seen as a way to reduce or prevent racial inequalities, & promote culturally appropriate services in health & social care
Evidence shows the influence of culture, diversity & equality on the availability, accessibility, acceptability & quality of healthcare service provision (Napier, et al, 2014)
UK healthcare services claim to ensure equity & the responsiveness of healthcare services to diverse needs
The aim is to be culturally inclusive
However, evidence shows that there are health inequalities, & disparities in health provision for members of minority groups
This shows that the UK health system does not adequately meet the needs of culturally diverse populations (Gallagher, 2015)
Cultural competency training is supposed help professionals to meet the needs of patients
Definition of ‘cultural competency’: “A set of congruent behaviours, attitudes and policies, that come together in a system, agency or among professionals, and enables that system, agency, or those professionals to work effectively in cross-cultural situations.” (Cross, et al, 1989)
In practice, ‘cultural competence’ is vaguely defined
Evidence shows that current ‘cultural competency training’ does not do enough to prepare professionals to meet the needs of culturally diverse communities (Turner, et al, 2014)
This seems to be, in part, because the concept of ‘cultural competence’ is not clearly defined
The most common definitions are North American, & little work has been done to see if they fit well in UK contexts
The idea of ‘diversity’ covers a range of groups in society, identified by a range of characteristics
‘Cultural competency training’ appears to focus mainly on issues of ‘race’ and ‘ethnicity’, as opposed to other characteristics and related differences – this seems very limiting; policy is thus often    too simplistic (lumps people together re: ‘culture’)
Diversity actually covers a range of differences: “working in partnership with service users, carers, families & colleagues to provide care & interventions that not only make a positive difference but do so in ways that respect & value diversity in age, race, culture, disability, gender, spirituality, & sexuality” (Hope, 2004, p.3)
An alternative
‘Cultural humility’ rather than ‘cultural competence’
Definition of Cultural Humility:
“Incorporates a life-long commitment to self-evaluation & self- critique, addressing power imbalances in the provider-client relationship and to the development of mutually beneficial and dynamic partnerships.” (Tervalon & Murray-Garcia, 1998)
Is this a better approach to ‘cultural competence’?
What does it mean to be ‘humble’? Understanding humility as a virtue:
Requires self-knowledge
Requires genuine gratitude towards others
Requires working in collaboration with the community
What can this mean in practice for health & social care professionals?
What is the difference between ‘competence’ & ‘humility’?
Cultural Humility
Cultural humility sees the professional as a ‘guest’
The ‘guest’ must be invited into the community, and must not force their way in
The professional must not demand that the community adheres to pre-defined bio-medical definitions
Try to develop co-participation & attitudes of serving the needs of the community
How does this approach compare to ‘cultural competence’?
Cross, et al (1989), Towards a Culturally Competent System of Care, Washington
Gallagher, (2015), Napier, et al (2014)
Tervalon & Murray-Garcia (1998), Cultural Humility versus Cultural Competence, Journal of Health Care for the Poor and Undeserved, p. 117-125
Turner, et al (2014)

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