Why Cultural Awareness is Key in Care Management
Understanding a Client’s Culture can Improve Compliance, Reduce Healthcare Costs
Each person is a product of their culture and is also a culture of one. Culture is a set of beliefs handed down from generation to generation and is unique to a group of individuals. It affects how we see the world, how we process information, and how we communicate.
In healthcare, culture plays a significant role in how we understand directions, reduce medical errors, improve preventive care, and encourage compliance. Each of these factors impacts healthcare costs, and each is an important facet of good case management.
But navigating this unique cultural landscape can be unnerving. Everyday routines we often take for granted—such as orientation to time, eye contact, touch or decision-making—are dramatically different between cultures, subcultures and religions. Something that may be considered unethical in one culture, such as allowing a family member to dictate all medical care and decision making, may be an accepted or expected practice in another.
Care Management and Cultural Competence
Cultural awareness is especially important in healthcare because it shapes the definition of health and illness, when and where care is sought, and what treatments may or may not be acceptable. For clinicians and case managers, developing cultural competence is critical to supporting patients across diverse backgrounds, values and behaviors.
In fact, cultural competence is central to the delivery of patient-centered care, enabling providers to educate clients about their healthcare needs in an environment they understand. This goes deeper than speaking their language, or even understanding their beliefs and culture.
By virtue of the immense number of cultures, subcultures and religions, however, it is impossible for one person to understand and know about all cultures. The culture of the healthcare practitioner—their personal attitudes, beliefs and behaviors—may also consciously or unconsciously influence interactions with clients and members of the care team. Practicing cultural humility and pursuing effective training is vital for case managers working with diverse populations.
Assessing Culture in Case Management
The assessment phase of the case management process is an ideal time in which to identify cultural practices that may impact a plan of care based on perceptions, values, and past experiences with health, wellness, illness, suffering and death. Specific cultural practices that may immediately impact care and planning include:
Perceptions: Cultures have a specific value placed on health and wellness. It is important to discover if your client believes illness is a stigma, outside their control individually, or whether they are bound by rituals and practices designed to promote health, cure a disease or prevent illness. Their perception of health and wellness will drive decision making and compliance with care recommendations.
Relationships: The power of family dynamics, both within the culture and the family unit, is a critical factor that helps determine the success or failure of your management plan. Using the family’s existing communication pattern helps ensure information reaches the decision-maker, whether it is the client or another person in the family. Some families elicit outside help and support to make decisions and others will restrict information to only one person or within nuclear family members. Each of these factors will impact how your plan of care is communicated and implemented.
Time, distance and space: Time is both a cultural concern and an individual pattern. The perspective and focus of your client must be understood in order to successfully develop a working plan of care. In other words, you may have a client who is committed to sacrifice in the present to ensure a healthy future, or those who are unwilling to make changes now in order to experience better health later. Space and distance orientation also varies among cultures. Some clients will enjoy having many people around them and others prefer to have their private and personal space. This tolerance can influence your client’s decision-making ability. In other words, a client may make healthier decisions while surrounded by their family, even though their family provides no input into the decision-making process.
Culture is integral to any person as a unique individual. It greatly impacts a client’s decision-making and reaction to treatments and care. With greater awareness of your client’s perspective, management of care may successfully impact the future of your client and family, all while reducing healthcare costs.
Taking intentional steps to develop and practice cultural competence must be a priority for case managers, care managers and healthcare organizations working with diverse populations.