Jayden Nixon is a member of HBHI's graduate institute. His interests include cultural competency and increasing healthcare occupational opportunities for people of color.
Cultural competency is defined as “the ability of providers and organizations to effectively deliver healthcare services that meet the social, cultural, and linguistic needs of patients.” The topic of competency has become a promising throughline for critiques of the traditional patent-provider experience and new ways of providing quality care for people of all backgrounds.
As a member of HBHI’S inaugural graduate institute cohort, my mentor Dr. Manuel Hermosilla and I have been challenging this definition. Each variation on the definition that we found lacks crucial components or is simply too broad. They don’t capture the story behind each patient-provider relationship, and they don’t give any insight into how to rebuild bridges from institutional mistrust. With the help of Dr. H and HBHI, I’ve gone on a personal mission to better define cultural competency in healthcare by connecting with professionals who have dedicated their lives to actualizing equity in medicine. In doing so, here is some of the most sagacious insights from the experience.
1. Competency in healthcare is as important for providers as it is for patients.
This came up in my first interview with Dr. China Scherz, a cultural and medical anthropologist at the University of Virginia. In her research, she has focused heavily on two struggling phenomena, alcoholism in Uganda, and the opioid epidemic in Tennessee. In both places, she’s found that religion, more specifically Pentecostal Christianity, has played a major positive role in healing those that suffer from addiction. With hope as its fuel, the culture of Pentecostal Christianity has given both providers and patients an uplifting framework with spiritual warfare as the driver for change. According to Dr. Scherz. In Pentecostalism, addiction resembles a demon that can be exorcised; not a clinical diagnosis that haunts the individual for life. Therefore, those who experience addiction can have it removed from their being entirely. Restructuring one's identity from addiction inspires recovery for those who have struggled with addiction as the community around them is more than willing to give them the support they need without fear of relapsing. In addition to positively reframing addiction, Dr. Scherz and her colleagues coined the term, structural competency, which is something I had never heard before. Structural competency is defined as the trained ability to discern how a host of issues defined clinically as symptoms. It also represents the downstream implications of a number of upstream decisions about these systems. This new framework for delivering care takes the essence of cultural competency and pinpoints the actionable issues behind it to generate direct solutions, thus improving the quality of care for both patients and providers.
2. Competency training needs to be baked into healthcare education.
My second interview on this topic was with Dr. Sacha Sharp, an assistant professor of medicine at Indiana University as well as the co-chair of the IUSM Diversity Council. In our conversation, we talked about the importance of teaching up-and-coming healthcare professionals about structural and cultural competency and the means to do so. For example, one class she teaches at the IU medical school is an art history class in medicine. In the class, her students look at pieces of art from different points in time and deduce how art portrays medicine in that era. Further, they examine how art represents the culture of medicine in each time period and draw resemblances to how past medical practices relate to the current medical culture. Although this may seem arbitrary, as this isn’t the typical medical school hard science class, it’s a perfect example of establishing structural and cultural competency. This class forces each professional to look at the world from a critical perspective and use it to care for patients.
3. Cultural competency is good for business.
As we all know, patients live in the same world as the ones who provide care for them. Therefore, we must look at patients from the perspective of the current life they partake in as well as the life of their ancestors before them. In doing this, we can treat them in the most effective and culturally congruent way possible. From its inception, the United States has cultivated an infrastructure of business that encourages innovation, optimization, and productivity. Nevertheless, what many forget is that a business is only as productive as the people running it. From CEOs to slavery, every culture, family, and person has a unique relationship with the working world dating to centuries before America’s inception.
In light of these trends, competency must be at the forefront of decision-making in order to further optimize, innovate, the U.S. healthcare industry,. Structural and cultural competency is necessary because interdependence is necessary. Therefore, we must acknowledge this interdependence to eclipse the business of health as we know it into a healthier, sustainable institution.
