Mandating Cultural Competency Training Through Legislation: Impact on Attitudes?

1. Mandating Cultural Competency Training Through Legislation: Impact on Attitudes? Guadalupe Pacheco, MSW Senior Health Advisor to the Director, Office of Minority Health, HHS Project Officer, Think Cultural Health March 19, 2011

2. HHS Office of Minority Health • Mission: To improve the health of racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities • National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards)

3. Think Cultural Health from the HHS Office of Minority Health • Continuing education programs that equip health professionals with awareness, knowledge, and skills to treat diverse patients • Up-to-date information on issues related to cultural competency and health inequities • Tracking of cultural competency legislation around the country

4. What is Cultural and Linguistic Competency? Cultural competency is effectively providing services to people of all cultures, races, ethnic backgrounds and religions in a manner that respects the worth of the individual and preserves their dignity. Graves 2001

5. Legislative Mandates on Cultural Competency Training Dark Blue denotes legislation requiring (WA, CA, NJ, NM) or strongly recommending (MD) cultural competence training, which was signed into law. Purple denotes legislation which has been referred to committee and is currently under consideration. Royal Blue denotes legislation which died in committee or was vetoed.

6. Legislative Mandates on Cultural Competency Training • Mandatory cultural competency education garners some criticism; however, many feel that it will improve patient-provider interactions, compliance, and patient satisfaction. • New Jersey: A case study on the implications of legislation for cultural competency curricula

7. A Physician’s Practical Guide to Culturally Competent Care • Free, online program accredited for physicians, physician assistants, and nurse practitioners • Designed to equip physicians with the awareness, knowledge and skills to treat diverse patients and improve quality of care

8. A Physician’s Practical Guide to Culturally Competent Care

9. A Physician’s Practical Guide to Culturally Competent Care • Two-year evaluation results: Curriculum participation results in development of knowledge, awareness and skills related to cultural competency. • The curriculum shows the potential for improving health outcomes and ultimately mitigating racial and ethnic health disparities.

10. Assessing the Impact of Cultural Competency Mandates • Mandatory training may be an ideal way to promote cultural competency as an effective strategy to eliminate health disparities: • Higher exposure to cultural competency due to legislative requirements • Higher exposure to cultural competency creates a workforce equipped to provide quality care to diverse patients

11. Assessing the Impact of Cultural Competency Mandates • New Jersey mandated 6 hours of cultural competency continuing education for physician relicensure. • Examination of differences in attitudes about cultural competency between individuals who self-select to take the program and those who take it to fulfill a mandate.

12. Assessing the Impact of Cultural Competency Mandates • Self-reflection components of the curriculum were compared among mandated and non-mandated individuals. • Physicians’ attitudes related to cultural competency were similar for mandated and non-mandated participants.

13. Assessing the Impact of Cultural Competency Mandates • Large increases in New Jersey physician participation in the cultural competency curriculum New Jersey physician participants:

14. Cultural Competency Mandates • Mandatory cultural competency education garners some criticism, including the idea that forced training will create negative reactions to cultural differences or cross-cultural efficacy. • However, these concerns seem to be unfounded based on these results.

15. Implications – Potential for Cultural Competency Mandates • Completion of the physicians’ curriculum, whether mandated or not, increases cultural competency knowledge and may improve practice behavior.

16. Implications – Potential for Cultural Competency Mandates • This negates criticism that mandatory cultural competency training is ineffective because mandated providers will show reluctance in grasping cultural competency concepts. • Mandates may be an ideal way to help improve care and ultimately help eliminate health disparities.

17. Summary • Cultural competency education has the potential to improve patient-provider interactions, compliance, and patient satisfaction. • Through cultural competency education mandates, policy can play a vital role in eliminating health disparities.

18. For information, contact: Guadalupe Pacheco, MSW Office of Minority Health, HHS Guadalupe.Pacheco@hhs.gov