EXECUTIVE SUMMARY
As the population becomes more diverse, it’s important for case managers to be aware of their patients’ cultural beliefs and practices, and respect them in order to build trust and ensure that patients and family members will follow the care plan.
- Hospitals should provide comprehensive education on the culture of the patients they serve, hire staff that are from the ethnic groups they serve, and revamp their educational materials so that they are in all the languages their patients speak.
- Case managers should have general information on patients’ cultures but also should conduct a detailed assessment to find out the beliefs and practices of each individual patient, rather than making assumptions.
- Whenever possible, case managers should work with the rest of the team to accommodate the beliefs and practices of patients. In most cases, it won’t interfere with the treatment plan.
If case managers don’t learn about their patients’ cultural beliefs and practices and incorporate them into the plan of care, their efforts to develop a trusting relationship with their patients and create a successful discharge plan may be in vain.
That’s why case managers need to be aware of their patients’ cultures and conduct research to learn about the beliefs and practices that could have an effect on the healthcare of each individual patient, says Jose Alejandro, PhD, RN-BC, MBA, CCM, FACHE, FAAN, director of case management at Tampa General Hospital.
“When providers are not familiar with the cultural beliefs of the population they serve, it can cause unintended consequences such as lack of adherence to treatment plans, fragmentation and disconnects in care, medical errors, and, increasingly, patient dissatisfaction,” says Catherine M. Mullahy, RN, BSN, CCRN, CCM, president and founder of Mullahy and Associates, a Huntington, NY, case management training, education, and consulting firm.
America has always been a nation of immigrants, and the population is becoming increasingly more diverse, points out Vivian Campagna, RN-BC, MSN, CCM, chief industry relations officer for the Commission for Case Manager Certification. She cites statistics that predict 85% of the nation’s population growth in the next 50 years will be due to immigrants and their descendants.
“It’s critical that all of us in healthcare get on board with cultural diversity and what it means to us personally and professionally. If case managers ignore a patient’s culture and beliefs, they might as well throw out the entire treatment plan and discharge plan,” Campagna says.
Case management directors should take a close look at the population they serve and compare it to the ethnicity of their staff, Mullahy suggests. “For instance, if the hospital is serving an increasing number of Chinese, Russians, or people from other parts of the world and the staff looks the same way it did 10 years ago, that’s a problem,” she says.
Make it a point to hire staff members who are from the populations you serve, Mullahy suggests. “The way the staff looks speaks volumes. Having nurses or social workers from the same community as your patients helps increase communication and build trust,” she says.
In addition, a multicultural staff can help their fellow staff members understand the preferences and nuances of patients from other cultures, she says.
If your patient population is becoming more diverse, it’s probably time to review the educational materials you give to patients. If they are written only in English, and maybe Spanish, it’s time to upgrade them, Mullahy says.
“Handouts need to be written in the languages that patients speak. What worked a few years ago may not be adequate now,” she says.
To meet the needs of a diverse patient population, case managers should have a tremendous amount of education on the patients their hospital serves, their practices, and beliefs. Be familiar with likely economic, language, religious, gender, and other barriers that may interfere with treatment, Campagna says.
“If case managers are educated on the populations they serve, they may not have all the answers when they first encounter a patient but they’ll have a foundation they can build on so they can understand the patient and come up with a successful plan,” Campagna says.
The first step in becoming culturally competent is to examine what you think about that culture and how you feel about an increased number of people who look and think differently from you, Mullahy says.
“Understand how you feel when you come face-to-face with a patient and you don’t speak the language,” she says.
Examine your own values and preferences and convey to your patients a sincere desire to understand theirs, Mullahy says.
“Case managers need to be able to put aside their personal beliefs in order to advocate for their patients. I encourage my staff to put their viewpoints out of sight if they can. Case managers can’t always choose the type of patients they see. It’s better to recognize a potential conflict than to let a difference in beliefs have a negative impact in your relationship with patients,” Campagna says.
Hospital leadership should be addressing cultural diversity and healthcare disparities and providing extensive, ongoing education that will enable the treatment team to understand and meet the unique needs of their patient population, Alejandro adds.
“If case managers do not address the cultural beliefs and practices of the individual patient, they run the risk of being unable to build a trusting relationship with the patient and family members, and ultimately creating a discharge plan that will not work,” he says.
Healthcare professionals tend to think that patients and family members are not being compliant when they don’t follow their discharge plan and end up back in the hospital, Alejandro says. “It may be because we haven’t given them the tools to be successful. Readmissions could be the result of the patient not understanding the discharge instructions because of a language barrier, or not being able to follow them because of a socioeconomic barrier,” he adds. Don’t make assumptions when it comes to creating a discharge plan for your patients from diverse populations, Alejandro says.
“Healthcare providers have to integrate patients’ culture and cultural beliefs within their healthcare system in order to provide care for all patients. If they don’t accommodate the cultural practices of their patients, it will be much more difficult to build a trusting relationship,” says Donna Zazworsky, RN, MS, CCM, FAAN, principal of Zazworsky Consulting in Tucson, AZ.
“Everything we do in case management reflects our understanding of our patients. Assuming that an individual thinks and acts as we do, or perhaps making assumptions based on a superficial understanding of someone’s culture, can be the beginning of problems that often result in mistrust, confusion, and costly complications,” she adds.
“Even if they don’t agree with the beliefs, case managers must be respectful of the individual. If they dismiss the beliefs or are unwilling to accommodate them, it’s like dismissing the patient,” Mullahy says.
Don’t be ethnocentric and evaluate patients’ cultures based on the preconceptions of your own culture, Zazworsky advises. Instead, be multicultural and tailor the care plan to each individual’s beliefs and practices, she adds.
Building relationships with your patients is an essential part of ensuring that the treatment plan will work, says Jill Lanning, RN, BSN, chief nursing officer for Dependable Home Health, a home health agency headquartered in Tucson, AZ. “You have to build trust and it sometimes takes a long time. The bottom line is to get acceptance any way you can. Work within the culture and collaborate with the community to help patients follow their discharge plan and maintain their own health,” Lanning says.
When patients don’t follow their plan of care, if you can find out why they are responding the way they are, it will help you deal with the problem, Campagna says.
“For instance, if people don’t understand how the healthcare system can help support their health, they will keep using the emergency department and wait to seek treatment until they are so sick they have to be hospitalized,” Zazworsky says.
In those situations, case managers should help the patients understand the Western healthcare system and how to be proactive. Educate them on the importance of accessing primary care before they go back to the ED. “Educate, educate, and then educate them some more,” Zazworsky adds.
Whenever possible, involve the caregiver in the discharge planning process to help with buy-in. Ask him or her to come to the hospital and participate in the discharge education, Zazworsky adds. Find out what community resources are available to meet their needs after discharge.
Determine if your community partners are appropriate for an individual patient. Make sure the organizations to which you refer patients have staff who speak their language and understand the culture, Zazworsky says.
“When case managers and other clinicians make an effort to accommodate their patients’ beliefs, they are truly providing patient-centered care and improving patient satisfaction. Patient-centered care is more than just involving patients in their medical care — it’s accommodating their cultural practice and spiritual beliefs and treating the entire person as an individual,” Mullahy says.
If case managers don’t learn about their patients’ cultural beliefs and practices and incorporate them into the plan of care, their efforts to develop a trusting relationship with their patients and create a successful discharge plan may be in vain.
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