How to be best in CLAS
One day every man, woman and child will receive effective, understandable, and respectful health care in a manner compatible with their cultural beliefs, practices and preferred language.
This is the lofty goal set by federal standards for Culturally and Linguistically Appropriate Services (CLAS) for health care institutions. Issued by the Office of Minority Health (OMH) in 2001, CLAS standards involve a combination of 14 mandates, guidelines and recommendations. Four of the standards mandate language access services; three offer guidelines for culturally competent care and seven standards propose best practices for weaving cultural competency into standard operating procedures.
Compliance seems a daunting task. CLAS standards affect any public or private institution involved in any aspect of delivering health care services. Compliance extends to individuals employed directly by the health care entity, as well as those subcontracted or affiliated with the organization. The patient as well as accompanying family members, guardians, or companions should experience culturally competent service.
Not surprisingly, most effort and energy has been placed on implementing language translation and interpreting services. Language differences pose an obvious and well-documented obstacle to effective and efficient medical care. If a professional interpreter is not available (which is typical) clinical staff must rely on their own inadequate language skills, impose on their proficient colleagues, or avoid communication with the patient and family members. Dealing with language barriers takes more time and resources and too often produces sub-optimal communication.
Cultural differences are not always about language. In some places religious differences may take precedence. Differences exist between rural and inner-city cultures and Western vs. non-western worldviews. Even body language needs to be understood in a cultural context. A gentle pat on the head perceived as an offer of comfort to some may offend an African-American or Asian patient or their family members. The accepted American hand gesture to signal "come here" is used to beckon prostitutes in certain Asian cultures.
Cultural incompetence cuts like a double-edged sword. Both patients and medical staff suffer because of an organization’s cultural incompetence. Cultural friction often lies at the heart of misunderstood communications and conflict among staff. Dig beneath the surface of sagging employee morale, high turnover, grievances, and disappointing customer satisfaction ratings and the roots of cultural conflict emerge.
Organizations that focus on complying with the CLAS mandates to provide language assistance services likely will miss the forest for the trees. Those that recognize the link between internal organizational challenges and serving their customers will make cultural competency a real priority, not just another administrative imperative. Leadership will be required. In unionized environments, viable and sustainable cultural competency will not happen without labor-management collaboration.
How can cultural competency be achieved? CLAS urges organizations to develop, implement and promote an integrated strategy to meet all the standards. Viewed in totality, CLAS standards offer a prescription to improve patient care, reduce costs and create a healthier organization:
- develop a strategic plan to address all 14 CLAS Standards
- include all stakeholders in formulating, implementing and evaluating the plan
- assess and address the cultural competency training needs of the organization
- monitor and evaluate program initiatives
CLAS is only the beginning. There will be more and more contractual and legislative demands for cultural competency in the delivery of medical care. Cultural competency is not a luxury. It’s an imperative for health care organizations that want to thrive.
Rodney L. Brown holds a Master of Human Services degree from Lincoln University and a Diploma in Educational Policy and Leadership from New York University. Mr. Brown is President of Brown, Brown & Associates, Inc. BBA is at the forefront of assisting organizations that want to realize the benefits of a culturally competent workforce.
