Reading through some paperwork this morning around Title X policies, and the language is driving me up the wall. Over and over, I see cultural competence this and cultural competence that. Cultural competence indicates an endpoint. It means that one can gain knowledge to master and be all knowing of a culture. That is not possible. Flat out and straight forward, you, I, and everyone in between cannot be competent in or a master of another’s culture. Cultural competence is nothing more than a cookie cutter approach that leads to stereotyping. But cultural humility, my friends, is where it is at!
In Healthfirst’s 2021 strategic plan, we identified and created the pillar of pursuing a value-based philosophy. So really, though, what are values and how are they relevant to medical decision-making? One of, if not the most familiar values we discuss in healthcare and medicine is ethics. However, values vary from person to person and extend beyond ethics. Values could include preferences, needs, hopes, expectations, and time. These values make providing healthcare complex as often times the values of the person and the provider or health system conflict.
The values, even when conflicting, play a role in day-to-day decision making with every client who walks through clinical doors. And when you mix values with a mission and core values, you end up pursuing a value-based philosophy. As part of our core values, we treat all with respect and dignity. Part of that respect and dignity is individual autonomy. People know who they are and what they need. It is our job in healthcare to meet them where they are at and help them achieve their goals, no matter what our medical opinion is.
That is how we began our journey to cultural humility. From pursuing a value-based philosophy to understanding patient autonomy-smack dab in the middle lies cultural humility. So, to establish a foundation of knowledge on the topic for the entire organization, I reached out to the founder and coiner of cultural humility, Dr. Melanie Tervalon. Although we were in the midst of Covid lockdowns, the timing could not have been more perfect. Dr. Tervalon was on her way to a well-deserved retirement, and we were one of her last consulting clients.
Through a virtual platform, my entire staff was able to engage with and learn about the concept of cultural humility. The concept is built on four pillars: being in a lifelong process of critical self-reflection, self-critique, and learning, recognizing and mitigating the inherent power imbalances in the patient-provider relationship, seeking and honoring the expertise that resides in the communities we serve in a non-paternalistic and mutually beneficial partnership, and advocating for and maintaining institutional accountability. In other words, our patients/clients and the community are the content experts of themselves-and we must practice and interact in a way that acknowledges and honors that.
After the training, we knew we needed to do more. How do we keep this concept alive within in our organization? How do we ensure that we honor and practice it every day? We started with a “book club” within our departments and began reading, “The Spirit Catches You and You Fall Down.” We would meet monthly with our teams and discuss the chapters through a cultural humility lens. We have also had monthly case study meetings with all staff to encourage interdisciplinary problem solving and cultural discussion. Lastly, we have had 5 staff complete a cultural humility train-the-trainer program in which they are now certified facilitators-they help keep the conversation going.
Out with the old and in with the new. Humility not competence. Live it, breathe it, do it.