HFMA VIEWS

Casey Nolan
Managing Director, Navigant Consulting, Inc.

America has in the past been described as a melting pot, in which, over time, immigrants eventually acclimated to the customs and culture of the U.S. While this may have been true in the past, it is no longer an accurate picture of what is taking place in America. Rather than a melting pot, the U.S. might be more appropriately described as a fruit salad--distinctly different and readily distinguishable elements in a shared container. As a country, we are--and will only be more so in the future--more ethnically diverse than virtually any country in the world. And rather than melting in, the ethnic groups are retaining much of their culture.

Population projections indicate that minorities will comprise more than 33% of the U.S. population by 2015. Two states (California and Texas) are already “majority minority.” The implications of this diversity for health care are enormous and, I believe, largely overlooked. Failing to understand the cultural nuances in treating minority populations can lead to more than just awkward situations--it can result in inefficiency for the provider and inadequate care for the patient.  A recent article in the Washington Post cited the example of a health clinic with a puzzling high no-show rate among Central American immigrants for follow-up visits. What the clinic didn’t understand--but found out after months of frustration--was that these immigrants KNEW they couldn’t return on the dates given to them but were too polite or timid to say “no” to a medical authority. Another example cited in the article was of a hospital whose market area experienced an influx of Vietnamese families and subsequently noted a surge in women who were becoming dehydrated after giving birth. It turned out that in Asian cultures the period after childbirth is a time in which women are supposed to consume only warm fluids and foods--not the ice chips and cold water dutifully brought to their bedside by a well-meaning and traditionally trained nurse. 

I believe that understanding cultural differences and nuances and being “culturally sensitive” is more than a politically correct nicety for healthcare organizations--it is an essential component in their increasingly difficult quest to improve quality, manage costs, and achieve profitable growth.