Cultural Competence in the Workplace
Cultural competence, defined as “a set of congruent behaviors, attitudes, and policies that come together in a system [or] agency or among professionals and enable that system, agency, or those professionals to work effectively in cross-cultural situations.”1
Human healthcare now places much more emphasis on cultural competence. Physicians and other healthcare professionals are expected and trained to work with colleagues and help patients from all walks of life, including those of different gender, sexual orientation, age, race, ethnicity, and social class.
Can the same be said for veterinary professionals?
Although the veterinary profession has embraced a strong diversity movement, as evidenced by AVMA policy and educational initiatives,2 there is constant pressure to keep pace with a rapidly changing environment. The United States is one of the most culturally diverse nations in the world, with a kaleidoscopic group of inhabitants,3 but do veterinary team members, who are used to working with diverse patients, extend that diversity to clients?
From a veterinary practice perspective, this means team members must be able to overcome cultural or linguistic barriers to secure the best clinical outcomes for patients.
Although attaining cultural competence seems like a simple goal, difficulties can arise simply because of human nature. For example, social psychology suggests people tend to categorize other people, experiences, and objects to give the world meaning.4 Studies also reveal people have a natural affinity for those who share the same values, beliefs, and backgrounds (ie, people who are “just like us”).5 In essence, people tend to have underlying thoughts and feelings known as “unconscious bias” that can inform their actions and trigger automatic decisions based on their implicit beliefs.6
The following steps can help a practice build cultural competence.
Be Aware of Unconscious Bias
The aphorism Physician, know thyself is a reminder that potential for bias exists in veterinary as well as human medicine conversations because many of the cognitive processes (eg, making medical diagnoses, recognizing patterns) are similar.
Consider the 10-year-old Cavalier King Charles spaniel with a hacking cough and exercise intolerance brought to the practice—most veterinary team members would have a working diagnosis before the patient even enters the examination room. This “pattern recognition” approach has its advantages but is not a perfect solution because it relies on assumptions. Similarly, problems arise when medical professionals make decisions based on their assumptions about diverse groups of people. Building cultural competence begins for both veterinary and human healthcare practitioners when they become aware that unconscious bias can exist.
Explore Other Viewpoints
A key step in building cultural competence is to be curious (yet not intrusive) with regard to other people’s lives. When working with veterinary clients from different backgrounds, respectful communication without making judgement is vital.
In most cases, listening is more important than talking. For example, when using an interpreter for a veterinary consultation, observing the nonverbal communication is as important as listening to the words, because often the interpreter is not only translating a language but also acting as a “cultural broker” to build a bridge between the client’s and veterinary team member’s different cultural beliefs.7 To elicit a client’s viewpoint and perspective, use open-ended questions such as:
- How do you explain Buddy’s illness?
- What approach have you taken already with Diesel?
- What thoughts do you have about why this started?
- You mentioned you had concerns—can you tell me more?
- What would you like to see happen with Suki’s care?
Be Flexible when Negotiating
Cultural competence requires flexibility and a willingness to understand the client and his or her individual beliefs, values, and needs on a deeper level. Such understanding allows the negotiation of a mutually acceptable plan that works for the clients and their pet(s). Sometimes these discussions will need extra people involved; for example, some clients may be uncomfortable making medical decisions and seek input from other family members or traditional healers.
In other cases, negotiating a plan that works for everyone will require lateral, flexible thinking and novel solutions. For example, consider offering more holistic treatment options at the practice or by referral, or providing clients educational resources written in several languages or easy-to-read, picture-based formats.
When the veterinary team operates without cultural competence, communication can break down and misunderstanding, frustration, and poor patient outcomes become a risk. However, cultural competence does not require an encyclopaedic knowledge of diversity, and veterinary professionals, because of the many different patients they treat every day, already have all the necessary traits—awareness, curiosity, experience with differences, and an openness to trying new things—in abundance.