The Impacts of Health Literacy and Cultural Competence on Patient Care

Effective communication is vital to both healthcare quality and patient safety. In fact, research shows that unaddressed language barriers put patients at high risk for many adverse events, including medication errors, delays in care and issues with discharge.

There are several factors that can affect patient-provider communication. However, health literacy, English proficiency and cultural competence are some of the most important. For example, patients who have limited health literacy—or the ability to find, understand and use health information—may struggle to make informed medical decisions and take appropriate action.

Healthcare organizations also play a role in promoting health literacy and must equally enable all individuals to use information and services to inform health-related decisions. Healthcare providers also carry the responsibility of ensuring their own cultural competence—the ability to effectively interact with people of different cultures.

The Risks of Low-Level Health Literacy

Low health literacy is particularly prevalent among high-risk populations, such as patients who are elderly; have limited education, lower income or chronic conditions; and are non-native English speakers.

Low-level health literacy poses various risks to the patient and can result in:

• care delays or noncompliance due to lack of understanding, trust or treatment that conflicts with cultural values;
• increased length of stay and resource utilization;
• increased risk of adverse events;
• greater risk of surgical delays; and
• chance of readmissions.

The Role of Cultural Awareness in Medical Care

Understanding a patient’s culture is key to providing effective care and building positive relationships. For example, a patient’s culture may impact how they describe pain or respond to authority figures.

Making an effort to understand an individual’s background can build trust and inform treatment plans. Alternatively, according to research published by the U.S. Department of Health and Human Services Office of Minority Health (OMH), lack of cultural awareness may lead to:

• medical advice that is not mindful of culture;
• incorrect clinical decision-making;
• under/over ordering of tests/treatments;
• lower patient satisfaction;
• delay in diagnosis/treatment; and
• potential liability.

Additionally, OMH data indicates that culturally diverse patients report that they are, at times, treated differently by physicians and healthcare staff and are spoken down to or looked down on because of their culture. It’s imperative that physicians develop cultural sensitivity to provide better care and, on a larger scale, promote health equity.

The Legal Ramifications of Ineffective Patient Communication

Data supports that ineffective patient communication is a major theme in medical professional liability cases. Some contributing elements, according to the Agency for Healthcare Research and Quality, include:

• inaccurate and incomplete medical history and registration forms;
• ineffective or improper use of medications or serious medication errors;
• improper preparation for tests and procedures;
• poor or inadequate informed consent;
• lack of follow-up; and
• using a family member, friend or nonqualified staff as interpreter.

How to Mitigate Risks Associated with Health Literacy

MLMIC recommends that healthcare organizations prioritize health literacy by making it an integral part of their mission, structure and operations.Healthcare facilities should aim to:

• Create well-maintained policies and well-informed staff.
• Keep staff current on care guidelines.
• Dedicate time and effort to improving services.
• Appreciate cultural differences.
• Foster a supportive culture for safety of diverse patient populations.
• Practice openness and flexibility.
• Demonstrate humility.
• Consider a self-assessment.
• Review existing policies and procedures.
• Involve the community.

MLMIC encourages our insureds to explore these additional resources that can help health organizations promote health literacy and cultural competency:

• National Patient Safety Foundation’s “Ask Me 3” program
• Using the Teach-Back Method to Improve Patient Understanding of Instructions
• The 4C’s of Culture

This information was originally shared by MLMIC Risk Management Consultants Deanna Mirro Altmann and Shelly Kriete in a presentation for Nassau County Medical Society and Nassau Academy of Medicine.