Program for Recovery and Community Health, Yale University School of Medicine, 319 Peck Street, Building 1, New Haven, CT 06513, USA.
Psychiatr Q. 2013 Mar;84(1):53-64. doi: 10.1007/s11126-012-9226-2.
Racial and ethnic disparities are disturbing facets of the American healthcare system that document the reality of unequal treatment. Research consistently shows that patients of color experience poorer quality of care and health outcomes contributing to increased risks and accelerated mortality rates relative to their white counterparts. While initially conceptualized as an approach for increasing the responsiveness of children's behavioral health care, cultural competence has been adopted as a key strategy for eliminating racial and ethnic health disparities across the healthcare system. However, cultural competence research and practices largely focus on improving provider competencies, while agency and system level approaches for meeting the service needs of diverse populations are given less attention. In this article we offer seven essential strategies for promoting and sustaining organizational and systemic cultural competence. These strategies are to: (1) Provide executive level support and accountability, (2) Foster patient, community and stakeholder participation and partnerships, (3) Conduct organizational cultural competence assessments, (4) Develop incremental and realistic cultural competence action plans, (5) Ensure linguistic competence, (6) Diversify, develop, and retain a culturally competent workforce, and (7) Develop an agency or system strategy for managing staff and patient grievances. For each strategy we offer several recommendations for implementation.
种族和民族差异是美国医疗保健系统令人不安的方面，反映了待遇不平等的现实。研究一致表明，有色人种患者的护理质量和健康结果较差，相对于他们的白人同龄人，他们面临更高的风险和更快的死亡率。虽然最初被概念化为提高儿童行为健康护理响应能力的方法，但文化能力已被采纳为消除整个医疗保健系统中种族和民族健康差异的关键策略。然而，文化能力研究和实践主要侧重于提高提供者的能力，而机构和系统层面满足不同人群服务需求的方法则得到的关注较少。在本文中，我们提供了促进和维持组织和系统文化能力的七个基本策略。这些策略是：（1）提供高层支持和问责制，（2）促进患者、社区和利益相关者的参与和合作，（3）进行组织文化能力评估，（4）制定渐进式和现实的文化能力行动计划，（5）确保语言能力，（6）使员工多样化、发展和保留文化能力，以及（7）制定机构或系统策略来管理员工和患者的不满。对于每个策略，我们都提供了一些实施建议。
