How we can improve health equity with culturally and linguistically appropriate services (CLAS)
Everyone deserves quality healthcare services. CLAS standards can help tailor care to the patient’s unique needs and help them feel included in their care. If we all do our part, we can move health equity straight to the head of the CLAS!
The CDC defines health equity as “the state in which everyone has a fair and just opportunity to attain their highest level of health.”* Health equity is a tenant of high-quality care and should remain a commitment for the entire healthcare community, as outlined in the overarching goals of Healthy People 2030.
Dr. Kedar Mate, the Institute for Healthcare Improvement president and CEO, challenges that there can be no progress on quality without equity. And yet, our data continues to highlight the gaps in care by characteristics such as race, ethnicity, socio-economic status, and geography. Commitment exists to provide equitable care and reduce disparities across healthcare organizations, requiring changes in policies and practices. Guidance is available to help build such policies and procedures and assist with staff education to get us closer to providing culturally and linguistically appropriate services (CLAS).
CLAS sets forth standards and guidelines to help healthcare organizations deliver culturally aware care, encompassing many aspects of healthcare delivery, including communication, language assistance, and organizational culture. Health services that are respectful of and responsive to the health beliefs, practices, and needs of diverse patients can help understand and break down barriers to ultimately close the gap in health outcomes.
Bias Is a Barrier
While many healthcare professionals are well-intentioned and dedicated to offering high-quality care, explicit or conscious bias as well as implicit bias—an unconscious association, belief, or attitude toward any social group—can be a barrier for building trust with patients.
How might incorporating CLAS standards improve the implicit bias in the following examples leading to improved care?
- A doctor diagnoses a Black patient with diabetes and focuses initial treatment efforts on nutritional changes—without first exploring if nutrition is a central factor in the patient’s condition; making assumptions about what the patient is eating due to their race.
- A nurse practitioner is surprised when a Hmong patient seems hesitant to try a treatment plan, not knowing that the patient is afraid to say they want to first try traditional healing practices.
- A nursing home administrator assumes they are being inclusive by putting up LGBTQIA+ posters throughout the facility but does not consider talking to the residents who are members of the LGBTQ+ population about what would make their care and stay respectful and inclusive.
Sadly, bias too often leads to inferior care that is not personalized or equitable. Without incorporating CLAS, providers may miss opportunities to provide even better care for their patients. The CLAS standards are a blueprint of 15 standards for individuals and organizations, providing simple, effective ways to address health equity, improve quality, and eliminate disparities.
Breaking Down Barriers
- Be intentional and involve your intended audience. When creating CLAS materials, it’s important to both identify the needs of your intended audience and validate those needs by involving those most impacted in the development and design of services. For example, when creating materials for a Spanish-speaking audience, it’s not always enough to rely on a translation firm’s expertise. Instead, involve people whose native language is of the Spanish dialect for the patients being served. Ask them to help you understand nuances among differing dialects. This can go a long way in creating materials that help patients feel welcome, heard, and understood.
- Educate your staff. Healthcare providers earn trust by showing they are knowledgeable and empathetic. Incorporate training, across the organization, to build cultural competency and reduce explicit and implicit bias. Our reach extends beyond our internal employees. We’re proud to partner with the University of Wisconsin-Madison effort on Community-Academic Aging Research Network (CAARN), which brings together community and health system partners with academic researchers to conduct research to improve the health of older adults and decrease health disparities.
- Understanding, and using, Z-codes. Z codes, which are a category of ICD-10 codes, represent reasons for healthcare encounters that are not related to disease, injury, or external cause. Instead, Z codes describe social, economic, and environmental factors that influence a person’s health. These codes include issues related to education and literacy, housing and economic challenges, and difficult family circumstances. By using Z codes, instead of merely identifying a patient as having diabetes or other ailment, patient files alert the physician to potential problems that may be affecting the patient such as poverty, homelessness, food insecurity, or other personal challenges that can shape the physician-patient conversation. By having this information at hand, healthcare providers may better avoid biases and misconceptions that stand in the way of the most effective care. It allows the provider to have the necessary information to focus on the unique patient in front them.
Providing equitable care is essential to improving the health of the communities we serve. Through a commitment to the CLAS standards, we can support cultural humility across the continuum of healthcare and move closer to the ultimate goal of health equity for all.
*What is Health Equity? | Health Equity | CDC