Second National Conference on
Quality Health Care for Culturally Diverse Populations:
Strategy and Action for Communities, Providers, and a Changing Health System

Executive Summary

I. Conference Rationale

II. Conference Design

III. Conference Conclusions

A. Health care executives see community involvement as key to organizational excellence and survival.
B. Policy initiatives set the standard for culturally competent health services.
C. Recruitment, training, and partnering with the community are the first steps toward a culturally representative workforce in the health professions.
D. New curricula and training requirements for health professionals integrate cultural competence into the educational environment.
E. The success of the clinical encounter often depends on an understanding of the patient’s culture.
F. Cross-cultural communication in health care settings is making strides toward quality.
G. Some managed care organizations are finding ways to integrate cultural competence into their way of doing business and seeing results.
H. Data and measurement break new ground for patients, communities, and organizations.

IV. Future Directions

V. Conference Plenary Presentations

• Opening Remarks
• Keynote Address: Reed V. Tuckson, MD
• The Case for a National Strategy on Promoting Cultural Competence in Health Care
• Strategy and Action for Serving a Culturally Diverse Population
• How Do We Achieve Cultural Competence in the Health Professions?
• How Do We Achieve Cultural Competence in the Health Professions?
• Managed Care and Culturally Diverse Populations
• Federal and State Governments Set the Standard for Serving Culturally Diverse Populations
• Federal and State Governments Set the Standard for Serving Culturally Diverse Populations
• The Role of Foundations in Supporting Culturally Competent Health Care

Executive Summary 

The "Second National Conference on Quality Health Care for Culturally Diverse Populations: Strategy and Action for Communities, Providers, and a Changing Health System," held October 2000, convened nearly 600 providers, policymakers, and community representatives from 33 states and 3 countries to address the challenges and successes of implementing culturally competent services. This conference is part of a continuing national series that is the first to apply a multi-disciplinary, systems oriented approach to implementing cultural competence in health care. One hundred fourteen experts, including health care executives, cultural competence trainers, interpreters, researchers, educators and representatives from government, managed care, and diverse communities, reported on model programs, presented updates on federal initiatives, and discussed innovative approaches for incorporating cultural competence into the provision of health care services. The goal of the national conference series is to raise awareness, teach skills, and use participant input to advance national policy and local agendas.

This document synthesizes content of the second national conference, highlighting model programs and initiatives and summarizing conference plenary presentations. The following conclusions were synthesized from conference presentations and discussions:

A. Health care executives see community involvement as key to organizational excellence and survival.

To be most effective, the health care system must convert from a disease-oriented, individual-focused model to a community-based, holistic model. This includes partnering with communities to utilize their input to help shape the decision-making process. Further, health care executives must take a leadership role in making cultural competence a priority.

B. Policy initiatives set the standard for culturally competent health services.

New policies at the federal, state, and local levels demonstrate intensified attention to the importance of cultural competence. Executive orders, guidances, standards and government-wide initiatives are directed at ensuring equal access to health and social services and reducing disparities in health care.

C. Recruitment, training, and partnering with the community are the first steps toward a culturally representative workforce in the health professions.

Developing a health professions workforce that is representative by race and ethnicity is a key component in assuring culturally competent care. Strategies include pre-college intervention programs, developing best practices in training, and research. Still, promising initiatives, such as collaborations between schools and hospitals and mentoring programs, need further development. Active collaboration with diverse communities is integral to this process.

D. New curricula and training requirements for health professionals integrate cultural competence into the educational environment.

Research has revealed a lack of cultural competence training in medical schools and continuing education programs. The Association of American Medical Colleges and several medical schools and residency programs are developing and implementing curricula and training programs to address cultural competence. Administrative and faculty support and community involvement are key to the success of these programs. Important components of the trainings include continuity and direct clinical applicability.

E. The success of the clinical encounter often depends on an understanding of the patient’s culture.

In addition to language barriers, sensitivities to medications, use of alternative therapies, and adherence to treatment regimens are some of the many cultural-related factors that influence clinical and pharmaceutical interventions. More research on the cultural implications for clinical and pharmaceutical care and additional innovative programs are needed.

F. Cross-cultural communication in health care settings is making strides toward quality.

Ongoing work in the areas of interpretation, translation and health literacy is focused on assuring quality, developing best practices, and assessing the impact on clinical outcomes. Efforts include a movement to organize and professionalize the field of medical interpretation, including the development of an accreditation process; web-based strategies for making translated documents available; and the performance of health literacy screenings for individuals in clinical care.

G. Some managed care organizations are finding ways to integrate cultural competence into their way of doing business and seeing results.

New initiatives are directly targeted at improving the health of diverse enrollees in several managed care plans, such as Alameda Alliance for Health, United Health of Minnesota, and Kaiser Permanente. Strategies include building clinics to increase outreach in diverse communities, printing health information in community newspapers, emphasizing diversity in hiring, developing a provider handbook, and implementing a web-based continuing medical education program.

H. Data and measurement break new ground for patients, communities, and organizations.

Measurement and outcomes have become increasingly important for demonstrating the effectiveness of culturally competent care. The growing research base draws upon organizational assessments and patient satisfaction surveys, although more culturally competent-specific surveys need to be developed to effectively measure cultural competence. Determining the efficacy of interventions is key to informing and guiding providers, policymakers and communities.

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