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New HHS Guidelines Aim for Culturally Appropriate Care

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Today, the Department of Health and Human Services released an updated version of the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care. Most people in the health field know these guidelines as the “CLAS” standards.

During today’s announcement of the new guidelines, HHS officials and stakeholders reviewed a familiar story: racial and ethnic minorities, people who speak limited English, and members of the LGBT community tend to have more health problems and receive worse care than people in the majority. (For a review of the literature about interpreters and the quality of health care, see this article.) That is why the CLAS standards are so important, and its why they’ve just received a comprehensive 2-year makeover.

The overall #1 standard is that health care organizations should “provide effective, equitable, understandable, respectful, and quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.”

This new version of the standards:

  • Expands the idea of culture to include all of the unique aspects of an individual’s background, including nationality and religion, but also military affiliation, political beliefs, urban/rural residence, and many other factors
  • Broadens the definition of health to include physical, mental, and social well-being and also broaden the definition of a “health care organization” to match the expanded idea of health
  • Addresses 3 themes: governance and leadership; language and communication; and engagement, assessment, and accountability  

In the coming months, the Office of Minority Health and the American Hospital Association will be educating health care organizations about the CLAS standards, providing technical assistance, and distributing success stories and practical advice from organizations who provide exemplary culturally and linguistically appropriate care. Assistant Secretary of Health Howard Koh encouraged organizations to start small: health care leaders can begin by simply stating that they believe in the values underlying the CLAS guidelines.

As a public health advocate, I spend a lot of time thinking about the ethical and health-related reasons for implementing these standards. But Richard Umbdenstock, the President and CEO of the American Hospital Association, reminded me that there is also a strong business case for pursuing these standards. Health care organizations will not be able to maintain or improve the quality of the care they provide, he said, if they don’t understand the unique needs of their population and strive to meet those needs. Furthermore, time and money are wasted when health care organizations don’t have the appropriate resources to care for patients from diverse backgrounds.

Providing culturally and linguistically appropriate care is no easy task. Organizations cannot become “culturally competent” with a simple workshop, a checklist, or an app, said Tawara Goode of the National Center for Cultural Competence. It takes serious self-reflection and self-assessment and a deep commitment to positive change. That kind of quality improvement effort requires training and capacity building, and those efforts aren’t free. But  those investments make better organizations. Not only will they be able to achieve the CLAS standards, but they will also be better prepared for continuous quality improvement efforts in the future.

Resources:

The National CLAS Standards

Equity of Care, a quality-improvement resource for hospitals

HHS Office of Minority Health



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