Sherree Wilson: Breaking barriers to care

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Sherree Wilson, PhD, envisions a health care environment at the University of Iowa that is welcoming, comfortable, and accessible for all patients, regardless of race, ethnicity, gender, gender identity, sexual orientation, religious beliefs, or socio-economic status. To make that vision a reality, she is working with colleagues across the UI Health Care campus—and across the state of Iowa—to help health care providers build a “culturally responsive” environment that breaks down or removes barriers such as language and cultural differences in an effort to ensure equitable care for everyone. 

Wilson, associate dean for cultural affairs and diversity initiatives in the UI Carver College of Medicine, sees it as her mission to encourage learners and health care providers to identify ways to build better communication and improve interactions with their patients in order to achieve UI Health Care’s goal of creating an environment of inclusion where individual differences are respected and all feel welcome.

Q: What is culturally responsive health care?

A: It means that providers or staff members with UI Health Care are in tune with cross-cultural issues that may arise in clinical encounters. That doesn’t mean a health care provider has to know everything about every culture. Culturally responsive health care begins with respecting cultural differences and then having a willingness to accept that there are many ways of viewing the world. Every patient, regardless of who they are, brings to the health care encounter various cultural backgrounds, beliefs, and practices that may influence their approach to health care. Our goal is for providers to take those factors into account, meet patients where they are, and do whatever is necessary to ensure all patients have the same quality experience when they come through our doors.

Q: How is being culturally responsive changing the way UI providers and staff interact with patients?

A: Initially, they are asking more questions of patients and gaining a better understanding of their cultural backgrounds, for instance, or determining levels of English proficiency or health literacy so that additional support or resources can be provided if necessary. Our overall patient population speaks more than 40 languages. If English isn’t the patient’s first language, we want to do everything we can from our standpoint to ensure effective communication between the patient and the provider regarding medication information, treatment options, or other important care procedures.

Another example of being culturally responsive is recognizing that some patients may rely on traditional healing practices or alternative therapies to address certain illnesses. It’s important that doctors and nurses recognize and understand their patients’ values and plan accordingly; in some cases it may be possible to negotiate a treatment plan that takes into account the patient’s preferences as well as the medical perspective.

Q: Besides individual providers practicing culturally responsive health care, does UI Health Care support major programs that promote this?

A: UI Hospitals and Clinics is already recognized for providing quality care; our goal is to continue to provide quality care by being responsive to our increasingly diverse patient population. Locally, we’re working with doctors, nurses, and staff to break down health care barriers that may exist because of language or cultural differences. For instance, staff with the Patient Education Program are experts in health literacy and provide support and a number of resources to health care providers, as well as to patients.

Statewide, we’re offering faculty development workshops on culturally responsive care at our six regional medical education centers across Iowa, through the UI Carver College of Medicine’s Office of Statewide Clinical Education Programs. It’s a chance for me to visit with the community providers who work with our students on their rotations. These providers are a key component in our efforts to teach cultural responsiveness to future physicians.

And in June we presented “Culturally Responsive Health Care in Iowa,” a daylong conference sponsored by
UI Health Care and the five health science colleges at the university. The conference was designed to educate future and practicing health care professionals on the importance of providing culturally responsive and competent care in order to improve access to quality health care and reduce health disparities.

Some clinics with UI Health Care are already working to change that. The LGBTQ clinic, for example, has been working on a culturally responsive health care model since it opened at UI Hospitals and Clinics—Iowa River Landing in Coralville in 2012. From the first person each patient sees to the last, our health care team membershave been trained in how to meet patients’ needs and make them feel more comfortable. It starts when a patient first enters the clinic. All patients are asked to fill out their check-in sheet, and one of the first questions asks by which gender a patient self-identifies.

Medical education at all levels, from undergraduate medical education to continuing medical education, is placing a priority on the concept of culturally responsive care. Our medical students are exposed to the topic and the majority of our departments sponsor grand rounds or other professional development sessions, which focus on aspects of cultural competence.