Patient centeredness and cultural competence are movements in healthcare that have garnered a great deal of attention and momentum in the last decade. Both aim to improve healthcare quality, but the emphasis of each is on different aspects of quality (). The primary aim of patient centeredness has been to individualize quality, to complement the healthcare quality movement’s focus on process measures and performance benchmarks with a return to emphasis on personal relationships and “customer service.” As such, patient centeredness aims to elevate quality for all patients. The primary aim of the cultural competence movement has been to balance quality, to improve equity and reduce disparities by specifically improving care for people of color and other disadvantaged populations. Because of these different emphases, patient centeredness and cultural competence have targeted different aspects of healthcare delivery. Despite these different focuses, however, there is substantial overlap in how patient centeredness and cultural competence are operationalized, and consequently in what they have the potential to achieve. Individualizing care must take into account the diversity of patient values and perspectives; to the extent that patient-centered care is delivered universally, care should become more equitable. Conversely, attending to the specific needs of people of color and other disadvantaged populations must take into account the wide range of worldviews within a given group, and the multifaceted nature of “culture;” to the extent that cultural competence enhances the ability of health systems and providers to address individual patients’ preferences and goals, care should become more patient centered.
Patient centeredness, cultural competence and healthcare quality
Because the cultural competence and patient-centered care movements both aim to improve healthcare quality in similar ways, one might reasonably ask whether it is better to keep the movements separate or to combine efforts into a single agenda. While many features are similar, important aspects of each remain that have not been formally adopted by the other. Since these nonoverlapping features also have the potential to improve healthcare quality, we suggest that the concepts should remain distinct, at least in the short term. While the concepts remain distinct, however, efforts to incorporate them into provider practices and health systems should occur in concert. Separating patient centeredness and cultural competence initiatives will duplicate effort, since so many of the principles are the same. In addition, as mentioned above, efforts to enhance patient centeredness, without adequate attention to the needs of minority and other disadvantaged groups, have the potential to exacerbate existing disparities in care.
A variety of specific recommendations can therefore be made. Healthcare organizations and providers should adopt principles of both patient centeredness and cultural competence jointly, so that services are aligned to meet the needs of all patients, including people of color and other disadvantaged groups, whose needs and preferences may be overshadowed by those of the majority. Health services researchers should develop measures of cultural competence and patient centeredness and explore the impact of their unique and overlapping components on patient outcomes. Medical educators should partner with social scientists, anthropologists and researchers to develop and evaluate educational programs to improve the patient centeredness and cultural competence of health professionals. Those responsible for ensuring health system quality should employ measurement of both patient centeredness and cultural competence as part of the process of delivering high-quality care. Finally, all patients should take advantage of every opportunity to provide feedback (e.g., participate in surveys and focus groups) to improve the design and evaluation of healthcare systems that reflect patients’ diverse needs and preferences.