Cultural Humility in Healthcare ________________________________________________________________
Othering assumes that various oppressed and marginalized populations are different from the American “norm,” com- monly understood as a White, middle class, able-bodied, straight, male, and individually responsible for any difficul- ties they may experience. Multicultural patient care delivery and cultural competency frameworks commonly assume that the healthcare professional is White and that patients are the “other” and set out to describe what various racial and ethnic groups believe and how they act as a group. On the other hand, a cultural humility framework emphasizes self-
understanding as primary to understanding others. To facili- tate self-understanding, cultural humility encourages ongoing critical self-reflection, asking the healthcare professionals to delve into their cultural identity and its effect on the deliv- ery of patient care. Cultural humility makes no assumption regarding the healthcare professional’s identity and especially challenges White practitioners to explore and understand their “White identity” (Carten, 2016). Table 5 illustrates the differences between (multi)cultural competence and cultural humility frameworks.
(MULTI)CULTURAL COMPETENCE AND CULTURAL HUMILITY (Multi)Cultural Competence Cultural Humility
Perspectives on Cul- ture
• Acknowledges layers of cultural identity. • Recognizes danger of stereotyping. • Assumes the problem is a lack of knowledge, awareness, and skills to work across lines of difference. • Individuals and organizations develop the values, knowledge, and skills to work across lines of difference.
• Acknowledges layers of cultural identity. • Understands that working with cultural differences is an ongoing, lifelong process. • Emphasizes understanding self as well as understanding patients. • Assumes an understanding of self, communities, and colleagues is needed to understand patients. • Requires humility and a recognition and understanding of power imbalances within the patient-healthcare professionals’ relationship and in society.
Assumptions
Components
• Knowledge • Skills • Values • Behaviors • Practitioner
• Ongoing critical self-reflection • Lifelong learning • Institutional accountability and change • Addressing and challenging power imbalances
Stakeholders
• Patient • Practitioner • Institution • Larger community
Critiques
• Suggests an end point. • Can lead to stereotyping. • Applied universally rather than based on a specific client’s experience(s). • Issues of social justice not adequately addressed. • Focus on gaining knowledge about specific cultures.
• A “young concept” • Empirical data in the early stages of development • Conceptual framework still being developed
Note. Adapted from Fisher-Borne, M., Cain, J. M., & Martin, S. L. (2015). From mastery to accountability: Cultural humility as an alternative to cultural competence. Social Work Education, 34, 165-181.
Table 5
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