What are person-centered care and culturally responsive care? And how can you, a busy healthcare professional, practice them with your patients?
This article will dive into both of these questions.
It’s a journey, so let’s get started!
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Why Does It Matter?
Person-centered and culturally responsive care matters because it keeps your patients healthier and improves their quality of life.
Evidence shows that healthcare providers have the same amount of unconscious bias as the rest of the population (FitzGerald & Hurst, 2017). And that our biases influence our diagnoses, treatment decisions, and even how much care we give (Hall et al, 2015; Smith, 2021).
In our current healthcare system, healthcare providers are the experts, so they make decisions for the patients instead of with the patients.
This means that we make assumptions about who our patients are and what our patients need, instead of asking and listening to the patients themselves.
But our assumptions, just like everyone else’s, are often biased.
And the evidence shows that we offer worse health care to people we have negative biases towards (Hall et al, 2015). Even when we’re not aware of them.
On the left are the results of the U.S. healthcare’s biomedical model. And on the right are the health outcomes when person-centered and culturally responsive care are in practice.
| Biomedical Model | Person-Centered & Culturally Responsive Care |
| The U.S. has the highest rate* of avoidable deaths1 | Lower ER visit rates |
| Long-known health disparities1 | Faster recovery |
| Rising healthcare spending1 | Decreased use of healthcare resources |
| Lowest life expectancy*1 | Increased patient, family, and care team satisfaction2,3 |
| Highest chronic disease and obesity rate*1 | Fewer clinician mistakes |
| Fewer physician visits*1 | Improved health outcomes |
| High hospitalizations from preventable causes1 |
*Compared to other high-income countries
What is Person-Centered Care?
Person-centered care is when you actively learn who your patient is so that you can make decisions together.
So how do you do this? By:
- Asking questions
- Listening
- Treating each patient as a unique individual whose needs and preferences matter
- Helping them meet their needs and preferences
Although it sounds simple, practicing person-centered care requires that you become more aware of your biases, listen better, and adjust how you show up for patients.
Principles of Person-Centered Care
| PERSON-CENTERED CARE | NOT PERSON-CENTERED CARE |
| Prioritize the patient’s preferences | One-size-fits all |
| Ask-tell-ask -Ask questions and listen -Ask for feedback1 -Confirm that they understood | Tell-tell-tell -Use medical jargon -Don’t share information freely -Don’t ask follow-up questions |
| Make decisions with the patient -Learn what matters most to them -Give time to think through options -Make a decision together | Make decisions for the patient |
| Involve family and friends -Ask who they want involved -Support caregivers | Not accommodate caregivers |
| Support physical comfort1 -Assess pain -Improve the environment (adjust lights, etc.) | Let another discipline deal with physical comfort |
| Emotional support3 -Listen -Show empathy and respect | Don’t provide emotional support |
| Smooth transitions of care1 -Prepare patients for the transition -Communicate with other providers | Discharge Don’t create a community of care |
| Promote self-management2 Teach how to monitor symptoms, find quality resources, & self-advocate | Do everything for the patient |
What is Culturally Responsive Care?
Culturally responsive care is understanding and respecting your patients’ cultures.
Human beings are cultural beings. Your unique culture is influenced by your personality, your family, where you live, your job, and so on.
Every time you interact with a patient, you bring this mix of cultures into the treatment room with you.
To be a culturally responsive clinician is to:
- Be aware of your own cultures and values
- Consider your patients’ cultural perspectives, beliefs, and values in all aspects of the care you give
Principles of Culturally Responsive Care
| CULTURALLY RESPONSIVE CARE | NOT CULTURALLY RESPONSIVE CARE |
| Person-centered care Nobody is a stereotype of their culture | Assume that everyone from a culture believes the same things |
| Acknowledge that you have unconscious biases | Deny that you have unconscious biases |
| Focus on your similarities and shared identities | Focus on your differences |
| Act on your biases to reduce potential harm | Deny the impact of unconscious biases Believe that you can treat all patients objectively |
| Adjust your behavior to show that you’re aware of and respect cultural differences | |
| Consider the patient’s culture, beliefs, and values when providing care | |
| Use interpreter services when appropriate1 |
How to Practice Person-Centered & Culturally Responsive Care
According to ASHA, developing cultural responsiveness involves self-awareness and cultural humility (ASHA, n.d.)
One way to practice person-centered and culturally responsive care is by becoming more self-aware.
Self-awareness is how well you understand yourself. These include how aware you are of your own:
- Strengths
- Weaknesses
- Thoughts
- Feelings
- Values
- Beliefs
- Assumptions
Becoming more aware of who you are and what you’re bringing into the treatment room can help you make better decisions as a healthcare provider.
Next, we’ll go through an exercise to help you become more self-aware.
Self-Awareness Exercise: What Are Your Identitities?
This exercise helps you understand your identities and the stereotypes around them.
Copy the diagram (here’s a PDF version).
Write your name in the center circle.
Write an important part of your identity in each of the satellite circles. These are labels that best describe who you are.
Examples are Mexican American, daughter, Christian, BTS ARMY, or any descriptor that you deeply identify with.
Questions:
- Write about a time you felt included or respected because of one of these identities.
- Write about a time you felt excluded or disrespected because of one of these identities.
- Name a stereotype associated with one of your identities that is not true to who you are. Fill in the following sentence:
I am a(n)_______________but I am not _______________
For example, if one of my identifiers was “Californian,” and I thought a stereotype was that all Californians are shallow, my sentence would be, ” I am a Californian, but I am not shallow.”
*This exercise is adapted from a resource uploaded by The University of Maryland.
More Resources
Download our free Person-Centered & Culturally Responsive Care worksheet for more journal prompts to improve self-awareness.
References
- American Speech-Language-Hearing Association. (n.d.). Cultural responsiveness [Practice Portal]. https://www.asha.org/Practice-Portal/Professional-Issues/Cultural-Responsiveness/.
- Brownie, S., & Nancarrow, S. (2013). Effects of person-centered care on residents and staff in aged-care facilities: a systematic review. Clinical interventions in aging, 8, 1–10. https://doi.org/10.2147/CIA.S38589
- FitzGerald, C., & Hurst, S. (2017). Implicit bias in healthcare professionals: a systematic review. BMC medical ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8
- Grady, P. A., & Gough, L. L. (2014). Self-management: a comprehensive approach to management of chronic conditions. American journal of public health, 104(8), e25–e31. https://doi.org/10.2105/AJPH.2014.302041
- Gunja, M. Z., Gumas, E. D., & Williams II, R.D. (January 31, 2023). U.S. Health Care from a Global Perspective, 2022: Accelerating Spending, Worsening Outcomes. The Commonwealth Fund. Retrieved June 7, 2024 from https://doi.org/10.26099/8ejy-yc74
- Hall, W. J., Chapman, M. V., Lee, K. M., Merino, Y. M., Thomas, T. W., Payne, B. K., Eng, E., Day, S. H., & Coyne-Beasley, T. (2015). Implicit Racial/Ethnic Bias Among Health Care Professionals and Its Influence on Health Care Outcomes: A Systematic Review. American journal of public health, 105(12), e60–e76. https://doi.org/10.2105/AJPH.2015.302903
- Lood, Q., Sjögren, K., Bergland, Å., Lindkvist, M., Kirkevold, M., Sandman, P. O., & Edvardsson, D. (2020). Effects of a staff education programme about person-centred care and promotion of thriving on relatives’ satisfaction with quality of care in nursing homes: a multi-centre, non-equivalent controlled before-after trial. BMC geriatrics, 20(1), 268. https://doi.org/10.1186/s12877-020-01677-7
- Saha, S., Beach, M. C., & Cooper, L. A. (2008). Patient centeredness, cultural competence and healthcare quality. Journal of the National Medical Association, 100(11), 1275–1285. https://doi.org/10.1016/s0027-9684(15)31505-4
- Smith, J. M., Jarrín, O. F., Lin, H., Tsui, J., Dharamdasani, T., & Thomas-Hawkins, C. (2021). Racial Disparities in Post-Acute Home Health Care Referral and Utilization among Older Adults with Diabetes. International journal of environmental research and public health, 18(6), 3196. https://doi.org/10.3390/ijerph18063196
