Advanced Effective Communication, Cultural Competence, and ...

Introduction
Every patient that enters the hospital has a unique set of
needs—clinical symptoms that require medical attention and
issues specific to the individual that can affect his or her care.
As patients move along the care continuum, it is important
for hospitals to be prepared to identify and address not just
the clinical aspects of care, but also the spectrum of each
patient’s demographic and personal characteristics.
The nation’s hospitals traditionally focus on meeting the
clinical needs of their patients; they seek to prevent errors and
avoid inaccuracies that negatively impact the safety and quality
of care. However, patients also have specific characteristics and
nonclinical needs that can affect the way they view, receive,
and participate in health care. A growing body of research
documents that a variety of patient populations experience
decreased patient safety, poorer health outcomes, and lower
quality care based on race, ethnicity, language, disability, and
sexual orientation [1-4]. As cultural, communication, mobility,
and other basic patient needs go unmet, hospitals will
continue to put themselves and their patients at risk for
negative consequences. To improve the overall safety and
quality of care provided in hospitals nationwide, health care
organizations should aspire to meet the unique needs of their
patients—patient by patient.
The Joint Commission has made several efforts, both past
and present, to better understand individual patients’ needs
and to provide guidance for organizations working to address
those needs. The Joint Commission first focused on studying
language, culture, and health literacy issues, but later
expanded its scope of work to include the broader issues of
effective communication, cultural competence, and patientand
family-centered care (see Table 1, page 2). No longer
considered to be simply a patient’s right, effective
communication is now accepted as an essential component
of quality care and patient safety [5,6]. Additional studies
show that incorporating the concepts of cultural competence
and patient- and family-centeredness into the care process
can increase patient satisfaction and adherence with
treatment [7,8].
Terminology
A clear understanding of the concepts addressed in the
Roadmap for Hospitals will ensure that the hospital is
approaching effective communication, cultural competence,
and patient- and family-centered care from the same
perspective. The following terms are used frequently
throughout this document.
• Effective communication The successful joint
establishment of meaning wherein patients and health care
providers exchange information, enabling patients to
participate actively in their care from admission through
discharge, and ensuring that the responsibilities of both
patients and providers are understood. To be truly
effective, communication requires a two-way process
(expressive and receptive) in which messages are
negotiated until the information is correctly understood
by both parties. Successful communication takes place
only when providers understand and integrate the
information gleaned from patients, and when patients
comprehend accurate, timely, complete, and unambiguous
messages from providers in a way that enables them to
participate responsibly in their care.
• Cultural competence The ability of health care providers
and health care organizations to understand and respond
effectively to the cultural and language needs brought by
the patient to the health care encounter. Cultural
competence requires organizations and their personnel to
do the following: (1) value diversity; (2) assess themselves;
(3) manage the dynamics of difference; (4) acquire and
institutionalize cultural knowledge; and (5) adapt to
diversity and the cultural contexts of individuals and
communities served [9].
• Patient- and family-centered care An innovative
approach to plan, deliver, and evaluate health care that is
grounded in mutually beneficial partnerships among
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