Hospital Impact: Bridge cultural gaps to provide optimal patient care

Healthcare leaders looking for an example of well-executed cultural competency can take a page out of the book of a hospital in California, which created a shaman program to build a bridge to the Hmong community. (Getty/orn_france)
headshot of Thomas Dahlborg
Thomas Dahlborg

Some years ago, I was blessed to lead a small nonprofit research institute, innovation laboratory and multispecialty group practice, founded by three nurses on the principles of Relationship-Centered Care. Our governance was based on the Circle Process, and a key premise of our model was cultural competence, defined as the ability to effectively deliver healthcare services that meet the social, cultural and linguistic needs of patients.

So it was fascinating when earlier this year on a flight from Florida back home to Maine the following conversation took place:

“Oh yes, Tom, we do a lot of work with the Indian Health Service. And it is sometimes very challenging to bridge Western medicine and traditional healing.”

Now, what I loved was the acknowledgement that it is important to build the bridge. And as far as the challenge noted? Not surprising.

In fact, Kee Straits, Ph.D., articulated these challenges very well in her piece: “Native American Traditional Healing: Information and Ways to Collaborate for Western Medicine and Mental Health Providers.”

Straits noted that patients do not share their participation in traditional healing for many reasons, including:

  • Lack of relationship with and trust in their physicians
  • Physicians not open to hearing about traditional healing
  • Physicians lacking understanding of traditional healing
  • The existing conflict between Western medicine and traditional healing
  • Cultural disconnection, societal perceptions/pressures, colonization and internalized oppression.

Straits also noted additional collaboration challenges:

  • Lack of respect and understanding from healthcare providers
  • Stigma of traditional healing (being considered “alternative medicine”)
  • Billing and coverage issues
  • Diverging philosophical approaches to healing: inner versus outer.

And yet, I have seen these challenges overcome.

For you see, within our Relationship-Centered Care model, I was fortunate to engage, partner and lead with traditional healers. Healers we credentialed and intentionally brought into the circle. Healers who were not only traditional healers, but also licensed clinical social workers and registered therapists in the state of Maine. Healers who embodied both Western medicine and traditional healing. Healers who met patients where the patients were (from a social, cultural and linguistic perspective).

These were healers who developed relationships with and trust in their Western medicine colleagues and with the patients and families they cared for and care about. They helped us create the bridge between Western medicine and traditional healing, thus allowing patients who truly needed physical and mental health services to cross between healing models (or in our case, our one circle model) and engage in their own healing through both lenses.

In her piece, Straits goes on to note several tactics to build stronger collaborations between Western and traditional practitioners:

  • Be patient-centered and build strong relationships
  • Ask permission to learn more about the patient’s and family’s culture
  • Be open to discussing traditional healing
  • Understand the strength-based approach to healing
  • Be aware of power differentials in healthcare
  • Meet patients where they are
  • Understand the cultural connection that may exist between a patient’s concerns
  • Seek a complementary approach between Western and traditional healing
  • Seek partnerships and collaboration with traditional healers
  • Use culturally appropriate tools, e.g., specific cultural assessment intake forms
  • Tap into available resources to learn more

From my experiences, these tactics work. And the movement has already started to take hold.

Mercy Medical Center in Merced, California, where many patients are Hmong from northern Laos, created a hospital shaman program designed to build a bridge with this community, as a 2009 New York Times piece describes.

On the Navajo reservation in northern Arizona, meanwhile, the Indian Health Service has three medicine men on staff and recently instituted a training program similar to Mercy’s shaman program, the article adds.

Healthcare leaders talk a great deal about cultural competence, and yet we continue to view this key aspect of healing through our own lens.

It is time for us to open our hearts and our minds (always with an eye on patient safety and well-being) and begin to look through the eyes of our patients and families. It is time to embrace and engage people from all cultures, and to create innovative healing models that bridge the gap between Western and traditional healing.

This approach is perhaps best explained by Lesley Xiong, M.D., a 26-year-old resident physician who grew up as the granddaughter of two distinguished shamans. "If I were sick, I would want a shaman to be there," she told the Times. "But I’d go to the hospital."

Thomas H. Dahlborg, M.S.H.S.M., is an industry voice for relationship-centered compassionate care and servant leadership. He is a keynote speaker, author, consultant and adviser and is the president of the Dahlborg Healthcare Leadership Group.