The intersection of patient satisfaction and quality of care is central to healthcare today, and a provider’s level of cultural competence can significantly impact his/her performance in both areas. Recent focus on diversity, equity, and inclusion initiatives in healthcare has impacted how policymakers are approaching related issues, such as cultural competence in patient care.[1] Some state governments have determined that a provider’s ability to deliver culturally competent care is an essential component to promoting effective and efficient healthcare delivery.[2] For example, Nevada, Oregon, Connecticut, New Jersey, California, Washington, New Mexico, and the District of Columbia each require some form of cultural competency training in their continuing education requirements for certain healthcare providers. In 2023, Illinois legislators introduced two major bills that mandate cultural competency training: H.B. 2450 and S.B. 2427. While these bills take different approaches, both seek to reduce challenges that patients can face in navigating the healthcare system in the absence of culturally competent care and well-resourced providers, including discrimination, reduced quality of services and insurance inadequacies.
1. New Laws Mandating Cultural Competency Training for Illinois Healthcare Providers
On August 8, 2023, Illinois Governor J.B. Pritzker approved H.B. 2450, which will require that on or after January 1, 2025, Illinois-licensed health care professionals complete one (1) or more continuing education hour(s) dedicated to cultural competency before renewing a license or registering to practice in the state. H.B. 2450 defines cultural competency as a “a set of integrated attitudes, knowledge, and skills that enables a health care professional or organization to care effectively for patients from diverse cultures, groups, and communities.” The Illinois Department of Financial & Professional Regulation will adopt rules for the implementation of the mandate, which will apply to doctors, nurses, psychologists, optometrists, physical therapists, pharmacists, physician assistants, licensed clinical social workers, nursing home administrators, occupational therapists, podiatrists, respiratory care technicians, professional counselors, speech therapists and audiologists, dentists, and behavioral analysts.
Proposed S.B. 2427, now under consideration by the Illinois legislature, seeks to mitigate discrimination and improve cultural competence for particular population groups by ensuring that certain Illinois-licensed health care professionals have skills needed to provide “affirming care to people in the person’s preferred language, people with disabilities, people who are intersex, people living with HIV, and people of diverse sexual orientations and gender identities, including, but not limited to, lesbian, gay, bisexual, transgender, queer, pansexual, asexual, and questioning individuals.”[3] Those specific skills include: (a) applying linguistic skills to communicate effectively with the target population; (b) utilizing cultural information to establish therapeutic relationships; (c) eliciting and incorporating pertinent cultural data in diagnosis and treatment; and (d) understanding and applying cultural and ethnic data to the process of clinic care. S.B. 2427 expands the definition of health care professional under H.B. 2450 to also include any persons licensed under the Music Therapy Licensing and Practice Act, Environmental Health Practitioner Licensing Act, and Orthotics, Prosthetics, and Pedorthics Practice Act.
2. Cultural Competency Training Legislation in Other Jurisdictions
S.B. 2427’s emphasis on the designated patient populations in Illinois follows precedent in a limited number of other jurisdictions, but the scope of legislation and mandated training varies in each one. For example, in Washington, D.C., healthcare providers are legally required under the LGBTQ Cultural Competency Continuing Education Amendment Act of 2015 to receive at least two (2) continuing education credits for instruction pertaining to “cultural competency or specialized clinical training focusing on patients who identify as lesbian, gay, bisexual, transgender, gender non-conforming, queer or questioning their sexual orientation or gender identity and expression (LGBTQ),” in order to legally maintain licensure.[4]
In Nevada, N.R.S. § 632.343, requires licensed nurses to complete one or more courses of instruction that provide at least two (2) hours of continuing education that must address persons of different cultural backgrounds, including: (1) gender, racial and ethnic backgrounds; (2) religious backgrounds; (3) LGBTQ+; (4) children and senior citizens; (5) veterans; (6) mental illness; (7) intellectual disability, developmental disability or physical disability; and (8) any other population that a person licensee may need to better understand.[5] Oregon passed a similar requirement to Nevada,[6] and Washington,[7] California,[8] Connecticut,[9] New Jersey,[10] and New Mexico[11] also require cultural competency training for patients of diverse backgrounds and identities.
3. Key Takeaways on Cultural Competency Training
Until now, certain legislation has focused on cultural and linguistic competency training pertaining to patients of diverse ethnic and cultural backgrounds. Like Illinois’ proposed law, S.B. 2427, future legislation may expand the scope of training to include people with disabilities, who are intersex, living with HIV, or of diverse sexual orientations or gender identities. Even where not legally required, healthcare entities can adopt cultural competency training now to help providers: (1) develop a better understanding of the healthcare needs and challenges faced by patients from diverse backgrounds; (2) improve patient communication and rapport, thereby improving patient satisfaction scores and outcomes; (3) reduce the risk of legal issues related to discrimination or inadequate care; and (4) enhance quality of care and organizational efficiency overall.
*Summer associate not yet licensed to practice law.
FOOTNOTES
[1] 2023 DEI initiatives report: Inside the lighthouses | McKinsey; Cultural Competence and Ethnic Diversity in Healthcare - PMC (nih.gov).
[2] Family physician perceptions of working with LGBTQ patients: physician training needs - PMC (nih.gov); Cultural Competency Among Physicians in Patient Care (healthgrades.com)
[3] Illinois General Assembly - Bill Status for SB2427 (ilga.gov)
[4] LGBTQ Cultural Competency Training Now Required - Providers - AmeriHealth Caritas District of Columbia (amerihealthcaritasdc.com)
[5] NRS: CHAPTER 632 - NURSING (state.nv.us)
[6] Oregon State Board of Nursing: Cultural Competency Continuing Education (CE): State of Oregon
[7] RCW 43.70.613: Health care professionals—Health equity continuing education. (wa.gov)
[8] Bill Text - AB-1195 Continuing education: cultural and linguistic competency.
[9] https://cga.ct.gov/2013/ACT/PA/2013PA-00076-R00SB-00366-PA.htm
[10] NJ Division of Consumer Affairs - State Board of Medical Examiners (njconsumeraffairs.gov)