Case Management Corner: Social Workers Essential for Ensuring Cultural Competence

By Kelly Bilodeau

When a patient comes into a hospital, they don’t come alone. They bring ideas, values, and cultural traditions that often play a major role in their health.

As the nation becomes increasingly diverse, understanding these factors is more critical than ever because they strongly influence health outcomes. Black, American Indian, and Alaska Native patients, for example, are much more likely to die from diseases such as cancer and diabetes than white Americans, according to KFF. These poor outcomes are not only a concern at the patient level but also for the overall health system. One study estimates that in 2018 alone, the economic burden from health inequities among ethnic minorities cost as much as $451 billion annually.

Case managers are on the front lines in the effort to reduce health inequities, but they’re also under pressure to discharge patients quickly, leaving little time to fully address these cultural factors, said Kalie Wolfinger, manager of clinical services at Phoenix. Support from social workers can help close that gap.

“Social workers are trained to understand patients as whole people, including their cultural identity, language access needs, beliefs about illness, and family roles,” she said. “While medical teams focus on treatment, social workers ensure the care plan is realistic and respectful of how the patient lives.”

Recent research reinforces this role, showing that innovative case management models led by social workers succeed by strengthening coordination between team members and improving equity, efficiency, and patient engagement. Having this support is crucial because organizations are increasingly being held accountable for providing culturally competent care. In 2023, the Joint Commission introduced six new elements of performance in its Leadership chapter, making the reduction of health care disparities a “quality and safety priority.” To this end, the Culturally and Linguistically Appropriate Standards from the Office of Minority Health offer a blueprint for organizations seeking to improve cultural competence.

What cultural competence means in case management

A patient’s culture encompasses many elements, from religion, language, and immigration experience to beliefs about medicine, gender identity, and family structure. Cultural competence in medicine is about more than just being aware of these differences.

“It means providing care that works for someone in the context of their culture. It affects how we complete psychosocial assessments, how we communicate with loved ones, and how we support discharge planning,” Wolfinger said.

The National Association of Social Workers Standards for Cultural Competence support this perspective, she said. They examine how cultural competence shows up in patient interactions and how professionals understand and address issues that affect patient health.

Understanding the patient’s culture starts with the initial assessment, ideally conducted in the patient’s preferred language. While translators are often in short supply, it’s best to seek professional services whenever possible rather than rely on family members, who can muddy interactions with their own emotions and beliefs. Discussions can also be colored by the interviewer’s personal experiences and biases, so experts recommend approaching conversations with cultural humility, allowing the patient to take the lead in explaining their beliefs and preferences. While much of the discussion will naturally center on medical issues, these conversations should also explore other factors that can affect care, such as spiritual or traditional healing practices, which should be built into the medical plan, Wolfinger said.

Consider the case of a Spanish-speaking heart-failure patient named Maria, who is scheduled to be discharged home from the hospital into the care of her adult children. Through her assessment, the medical team learns that Maria not only takes physician-prescribed medications but also incorporates traditional healing practices. The medical team now knows that instructions should be written in Maria’s native language to ensure comprehension, and the case manager must understand the alternative remedies she uses to protect against dangerous interactions with her prescribed medications.

By taking the time to learn about a patient’s culture, social workers can build crucial bridges between them and the medical team. “They see the full system around the patient and often recognize barriers that others miss,” Wolfinger said.

Overcoming barriers

However, while providing culturally competent care might appear easy on paper, there are major implementation barriers to overcome, including interpreter shortages, personal biases, and a fast-paced hospital environment that often leaves insufficient time for true cultural exploration. Hospital structures frequently prioritize efficiency over individual needs.

“Social workers are critical, because they can identify and push back on harmful patterns,” Wolfinger said.

Despite these barriers, the path to better care is possible if organizations prioritize the following:

• Providing care that includes cultural needs from the start.

• Involving families and communities in supporting the patient’s unique needs.

• Ensuring that information is available to patients in their preferred language.

• Prioritizing both medical and cultural factors when creating a discharge plan.

These priorities align closely with the National CLAS standards, and organizations can support these efforts by designating care coordinators who specialize in cultural needs or by implementing hospital dashboards that track equity outcomes and other metrics related to cultural competence, Wolfinger said.

Ultimately, making this shift requires work. Organizations can benefit from consultants or experts who can help build cultural humility into training and hiring, strengthen interpreter policies, and evaluate organizational outcomes for remaining disparities.

“Hospitals that want to succeed in equity and performance goals must improve cultural competence in case management. Social workers are positioned to lead this work,” Wolfinger said.

Case Management Corner is your go-to source for insightful discussions on relevant topics in case management. Through an engaging interview-style format, our team members share their expertise, experiences, and best practices to keep you informed and empowered. Whether you're looking for industry updates, practical strategies, or real-world perspectives, we bring you valuable conversations designed to enhance your knowledge and support your professional growth. Stay tuned for expert insights straight from the field! Kelly Bilodeau has been a longtime writer for HCPro’s Case Management Monthly.