Anthropology Underutilized in Healthcare Design
Cultural anthropologists have been used by some of the leading industrial design firms to help study human behavior and produce more successful design solutions. They help decipher actions that consumers themselves are unaware they perform, while understanding those actions within the context of the culture they are studying.
Anthropologists are experts in humanity and the differences between cultures. When and where these cultures meet, product and service providers have a difficult time communicating and bridging the sometimes subtle gap.
Therefore, cultural competence is a must for healthcare providers and designers. Cultural competence refers to “an ability to interact effectively with people of different cultures.” There are four parts to this competency:
1. Awareness of your own cultural worldview / bias;
2. Positive attitude toward cultural differences;
3. Knowledge of different cultural practices and worldviews; and
4. Cross-cultural skills.
With these four attributes, it is possible to successfully understand, communicate and interact with other cultures.
I met a cultural anthropologist, Dr. Wendy Welch, last December at the Virginia Rural Health Association meeting and she helped educate me on the importance of this in healthcare. Our culture and language affect everything we do; it is the filter through which we interact in the world. Likewise for healthcare designers, we must recognize that culture and language may influence a person’s:
• Health / healing and wellness belief systems;
• Perceptions of causes of illness and disease;
• Patient behavior when seeking healthcare; and
• Delivery of care by providers with an uneducated cultural viewpoint.
I can definitively say these four aspects have been evident in my own family, in how my immigrant great-grandparents saw their health and healthcare versus how I see it.
Last month I toured a new critical access hospital (CAH). CAHs are, by definition, rural. I asked the administrator how he guided his architect to come up with something technologically advanced yet culturally sensitive. He said it was a challenge because his community wanted a new hospital that did not feel grandiose. The community identified strongly with its rural roots, he noted, and "would have been happy with a new hospital made of logs" if they had their choice.
A big city architect not familiar with the local culture would have really missed the mark in communicating healthcare to this rural community. In this case, cultural competence dictated a building design that conveyed quality care in an appropriately modern way, but not so state-of-the-art that it made patients self-conscious and uncomfortable in the new hospital.
As Dr. Welch pointed out, cultural competency requires someone from that culture who has these personal qualities: good listening, benevolence, intelligence, creativity, and common sense. For instance, the U.S. Department of Veterans Affairs (VA) looks favorably upon design teams who have military veteran architects or team leaders; in some cases, a team may gain additional points in its proposal submission because this cultural understanding is important to the project from the VA’s view.
To gain these skills, an organization must acquire a cultural specialist in one of four ways: hire, borrow, become one, or develop your own. And although the out-of-pocket cost are estimated to be in the neighborhood of $60k, the value of cultural competence in healthcare is immeasurable because it saves money, time, lives, gains the trust of a community, and is a morally good thing to do. Cultural competence makes sense because it improves patient outcomes.
Cultural competency is a differentiator because so few have invested in training or education for this approach—in healthcare or design. Yet, as cities and neighborhoods become more culturally heterogeneous, it will take additional insight to provide appropriate care and design. And cultural sensitivity will help make it that much easier, and effective.