Using Cultural Competency to Improve Care

The Tufts School of Dental Medicine joins efforts to remove language and other barriers to those seeking its services

photo of multilingual sign at One Kneeland Street, Boston

Visitors to the Tufts School of Dental Medicine at One Kneeland Street now will find signs by the lobby elevators that provide a building directory in both English and Chinese, and the school’s website includes information for patients in English, Chinese and Spanish.

These multilingual communications are some of the school’s first steps in adopting guidelines from the U.S. Department of Health and Human Services (HHS) designed to help eliminate health-care disparities by making it easier for patients from all backgrounds to access care and for providers to deliver that care.

The guidelines are known as the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care, or CLAS. “The whole purpose of CLAS is to advance equity and improve quality,” says Nicole Holland, director of health communication, education and promotion at the dental school.

Holland heads a working group dedicated to assessing the school’s status with regard to CLAS, and devising a strategy for implementation of the guidelines. The group includes about a dozen representatives from the school’s clinical, IT, research, curriculum and administrative areas.

The HHS reports that “racial and ethnic disparities in health and health care remain a significant public health issue, despite advances in health-care technology and delivery, even when factors such as insurance coverage, income and educational attainment are taken into account.” For example, it has been estimated that the combined cost of health disparities and deaths resulting from inadequate and/or inequitable care in the U.S. was $1.24 trillion between 2003 and 2006.

At the School of Dental Medicine, Holland says, the CLAS efforts will touch on many aspects of operations and overlap with other ongoing efforts in many cases. For instance, the curriculum has been revised to increase dental students’ understanding of the complex interplay between culture and health. Likewise, a federal initiative connected to the Affordable Care Act to enhance the collection of data on race, ethnicity and language in electronic health records—including the Axium system used in the dental school clinics—also aligns with CLAS.

“We’ll have a chance to learn who our patient population is, and that information will help to determine how to improve the quality of care we provide,” Holland says. For example, collecting data on languages spoken by patients could be useful in applying for grants to hire interpreters and formalizing the school’s interpretation program.

The dental school, Holland says, wants “to advance health equity in our patient population, eliminate any disparities if they do exist and improve the quality of care.” The CLAS standards “don’t seem to be a conversation within dentistry right now,” she says. “Tufts has an opportunity to help build that as a priority area, and that’s exciting.”

Helene Ragovin can be reached at

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