Advanced Directives Standards and Cultural Competence

Advanced Directives Standards and Cultural Competence

With the continual emphasis on health care facilities to become culturally competent, there is a need for analysis of all services provided by these institutions. Such a scrutiny will enable one to spot strengths as well as deficiencies in the reviewed health care processes. A befitting example of a health care organization process that is worth evaluation and central to this discussion is the advanced directive. The use of advanced directives in the USA health care system is common given the guidelines by existent policies that demand the use of these documents in the management of end-life illnesses. The advanced directives guide the medical personnel on how to care for a terminally ill individual if he/she is incompetent to make decisions. As such, the advanced directives help protect the patient’s wishes and values, which is a core tenet of patient-centered care. An analysis of advanced directive used by a local medical institution while considering the JCAHO and Culturally and Linguistically Appropriate Services (CLAS) standards is thus worthwhile. That is the case because it will help determine the preservation of the advanced directives’ sole purpose, patient-centeredness.

Primarily, the considered advanced directive policy is the one used at Horn Memorial Hospital (HMH) in the state of Iowa. In this health care center, the advanced directive policy is that all persons admitted to acute or skilled levels of care receive a copy of the Iowa’s advance directive brochure. As such, on admission every patient must receive an HMH folder, containing an informational insert that enlightens him/her on the available advance directive options (FastHealth Corporation, 2017). The contents of the brochure are in the English language. Thus, it has a limitation for utilization by persons with low English proficiency in the absence of trained interpreters to help in translating the information to the preferred language.

Also, central to this analysis is a comparison between the advanced care planning procedures of HMH with the existent JCAHO standards that are essential for directing the practice. To begin with, on the positive side, the advanced directives processes of the HMH are as per JCAHO’s standards for the practice. For instance, JCAHO demands that all hospitals establish the patient’s possession of an advanced directive and his/her interests of implementing one. Furthermore, they must provide help to all patients seeking to formulate advance directives. Besides, it is a requirement that only an authorized staff that has the training in this area or an attending physician carries out a discussion with a patient on the advanced care planning alternatives (Worth-Staten, & Poniatowski, 1997). HMH is compliant with all these JCAHO standards as evidenced by its policy procedures. The procedures include assessing the possession of this document on admission, helping one to fill one in the absence of one, and conducting an expert staff/attending-led discussion on the various alternatives (U.S. Department of Health & Human Services, 2017). Clearly, with such instances, it is beyond doubt that the HMH is compliant with JCAHO standards for advanced directives.

Lastly, the determination of the cultural competence of the HMH advanced care directives is also important to this discussion. Of significance to the achievement of this purpose is a comparison between HMH’s practice of advanced directives with the CLAS standards. The CLAS’ principal standard is that health care facilities must offer effective, equitable, respectful and comprehensible quality services, which are sensitive to diverse cultures and preferred languages. Moreover, they must provide easy to comprehend print and multimedia resources with multiple languages to incorporate people of different cultural backgrounds (U.S. Department of Health & Human Services, 2017). However, contrary to these expectations, HMH only uses the English language in its advanced planning documents. Such reliance on the English language limits the health care access for people with low English proficiency. Evidently, such a deficiency makes HMH advance directives cultural insensitive.

Concisely, this paper aimed at evaluating advanced care planning practice of a local health care agency through comparison of the practice with the JCAHO and CLAS standards. Indeed, it is clear that HMH is compliant with JCAHO standards of advanced directives but fails to adhere to the CLAS standards. As such, going forwards into the future, HMH and other medical institutions in the USA must ensure they comply with the CLAS standards if there are to be competent cultural centers. Failure to do so, however, will only propagate this form injustice to the unforeseeable future.


FastHealth Corporation,. (2017). Advanced Directives Policy. Retrieved 14 February 2017, from

U.S. Department of Health & Human Services,. (2017). CLAS Standards. Think Cultural Health. Retrieved 14 February 2017, from

Worth-Staten, P. A., & Poniatowski, L. (1997). Advance directives and patient rights: a joint commission perspective. In Bioethics forum (Vol. 13, No. 2, pp. 47-50).