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The Need and Importance of CLASS in the Healthcare Systems Research Paper

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Sicknesses are a reality in our existence and while some are avoidable, some are inevitable. How we go about managing an illness greatly determines the extent of damage done. When dealing with any type of sickness, the various personnel involved have to effectively communicate and coordinate their operations to contain the situation. Due to the heightened levels of psychological pressure, anxiety, and strain on resources, the normal forms of organization and communication may prove to be inadequate. One feasible solution to the potential problems that may arise in the event of these situations is the adoption of culturally competent care standards.

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CLAS refers to standards applicable in the coordination and implementation of feasible solutions, especially in complex emergency operations that may arise in a community where culture and language present possible barriers to the success of the medical intervention (Rich & Mitchell, 2008).

The need for CLAS in medical organizations

For a group to deem itself as an organization, there must be observable elements of cooperation and coordination within the members of the group by a pre-prescribed format (Morgan, 2006). As such, the key to the establishment of any organization is the presence of some common and quantifiable goals that require a collective effort from both the clients and the organization to pursue them. In an organization, a comparison of the role that each party plays against the background of the overall effects that their actions may have on the entire organization is important. The traditional organization evolves around pre-defined plans and goals that gear towards the optimization of performance by the organization (Nemie, 2009). The development of most of the activities is such that they adhere to organizational routines that are inherent to a well-established structure.

Present conditions have called for restructuring to how organizations function. One of the reassessments made is the placement of even greater emphasis and value on the input of the cultural and linguistic differences of the patients to ensure that the healthcare providers survive the various competitive forces that constantly threaten their existence and success rate as regards to the provision of quality services.

Bearing in mind the factors discussed above, the organizational structure is constantly facing major modifications such that it conforms to the various realities that arise in a medical-oriented environment. As such, the role of the individual has in the past few years been raised to the forefront and may indeed act as the last line of defense in instances where the traditional means of relying on contemporary methods has failed.

A brief overview of CLAS

As the population in different parts of the world continues to interact and grow rapidly, an aspect of diversity is unavoidable (AHRQ, 2010). This diversity may come in form of cultural and linguistic differences among others. Documentations of literature highlighting the benefits of such diversities are present. However, these diversities present a challenge to healthcare providers and other practitioners in the medical arena who are constantly interacting with consumers/patients with different cultural and lingual backgrounds. Putting in mind that language and culture play a pivotal role in service rendering, there is a dire need for healthcare organizations to understand and respond to the needs of their clients irrespective of their cultural and lingual differences (Dayer-Berenson, 2010).

On a sad note, there had been a lack of standards that act as guidelines about these barriers. In a bid to create the much-needed standards, the Office of Minority Health (OMH) undertook the hard task of establishing national standards relating to CLAS (OPHS, 2001). After carefully reviewing the proposed standards and amending the contentious issues, a final draft passed on December 22, 2000. Medical practitioners both in the public and private practice agreed upon this draft.

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Review of the CLAS standards

Heath personnel was to play a key role in the implementation of the proposed standards. As such, their training and preparedness were also a key priority if CLAS plans were to prove to be effective.

According to Ring & Mitchell (2008), there are 14 standards within this project. They come in three categories namely: CLAS mandates, guidelines, and recommendations. CLAS mandates refer to the federal requirements of all the recipients that receive federal funding (standards 4-7). CLAS guidelines on the other hand cover the recommended activities that gear towards the conformity to the federal mandates (standards 1-3, 8-13). Finally, CLAS recommendations refer to the ideas suggested by OMH whose adoption is voluntary by medical organizations.

Standard No. 1

The first standard stipulates that health care providers should put more emphasis on the provision of medical services in a manner that is understanding and respectful to the patient’s cultural beliefs, practices, and language when it comes to healthcare. This standard aims at ensuring that all patients get their services in a manner that is considerate of their cultural beliefs and lingual abilities.

Standard No. 2

This standard insists that all healthcare organizations should put in place avenues through which a diverse staff can be cultured to meet the cultural and language specification of the service area. Achieving this can be through recruiting, training, or retraining the staff to meet these requirements.

Standard No. 3

According to this standard, staff at all levels must constantly receive the appropriate education and training regarding the delivery of services that are culturally and linguistically oriented. Hiring a diverse staff does not necessarily mean that they are going to meet the required standards. The only way to achieve this is through the provision of education that equips them with the necessary skills.

Standard No. 4

This standard inputs the notion that all healthcare providers must provide language assistance services to their clients in an appropriate and timely manner. The standard has its roots in title 6 of the civil Act as regards Limited English Proficient (LEP) individuals. It aims at ensuring that all clients that cannot read/write or understand English get quality interpretation services whenever required.

Standard No. 5

According to this standard, all clients must receive a notification verbally and in writing informing them of their right to free language assistance services in a language that they understand. This standard aims at assuring the clients that these services are available and at their disposal, if required.

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Standard No. 6

This standard states that health organizations must assure their LEP clients of competent language assistance, translation, or interpretation services. At no given time should friends or family offer these services to the patients unless under a request from the client. This standard acknowledges that effective communication is the determining factor between success and failure in service delivery. As such, efficient translators and bilingual staff must receive training and retraining services to ensure that they give the best of services whenever required.

Standard No. 7

As per the standard, patient-related posters and signage should be availed to all clients in an easily understandable language that considers the frequent population catered for within a given area.

In addition, the design used for these materials should be responsive to the cultural, educational, and language needs of the majority of the clients frequenting the healthcare provider.

Standard No. 8

This standard articulates that healthcare providers should develop, implement and promote a written strategic plan that highlights their goals, objectives, and policies regarding their provision of culturally and linguistically competent services to their clients. The main aim of this standard is to assist healthcare providers in the process of resource allocation, structuring of activities, and planning of operations in a diverse population.

Standard No. 9

This standard gives out clear directives to healthcare providers to ensure that they carry out self-assessments regarding CLAS-related activities. It also encourages them to put in place measures that are culturally and linguistically competent within their internal affairs. This standard aims to ensure the implementation of other standards such as the eighth and the fourteenth standards in the day-to-day running of health encounters (GUCCHD, 2010).

Standard No. 10

According to this standard, all client information should be collected and updated periodically about their proficiency in English (written and verbal), their ethnic background, and race. It gears towards the identification of the population mix within the service area, assisting in resource allocation when it comes to CLAS-related issues, and helping in prioritizing and assessing the client’s needs.

Standard No. 11

It states that all current data about the population mix, culture, and epidemiology should be available as well as an assessment of the population’s needs and the strategic plan on how the organization wishes to implement cultural and linguistic related services to the community they serve. The main purpose of this data collection is to equip the organization with adequate information about the community that they serve to better understand their needs and consequently, provide better services.

Standard No. 12

For any proposed policy to pass or receive any acknowledgment from the people, they need to feel that they have contributed to its development or implementation. This standard aims at ensuring that the designing and implementation of all CLAS standards is a collaborative effort between the clinicians and the community that they serve. In so doing, it minimizes any chances of conflict or rejection by the intended targets making it easy to implement.

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Standard No. 13

Where diversity is involved, the chances of intercultural misunderstandings and conflicts are very high. As such, this standard states that the conflict and grievance resolution measures adopted by an organization should be sensitive to the culture and language of the clients. This standard aims to ensure that the resolution processes used by an organization can identify, prevent and solve any conflict that may arise in a health encounter.

Standard No. 14

Sharing information about the organization’s goals policies and objectives is very important because it shapes the perception of the clients towards the organization. According to this standard, healthcare organizations must share such information with the public as well as their progress and innovations about providing CLAS services.

Culturally competent care appropriate in Medical-Surgical workplace

About the above review, culturally competent care refers to the ability of surgical practitioners to analyze, assess and render services to their clients in a manner that is sensitive and considerate to their cultural and language needs. This means that all information about any surgical procedure a client is about to receive is availed to them both in writing and verbally in a language that they understand and within their cultural boundaries.

The populations served and any issues of population vulnerability

The underlying reason behind the establishment of these standards was to cater to the “minorities” in various communities. Due to globalization, America has had a high influx of immigrants from different ethnic and racial backgrounds. Most of these people have little knowledge of the English language and therefore, there is a need for establishing measures that will consider their flaws when it comes to service delivery. The audience targeted by these standards includes LEPs, the elderly, the mentally challenged, and the disabled members in various communities.

These standards also dictate the amount of power the patient has over the kind of treatment that he gets. In western countries where freedom of choice is highly regarded, informed consent is necessary in most cases and the patient has the right to either consent to or decline certain treatments. This however may be ineffective if the client does not understand the risks or benefits contained in a mode of treatment (Nemie, 2009). Consequently, in cases whereby the patients are not aware of their rights to these standards or where the medical practitioner is held in awe and reverence and as such is seen to know what is best for the patient, the patient is almost always excluded in the decision-making process a factor that may lead to unforeseen conflicts (Nemie, 2009).

The extent to which these standards apply in healthcare organizations

The implementation and promotion of these standards are slowly becoming a requirement for all medical care providers. In almost all hospitals, CLAS is available to the clients that require them. However, due to resource inadequacies (funds and human resources), some hospitals ignore such standards as retraining and providing educational services to their staff due to financial constraints.

The impacts of CLAS on the delivery of nursing care

Johnstone (2008) reasserts the fact that professional nursing ethics require nurses to protect and promote the interests and wellbeing of the people in their care. This is by the nursing code of ethics which explicitly states that nurses place great value in quality nursing care and refrain from providing services that are deemed as below standard and therefore unacceptable. As such, when nurses implement the CLAS standards in their health encounters, there is a high probability that they will provide quality care to their patients. On the other hand, where these standards cease to apply, the nurse is bound to face many difficulties while delivering healthcare services to patients who have different cultural and language differences.


The need and importance of CLAS in our health care systems cannot be understated. Cultural integration is pivotal to the success of the human race and the implementation and promotion of such measures are therefore paramount as we try to counter any conflicts that may arise because of serving a diverse population.

In cases where the standards are not applied, the organization should invest in retraining, training, and educating their staff on the importance of these standards. In addition, the responsible bodies should set out a campaign aiming at creating awareness of this issue. In so doing, the masses will be civically educated of their rights and this will in turn pressure the reluctant providers into implementing these standards.


AHRQ (2010). Oral, Linguistic, and Culturally Competent Services: Guides for Managed Care Plans. Web.

Dayer-Berenson, L. (2010). Cultural Competencies for Nurses: Impact on Health and Illness. USA: Jones & Bartlett Learning.

DHHS Office of Minority Health (2010). National Standards on Culturally and Linguistically Appropriate Services (CLAS). Web.

GUCCHD. (2010). The Cultural and Linguistic Competence Family Organization Assessment. Web.

Johnstone, M. (2008). Questioning nursing ethics (ethics & legal). Australian Nursing Journal. Vol 15. p. 19.

Morgan, G 2006, Images of Organization, USA: Sage.

Nemie, J. K. (2009). Challenges for the Nursing Profession in Malaysia: Evolving Legal and Ethical Standards. Journal of Nursing Law. New York: 2009. Vol. 13, p. 54-63.

Ring, J, M & Mitchell, S. (2008). Curriculum for Culturally Responsive Health Care: The Step-by-step Guide for Cultural Competence Training. USA: Radcliffe Publishing.

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