Building an Organizational Environment of Cultural Competence

Abstract

The purpose of this chapter is to consolidate elements from the other guidelines for culturally competent healthcare and illustrate their application at the organizational level. A commitment to cultural competence is needed at the highest administrative level of healthcare institutions, reflected in their mission and vision statements, formation of a diversity committee accountable to leadership, and engaging community members in committees, such as patient education, research and ethics committees. These community members can also help develop culturally appropriate alternatives to unsafe traditional practices. Recruitment of a multicultural workforce and cultural competence training of all the employees are also necessary. Signage in languages of the populations served and interpreters’ services are needed to improve communication and patient education services for those populations not speaking the dominant language. Linking quality of care with equity of care aims to reduce the disparities of health outcomes for our most vulnerable populations.

Guideline: Healthcare organizations should provide the structure and resources necessary to evaluate and meet the cultural and language needs of their diverse clients.

Appendices

Appendix 1: Cultural Assessment of an Organization, Institution, or Agency

1.1 Demographic/Descriptive Data

• What types of cultural diversity are represented by clients, families, visitors, and others significant to the clients? Indicate approximate numbers and percentages according to the conventional system used for reporting census data.

• What types of cultural diversity are represented? What types of diversity are present among patients, physicians, nurses, X-ray technicians, and other staff? Indicate approximate numbers and percentages by department and discipline.

• How is the organization, institution, or agency structured? Who is in charge? How do the administrators support cultural diversity and interventions to foster multiculturalism?

• How many key leaders/decision-makers within the organization, institution, or agency come from culturally diverse backgrounds?

• What languages are spoken by patients, family members or significant others, and staff?

1.2 Assessment of Strengths

• What are the cultural strengths or positive characteristics and qualities?

• What institutional resources (fiscal, human) are available to support multiculturalism?

• What goals and needs related to cultural diversity already have been expressed?

• What successes in making services accessible and culturally appropriate have occurred to date? Highlight goals, programs, and activities that have been successful.

• What positive comments have been given by clients and significant others from culturally diverse backgrounds about their experiences with the organization, institution, or agency?

1.3 Assessment of Community Resources

• What efforts are made to use multicultural community-based resources (e.g., community organizations for ethnic or religious groups, anthropology and foreign language faculty and students from area colleges and universities, and similar resources)?

• To what extent are leaders from racial, ethnic, and religious communities involved with the institution (e.g., invited to serve on boards and advisory committees)?

• To what extent is there political and economic support for multicultural programs and projects?

1.4 Assessment of Weakness/Areas for Continued Growth

• What are the organization’s weaknesses, limitations, and areas for continued growth?

• What could be done to better promote multiculturalism?

1.5 Assessment from the Perspective of Clients and Families

• How do clients (and families/significant others) evaluate the multicultural aspects of the organization, institution, or agency? Do patient satisfaction data indicate that clients from various cultural backgrounds are satisfied or dissatisfied with care? How are the quality outcomes the same or different for individuals of various races and ethnicities?

• How adequate is the system for translation and interpretation? What materials are available in the client’s primary language (in written and in other forms, such as audiocassettes, videotapes, computer programs)? How is the literacy level of clients assessed?

• Are educational programs available in the languages spoken by clients?

• Are cultural and religious calendars used in determining scheduling for preadmission testing, procedures, educational programs, follow-up visits, or other appointments?

• Are cultural considerations given to the acceptability of certain medical and surgical procedures (e.g., amputations, blood transfusions, disposal of body parts, and handling of various types of human tissue)?

• Are cultural considerations a factor in administering medicines? How familiar are nurses, physicians, and pharmacists with current research in ethnopharmacology?

• If a client dies, what cultural considerations are given during post-mortem care? How are cultural needs associated with dying addressed with the family and others significant to the deceased? Does the roster of religious representatives available to the nursing staff include traditional spiritual healers such as shamans and medicine men/women as well as rabbis, priests, elders, and others?

1.6 Assessment from an Institutional Perspective

• To what extent do the philosophy and mission statement support, foster, and promote multiculturalism and respect for cultural diversity? Is there congruence between philosophy/mission statement and reality? How is this evident?

• To what extent is there administrative support for multiculturalism? In what ways is support present or absent? Provide evidence to support this.

• Are data being gathered to provide documentation concerning multicultural issues? Are there missing data? Are data disseminated to appropriate decision-makers and leaders within the institution? How are these data used?

• Are opportunities for continuing professional education and development in topics pertaining to multiculturalism provided for nurses and other staff?

• Are there racial, ethnic, religious, or other tensions evident within the institution? If so, objectively and nonjudgmentally assess their origins and nature in as much detail as possible.

• Are adequate resources being allocated for the purpose of promoting a harmonious multicultural healthcare environment? If not, indicate areas in which additional resources are needed.

• What multicultural library resources and audiovisual and computer software are available for use by nurses and other staff?

• What efforts are made to recruit and retain nurses and other staff from racially, ethnically, and religiously diverse backgrounds? What other types of diversity (e.g., sexual orientation) are fostered or discouraged?

• How would you describe the cultural climate of the institution? Are ethnic/racial/religious jokes prevalent? Are negative remarks or comments about certain cultural groups permitted? Who is doing the talking and who is listening to negative comments/jokes?

• Are human resources initiatives pertaining to advertising, hiring, promotion, and performance evaluation free from discrimi-nation?

• Are cultural and religious considerations reflected in staff scheduling policies for nursing and other departments?

• Are policies and procedures appropriate from a multicultural perspective? What process is used for reviewing them for cultural appropriateness and relevance?

1.7 Assessment of Need and Readiness for Change

• Is there a need for change? If so, indicate who, what, when, where, why and how.

• Who is in favor of change? Who is against it?

• What are the anticipated obstacles to change?

• What financial and human resources would be necessary to bring about the recommended changes?

Source: Andrews MM. (2016) Cultural Diversity in the Health Care Workforce. In: M Andrews & J Boyle, eds., Transcultural Concepts in Nursing Care, 7th ed. Philadelphia, PA: Wolters Kluwer. pg. 383. Reprinted with Permission.

Appendix 2: Key Concepts for Organizational Orientation and Continuing Education Training in Cultural Competence for Professional Clinical Staff

• Definition of culture, ethnicity, cultural sensitivity and culturally competent care

• Critical reflection

  • (a) Exercises to identify one’s own heritage and unconscious biases

  • (b) Stereotyping versus generalizing

  • (c) Ethnocentrism

  • (d) Assimilation into dominant culture

• Cultural variations in modes of communication

  • (a) Differences in greetings, e.g., formal versus informal

  • (b) Verbal language

  • (c) Non-verbal language, i.e., body language

  • (d) Interpreters versus translators

• Cultural differences in health beliefs and practices

  • (a) Select examples from ethnic populations most frequently served

  • (b) Select examples of health problems of ethnic populations most frequently served

  • (c) Select beliefs and practices applicable to specific clinical area, e.g., maternity

  • (d) Provide clinical experiences with ethnic populations

• Biological variations among racial and ethnic populations

  • (a) Assessment of skin conditions in different racial populations

  • (b) Assessment of cyanosis and jaundice in different racial populations

• Dietary practices among various ethnic populations

  • (a) For example, kosher foods for Jewish patients

  • (b) For example, no pork for Muslim patients

  • (c) Balance of “hot” and “cold” for many Asian groups

• Use of traditional remedies (complementary and alternative medicines)

  • (a) Select examples from ethnic populations most frequently served

  • (b) Interactions with prescription medicines (ethnopharmacology)

• Small group discussion of case studies that integrate principles of cultural competence

  • (a) Identify cultural conflict

  • (b) Develop a plan of care or solutions to conflict

  • (c) Present plan to whole group