Healthcare leaders are eager to develop the competence needed to serve people across different cultures. One reason is that a serious patient care mishap due to cultural misunderstanding can potentially cost a life. However, the cultural competence needed in one setting to another varies as a result of different patient demographics, and those demographics may shift over time. A metropolitan area hospital may serve a large number of immigrants and refugee populations, whereas a rural organization may serve large numbers of Latinos. It is also common to witness a shift from serving a predominantly white Dutch population within a community within Amsterdam to Muslim immigrants who increasingly move into the area. Managing such diversity is no easy matter for the healthcare professional who needs to understand each group’s attitude towards illness, medical practice, and practitioner-client relationships.
Preparing healthcare professionals to manage diverse populations is certainly important, but how do you know what education the professionals within an organization needs? Assessment-driven diversity education is the key. Let’s me give an example of how to drive a diversity initiative with measurement from professional experience.
Our company, Kaleidoscope Community, Inc. (KCI), secured a contract with a United States healthcare provider located in Washington state. We selected the survey and the key informant interview questionnaire from the Cultural Competence Assessment Toolkit (CCAT) to identify gaps within the organization pertaining to cultural competency and inclusion. The CCAT is unique in that it measures five cultural competence components: Awareness, Attitude, Knowledge, Skills, and Experience. The aggregate score of the survey corresponds to one of five cultural competence development stages: Conventional Stage (The lowest cultural competence level), Defensive Stage, Ambivalent Stage, Integrative State, and Inclusive Stage (The highest level).
After some minor changes to utilize the survey with this organization’s workforce, we started with administering it to the organization’s 26-member Leadership Team. Nineteen of the members were managers. We also conducted key informant interviews with each of these individuals to collect anecdotal data and find common themes to better explain the numerical survey results. The CCAT results are useful for providing recommendations that best suit the organization’s identified needs with the use of both numerical and qualitative data.
Survey results indicated that the organization’s score fell between the Ambivalent and Integrative Stages of cultural competence development. The results were similar across gender and roles within the organization’s leadership team. We analyzed the interview results to better understand what these scores mean for the everyday lives of the participants, and to determine the best stage within to place the organization (i.e., the lower Ambivalent Stage or higher Integrative Stage).
The results of the interviews supported placement of the organization in the Ambivalent Stage of cultural competence development. Healthcare workers in an Ambivalent Stage organization, as a whole, are aware that cultural bias causes inequality, but they do not necessarily view themselves, or the organization, as biased. Furthermore, cultural stereotypes and ethnocentrism tend to be prevalent within organizations in this stage.
A mix of Awareness and lack of awareness within the organization was common theme from the interviews that supports the Ambivalent Stage designation: (a) “There are pockets of people who are exposed to cultural diversity, and there are those who are less aware”, (b) “There are those who don’t know that they need to be more aware”. The Attitude component themes were also mixed: (a) “some people get stuck in a rut” and (b) “the majority of employees do (value diversity) but there are pockets who treat others differently.”
When asked whether management and employees have the knowledge and ability to work with a diverse workforce, the themes were “I think we can use more education”, “It’s hard to answer because we’re not that diverse”; “We do fine as we are; but if we’re more diverse, we’d need more training”; and, “People have different styles in how they deal with people, depending on their exposure (to culturally diverse individuals).”
At the conclusion of the assessment, KCI submitted a report to the leadership team. It identified gaps in the organization that we think need to be addressed in order to create a culturally competent and inclusive work environment as well as presented recommendations for next steps. At present, KCI has been retained to conduct an assessment of the whole organization. This will provide the data needed to determine the organization’s cultural competence gaps as a whole and provide insight into the interventions needed to increase the competence for serving clients across cultures.
Rowena Pineda is a cultural competence professional for Kaleidoscope Community Inc. She can be reached at Rowena@dtui.com.