Cultural Competence
The client-oriented model of cultural competence in healthcare organizations Giovanni Di Stefano , Eleonora Cataldo and Chiara Laghetti
Dipartimento di Scienze Psicologiche, Pedagogiche e della Formazione, Università degli Studi di Palermo , Palermo, Italy
ABSTRACT The paper aims to propose a new model of cultural competence in health organizations based on the paradigm of client orientation. Starting from a literature review, this study takes inspiration from dimensions that characterize the cultural competence of health organizations, and re-articulates them in more detail by applying a client orientation view. The resulting framework is articulated into six dimensions (formal references; procedures and practices; cultural competences of human resources; cultural orientation toward client; partnership with community; and self-assessment) that define the ability of a health organization to achieve its mission, acknowledging, understanding, and valorizing cultural differences of internal clients (staff) and external clients (consumers). This study makes an effort to address the paucity of studies linking approaches to managing cultural diversity in health organizations with cultural competence within the framework of client orientation.
ARTICLE HISTORY Received 30 March 2017 Accepted 3 October 2017
KEYWORDS Cultural competence; health organizations; client-oriented model
Introduction
Globalization has deeply changed the profile of both the workforce and the users of organizations in the societies of the new millennium. One important ques- tion is how to deal with growing cultural diversity in such a way that it may produce positive results – in terms of productivity and service quality, well-being and satisfaction – for organizational systems and for people, both workers and users.
The Diversity Management (DM) approach aims to accomplish such a result by adopting a heterogeneous viewpoint in order to lever cultural differences and treat them as an added value rather than an obstacle. In fact, the premise for managing diversity is the recog- nition of differences as positive attributes of an organ- ization, rather than as problems to be solved [1]. In this way, diversity may become a source of competitive advantage, increase the quality of organizational life and ultimately be advantageous for business [2]. The point is not, therefore, the acceptance of differences, but the creation of an inclusive environment and the commitment to valuing them. This can be made poss- ible through a culture of inclusion that creates a work environment nurturing teamwork, participation, and cohesiveness. However, many organizations do not see the advantages that cultural diversity could bring to them and how well-managed cultural diversity may achieve a competitive edge in the market.
The topics of cultural differences and disparities that may result from them have been already described in healthcare organizations, since the emerging challenges of providing health services in a growing multi-ethnic
world [3,4]; within these organizations, the approach of intercultural DM and the cultural competence are considered a priority. In particular, cultural compe- tence is a powerful instrument for managing cultural diversity in multicultural settings, since it improves quality and eliminates racial/ethnic disparities in organizations. The goal of cultural competence is to create a healthcare system and workforce that are capable of delivering the highest quality care to every patient regardless of race, ethnicity, culture, or language proficiency.
Although cultural competence may be considered an important need for every contemporary organiz- ation, since the growing pressures of globalization to develop international influence or operating on an international scale, it is indeed a core requirement for healthcare organizations, since the exigency they have to respond to the specific needs of any person seeking help, and the related concerns that come from working with culturally diverse patient groups, in order to alle- viate, at least in part, health disparities related to racial and ethnic differences.
The aim of this work is to propose a client-oriented model of cultural competence, meaning the ability of a health organization to acknowledge, understand, and value cultural differences of internal clients (staff) and external clients (consumers), as well as the ability to commit to achieving its mission, taking account of clients’ cultural identity and the individual needs. In order to respond to this objective, we reviewed the literature on cultural competence to identify a set of elements that define a culturally competent
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CONTACT Giovanni Di Stefano giovanni.distefano@unipa.it Dipartimento di Scienze Psicologiche, Pedagogiche e della Formazione, Università degli Studi di Palermo , Viale delle Scienze, Ed. 15, Palermo 90128, Italy
INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019, VOL. 12, NO. 3, 189–196 https://doi.org/10.1080/20479700.2017.1389476
http://crossmark.crossref.org/dialog/?doi=10.1080/20479700.2017.1389476&domain=pdf
http://orcid.org/0000-0001-7276-549X
mailto:giovanni.distefano@unipa.it
http://www.tandfonline.com
organization within the framework of client orien- tation. EBSCO, MEDLINE, Scopus, and Web of Science databases were searched for relevant peer- reviewed articles regarding the organizational cultural competence and client orientation in healthcare.
Toward a definition of cultural competence for health organizations
Since the 1980s, several scholars have paid attention to the construct of cultural competence, focusing on stu- dents [5–7], research [8], policy organizations [9], counseling services [10–12], and above all, the human service sector – social work and healthcare [3,4,13–24]. With specific reference to healthcare organizations, the concept of cultural competence was used not only in reference to the individual’s ability to provide care in a culturally appropriate way but also in relation to systems and organizations.
Cultural competence has been defined variously in the literature. For example, Green [20] first defined it as the ability to conduct professional work in a way that is consistent with the expectations, which mem- bers of a distinctive culture regard as appropriate among themselves. This definition emphasizes the worker’s ability to adapt professional tasks and work styles to the cultural values and preferences of clients. According to Cross et al., cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among pro- fessionals and enable that system, agency, or those pro- fessionals to work effectively in cross-cultural situation [25],p.1. Sue defines cultural competence as the ability to engage in actions or create conditions that maximize the optimal development of client and client systems [11],p.817. According to the National Quality Forum, cultural competence is the ongoing capacity of health- care systems, organizations, and professionals to pro- vide for diverse patient populations high-quality care that is safe, patient- and family centered, evidence based and equitable [26],p.2. Last but not least, Betan- court et al. [3] define cultural competence as the ability of systems to provide care to patients with diverse values, beliefs, and behaviors, including tailoring deliv- ery to meet patients’ social, cultural, and linguistic needs.
Despite these differences, authors seem to agree that cultural competence is an active and developmental process that is ongoing and never reaches an endpoint. Cultural competence develops over time through train- ing, experience, guidance, and self-evaluation [4,14,25]. In connection to such a general statement, Campinha- Bacote views cultural competence in the specific field of healthcare as the ongoing process in which the health- care provider continuously strives to achieve the ability to effectively work within the cultural context of the cli- ent (individual, family, community) [4],p.181. Scholars
tend to consider cultural competence as increasingly important for healthcare quality [13,14,15,22], and believe that there is a link between cultural competence and reducing or eliminating racial and ethnic dispar- ities in health care [7,16,27].
Although the centrality of cultural competence in health practice appears to be a widely accepted concept [3,13,14], still exists a scarce research on the effects and the outcomes of developing culturally competent healthcare organizations [16,28]. Nevertheless, there is some evidence that the implementation of cultural competence models improves the ability of health sys- tems and their workers to provide services to culturally diverse patient groups, reducing disparities in quality of health care [13,15,16].
Main models of cultural competence
Several models of cultural competence have been developed in the last two decades; in them, the dimen- sions of this construct were delineated with particular attention to individuals and organizations.
Cross et al. [25], focusing on systems of care, pro- pose a continuum that ranges from cultural destructive- ness, that is destructive attitudes, policies, and practices toward diverse cultures and individuals within a cul- ture to cultural proficiency or advanced cultural compe- tence, i.e. attitudes, policies, and practices that hold culture in high esteem, with the intermediate stages of cultural incapacity, in which the organization not intentionally seeks to be culturally destructive, but rather is not able to help minority clients, cultural blindness, that is believing that all people are the same and that approaches used by a dominant culture are universally applicable, cultural pre-competence, namely realizing weaknesses in serving minorities and attempting to improve service for a specific part of the…
