1. Chapter 12 Cultural Competency and Diversity in Healthcare Management
Joanna Basuray, RN, PhD
Towson University

2. US Population Changes
30% of the overall US population comprised of racial and ethnic minorities in 2001 vs. 17% in1970.
Large scale immigration from Latin America and Asia in the 1980s accounted for a high growth in minority populations.
By 2050, nearly 50% of the overall US population will be composed of minority groups.

3. Immigration Trends
Migration flows in the U.S. include low-skilled and high-skilled workers, with varying ethnicities.
Rapid domestic migration flow in the middle class, well-educated population to the suburbs, creates pull on immigrant groups for employment.

4. Diversity
Historically defined by categorical markers such as age, sexual orientation, religion, and ethnicity.
Not only must consider the prolific numbers of ethnic groups in the United States, but also consider factors relevant to their minority status, such as groups that are migrants, uninsured, poor, and refugees.

5. Global Economy
Rapid global changes to the economy address national borders, especially in policy concerning trade and the migration of people.
Free movement of labor influences organizations and businesses to re-establish management policies for their diverse clients and their workforce

6. Healthcare Employees
Health industries in large cities face language barriers and cultural differences in recruitment and retention of employees.
Recent trend to hire newly arrived immigrant workers and temporary staff (particularly those from South East Asia), who have been employed by hospitals, rehabilitation centers, and nursing homes.

7. Managing Diversity The essential processes in managing diversity are:
communicating in clear language the institution’s policies and practices,
establishing and running effective teams,
obtaining cultural knowledge of employees and clients, and
utilizing cultural competency as a benchmark for evaluating health care services.

8. Models of Diversity “Four Layers of Diversity” Personality,
Internal dimensions,
External dimensions, and
Organizational dimension.

9. Organizational Culture
Schein describes three levels of organizational culture:
Artifacts,
Espoused values, and
Basic underlying assumptions.
Differentiates visible behaviors from invisible behaviors.

10. Values Orientation Culture Model
Kluckhohn and Strodbeck five basic assumptions of culture
(a) people’s relationship with nature;
(b) a temporal focus on human life;
(c) the innate character of human nature;
(d) the modality of human activity; and
(e) the modality of a person’s relationships to other persons.

11. Cultural Dimensions Hofstede defined cultural dimensions as:
(a) relationships between the individual and the group;
(b) social inequality;
(c) social implications of gender; and
(d) handling of uncertainty inherent in economic and social processes

12. Cultural Competency
Many people mistakenly believe that common sense will enable people to cope in another culture.
Common sense is derived from experience, but that experience is culturally bound.
Sharing a profession is not sufficient experience to override cultural differences.

13. Emotional Intelligence
Goleman described four abilities:
Self awareness,
Self management,
Social awareness, and
Relationship management

14. Multicultural Organization
Cox defines this organization as:
inclusive to all members within an acculturation process context rather than one concerned with assimilation;
effective in managing diversity since it is focused on integration
Cultural competency building starts with becoming aware of one’s own culture, worldview, and skills.

15. Language & Communication
Workplace culture coupled with cultural heritage guides communication patterns and styles of speech.
Example: In the South, a person entering a room of people in a work setting or gathering, he or she exchanges greetings with familiar and unknown people -- to simply arrive without acknowledging presence of others is considered impolite.

16. Health Beliefs
A large number of the global population’s health beliefs are not based on germ theory or allopathic medicine.
Beliefs vary from culture to culture, the cause or reason for the illness could be through natural conditions or supernatural conditions.

17. Communication Styles
Views vary by culture regarding authority and the line of decision making process.
Group decisions may be more valued than individual decisions in the group.
Many cultures do not make direct eye contact during a conversation or while receiving instructions from a person in authority or of greater age or status. This is to show respect and deference.

18. Other Issues Signs of deference to authority Time orientation
Standing, use of formal titles
Time orientation
Drop ins, late arrivals
Personal space and proximity
US personal space bubble about 3 feet vs. other cultures

19. Diversity Training
Models to provide culturally sensitive services and care exist;
Trainers and consultants offer conflict resolution or conflict mediation models to solve issues related to a multicultural and diverse work environment.

20. Diversity Un-Training
Despite best intentions, it may take years to un-train people’s preconceived notions.
The education of healthcare personnel must be ongoing, persistent, and pro-active to prevent conflicts.
Healthcare managers need to be aware of the issues surrounding cultural competency and be prepared to intervene.