Can Hospital Cultural Competency Reduce Disparities in Patient Experiences With Care? (original) (raw)
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Health Psychology, 2008
Health researchers have proposed that provider cultural competency may contribute to health disparities. Yet, this belief continues to lack empirical support, and this is due in part to measurement issues that have plagued the cultural competency construct. In the present research, we report on the development of a theoretically grounded, generally applicable, and patient report measure of provider cultural competency. Design: Samples of predominantly African American patients (N ϭ 310) were recruited from three urban medical clinics to complete a survey about their relationship with their physician. Main Outcome Measures: We examined the factor structure, validity and other psychometric characteristics of a newly proposed patient report measure of provider cultural competency. Results: Psychometric analyses supported a tripartite model of cultural competency that was comprised of patient judgments of their physician's cultural knowledge, awareness, and skill. In addition, this result was replicated across multiple clinical contexts, while also demonstrating convergent and incremental validity when correlated with measures of trust, satisfaction and discrimination. Conclusion: This newly proposed measure addresses prior limitations in cultural competency measurement and may enhance future research by providing a standardized tool for use in multiple clinical and cultural contexts.
The American journal of managed care
Culture in and of itself is not the most central variable in the patient-provider encounter. The effect of culture is most pronounced when it intersects with low education, low literacy skills, limited proficiency in English, culture-specific values regarding the authority of the physician, and poor assertiveness skills. These dimensions require attention in Medicaid managed care settings. However, the promise of better-coordinated and higher quality care for low-income and working-poor racial/ethnic populations--at a lower cost to government--has yet to be fully realized. This paper identifies strategies to reduce disparities in access to healthcare that call for partnerships across government agencies and between federal and state governments, provider institutions, and community organizations. Lessons learned from successful precedents must drive the development of new programs in Medicaid managed care organizations (MCOs) to reduce disparities. Collection of population-based dat...
Assessing cultural competence at a local hospital system in the United States
The Health Care Manager, 2009
Cultural competence in health care has come to the forefront with the changing demographics in the United States. Standards have been created by the Office of Minority Health for culturally appropriate health care. This article presents the findings of one hospital system's cultural competency assessment. Employee surveys and patient and physician focus groups were conducted to gain insight into cultural differences and challenges encountered in this system. Statistically significant effects of ethnicity and gender on language skills and awareness, as well as differences in awareness and knowledge by the respondent's employment position, were found. Patient concerns included access to care and respect from staff. The need for cross-cultural education and training for all health care delivery personnel was reinforced. Cultural competency will not be achieved if education, attention to diversity, trained interpreters, and the understanding that social factors have a profound i...
Hospital cultural competency as a systematic organizational intervention
Health Care Management Review, 2016
Background: Cultural competency or the ongoing capacity of health care systems to provide for high-quality care to diverse patient populations (National Quality Forum, 2008) has been proposed as an organizational strategy to address disparities in quality of care, patient experience, and workforce representation. But far too many health care organizations still do not treat cultural competency as a business imperative and driver of strategy. Purposes: The aim of the study was to examine the impact of a systematic, multifaceted, and organizational level cultural competency initiative on hospital performance metrics at the organizational and individual levels. Methodology/Approach: This demonstration project employs a pre–post control group design. Two hospital systems participated in the study. Within each system, two hospitals were selected to serve as the intervention and control hospitals. Executive leadership (C-suite) and all staff at one general medical/surgical nursing unit at...
Cultural Competence in Health Care Systems
Californian Journal of Health Promotion, 2006
This study studied cultural competence training needs in a health services system in California. Results indicated that the major training needs were related to (1) cultural factors that affect consumers’ access to services, (2) ethnic and cultural beliefs, traditions, and customs, (3) training for interpreters, and (4) crosscultural communication. Significant differences were found in regard to administrator and staff participation in cultural awareness activities, perception of the work environment as culturally competent, perception of culturally-related barriers, and perceived training needs. The findings support the importance of a continuous assessment of the educational needs of employees regarding cultural competence.
Journal of health care for the poor and underserved, 2018
As part of a cultural competence needs assessment study at a large academic health care system, we conducted a survey among 1,220 practicing physicians to assess their perceptions of the organization's cultural competence climate and their skills and behaviors targeting patient-centered care for culturally and socially diverse patients. Less than half of providers reported engaging in behaviors to address cultural and social barriers more than 75% of the time. In multivariable logistic regression models, providers who reported moderate or major structural problems were more likely to report low skillfulness in identifying patient mistrust (aOR: 2.01; 95% CI: 1.23-3.28, p<0.01), how well patients read and write English (aOR: 1.63; 95% CI: 1.03-2.57, p=0.03), and socioeconomic barriers (aOR: 2.14; 95% CI: 1.14-4.01, p=0.01), than providers who reported only small or no structural problems. Improved structural support for socially and culturally complex medical encounters is nee...
Satisfaction with and perceived cultural competency of healthcare providers: the minority experience
2005
It is well known that nonwhite minority participation in clinical research is lower than their representation in the community. The goal of this study was to assess satisfaction of minority community members in Omaha with the care received and cultural competency of healthcare providers. We sought input from Omaha minority communities on how to improve the care they received and asked why they did not participate in healthcare research. Seventy-two minority members representing African Americans, Hispanic Americans, Native Americans, Sudanese, and Vietnamese; and eight whites were surveyed. The results of this study indicated that the majority of our respondents were satisfied with the care they received, but for a small percentage, language, communication and/or culture contributed to dissatisfaction. In addition, some respondents did not think the provider was culturally competent, i.e., not sufficiently knowledgeable about their racial, ethnic and/or cultural background. Some par...
Moving towards culturally competent health systems: Organizational and market factors
Social Science & Medicine, 2012
Cultural competency has been proposed as an organizational strategy to address racial/ethnic disparities in the health care system; disparities are a long-standing policy challenge whose relevance is only increasing with the increasing population diversity of the US and across the world. Using an integrative conceptual framework based on the resource dependency and institutional theories, we examine the relationship between organizational and market factors and hospitals' degree of cultural competency. Our sample consists of 119 hospitals located in the state of California (US) and is constructed using the following datasets for the year 2006: Cultural
Provider and clinic cultural competence in a primary care setting
Social Science & Medicine, 2008
A multilevel approach that enhances the cultural competence of clinicians and healthcare systems is suggested as one solution to reducing racial/ethnic disparities in healthcare. The primary objective of this cross-sectional study was to determine if there is a relationship between the cultural competence of primary care providers and the clinics where they work. Forty-nine providers from 23 clinics in Baltimore, Maryland and Wilmington, Delaware, USA. completed an on-line survey which included items assessing provider and clinic cultural competence. Using simple linear regression, it was found that providers with attitudes reflecting greater cultural motivation to learn were more likely to work in clinics with a higher percent of nonwhite staff, and those offering cultural diversity training and culturally adapted patient education materials. More culturally appropriate provider behavior was associated with a higher percent of nonwhite staff in the clinic, and culturally adapted patient education materials. Enhancing provider and clinic cultural competence may be synergistic strategies for reducing healthcare disparities.
Moving Towards Culturally Competent Health Systems
2012
Cultural competency has been proposed as an organizational strategy to address racial/ethnic disparities in the health care system; disparities are a long-standing policy challenge whose relevance is only increasing with the increasing population diversity of the US and across the world. Using an integrative conceptual framework based on the resource dependency and institutional theories, we examine the relationship between organizational and market factors and hospitals' degree of cultural competency. Our sample consists of 119 hospitals located in the state of California (US) and is constructed using the following datasets for the year 2006: Cultural