Culturally competent staff in a non-culturally competent organization

Globalization of society and the increasing evidence on health disparities has shifted the need for culturally competent clinical care from important to urgent. Considerable literature exists on frameworks and guidelines for developing cultural competence at the individual as well as the organizational level. However, despite good intentions and multiple initiatives to support cultural competence in clinical care, there is little evidence as to which initiatives are successful. Even less is known about how the organizational initiatives influence practices at the level of clinical care, particularly in a context that lacks overarching standards or mandate for cultural competence in health care.  Understanding the critical processes that link organizational initiative to clinical care practices is critical to developing evidence based foundation for promoting cultural competence.

This paper will present findings from a qualitative research study examining the influence of organizational factors on clinical cultural competence. The purpose of this study was twofold: (a) to identify the salient features of cultural competence at the clinical level and (b) examine the processes through which organizational factors impact on the clinician's ability to provide culturally competent care. The study utilized a qualitative, case study method, which allows for an examination of the context, processes, salient elements, and lessons learned with respect to the influence of organizational factors on clinical cultural competence. Data were collected at two clinical programs within a hospital, located in one of the most multicultural cities in the world, and engaged in a major diversity initiative. Findings are based on interviews with clinicians from a variety of disciplines as well as administrators and diversity consultants. Findings indicate a critical need to develop a common understanding of cultural competence, differentiate clinical cultural competence from client-centered care and make cultural competence visible to practitioners. In particular clinicians expressed a sense of inadequacy and had difficulty describing indicators of success.

The study also revealed mediating processes that are necessary to ensure the effectiveness of critical resources such as policy and education. Results show that organizational supports were experienced positively as well as negatively and in some instances fostered a culture of silence and inaction.  This raises critical questions with respect to clinical leadership and measurement strategies to promote clinical cultural competence. Findings from this study have implications for how cultural competence education and other organizational interventions are designed, delivered, and supported in organizations.  Previous literature has addressed cultural competence at the individual, organizational, and systems level; this study points to a need to consider and support cultural competence at the team level and shift focus from individual and organizational change to practice change in a manner that emphasizes exploration, engagement and  empowerment of clinicians.