Culturally competent staff in a non-culturally competent organization

The diverse cultural backgrounds of patients in hospitals present staff with challenges to achieving good health outcomes. A dominant approach in health research is to focus on practitioners’ capacities to reflect on their own and the patient’s culture: cultural competency. However, critical cultural theorists argue that these approaches do not account for the social and political contexts that generate patients’ disadvantages (Gustafson, 2005). The professional and organisational cultures in the organisation may also affect health care quality (Hong, 2001). My research confirms these views, but also highlights the importance of inter-staff advocacy in negotiating cultural difference and systemic disadvantage in health organisations.

I will present findings from research at two children’s hospitals in Sydney, Australia during 2005-2007. This research sought the perspectives of a cross-section of senior and front-line staff and patients: a time consuming and therefore challenging methodology that needs the support of senior hospital executives and funding bodies. We interviewed seventeen managers, over thirty health professionals, and three families, each with a child with a chronic illness/disability. We conducted participant observations in the wards and at hospital meetings. This research analyses the role of senior manager’s leadership and multicultural health policies in interactions between health staff and families. It revealed that staff were often constrained in their ability to meet the needs of families from culturally and linguistically diverse (CALD) backgrounds because of broader systemic factors. However, some did negotiate diversity quite well. The staff interviews and case studies revealed that some staff advocated on behalf of CALD families to other staff beyond the professional – patient relationship.

This presentation concentrates on the views of senior management and on a case study. The main policies to benefit CALD patients were evaluated on an annual basis, and offered managers no incentives to plan strategically. Other policy concerns such as time efficiency and economic rationalism held precedence. I will discuss how these conditions affected a boy from a Chinese background who had a long stay in the hospital with a brain injury. Health staff assisted the family through advocacy and negotiation between the needs of the family and the dominant institutional discourses. These actions were not taken only by staff from backgrounds close to the family’s, but by staff from a range of backgrounds, who used their knowledge and skills to reflect on how the family may have been disadvantaged. Health service literature discusses the benefits of staff’s ethnicity matching their patients (Snowden, Hu, & Jerrell, 1995). While this guideline is important, it does not highlight how the knowledge, experience and skills of staff from a range of backgrounds contribute to an effective workplace (Hong, 2001). This presentation will use power-point slides and handouts based on the case study to give participants the opportunity to discuss different staff responses.

Lessons to improve mainstream health include understanding the impact of the organisational and professional discourses on service provision for patients from CALD backgrounds. There is also value in providing avenues for all staff to advocate on behalf of disadvantaged patients.