Moving towards culturally competent health systems: Organizational and market factors

Abstract

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 Competency Assessment Tool of Hospitals (CCATH) Survey, California’s Office of Statewide Health Planning & Development’s Hospital Inpatient Discharges and Annual Hospital Financial Data, American Hospital Association’s Annual Survey, and the Area Resource File. The dependent variable consists of the degree of hospital cultural competency, as assessed by the CCATH overall score. Organizational variables include ownership status, teaching hospital, payer mix, size, system membership, financial performance, and the proportion of inpatient racial/ethnic minorities. Market characteristics included hospital competition, the proportion of racial/ethnic minorities in the area, metropolitan area, and per capita income. Regression analyses were conducted to assess the relationship between the CCATH overall score and organizational and market variables. Our results show that hospitals which are not-for-profit, serve a more diverse inpatient population, and are located in more competitive and affluent markets exhibit a higher degree of cultural competency. Our results underscore the importance of both institutional and competitive market pressures in guiding hospital behavior. For instance, while not-for-profit may adopt innovative/progressive policies like cultural competency simply as a function of their organizational goals, linking cultural competency with organizational performance may be essential to attract more profit driven hospitals.

Challenges of healthcare professionals in providing care to South Asian ethnic minority patients in Hong Kong: A qualitative study

“…In addition, effective strategies, such as the provision of incentivisation, should be developed at the system level to facilitate and encourage HPs to undergo such training. These incentives can be further invigorated by incorporating cultural competence practices directly into public reporting or quality metrics considered for incentive payments (Weech‐Maldonado et al, ).…”

Predictors of language service availability in U.S. hospitals

“…Response continues to mount for this important service and will continue to do so in this new era of the Affordable Care Act (ACA) (37,38). Research dedicated to making the market case for healthcare organizations to adopt LS as a strategic imperative would undoubtedly fold executive visionaries into the same call to action that healthcare and social justice advocates have been pushing forward for decades: LS (and ultimately culturallycompetent healthcare) benefits patients, they benefit hospitals, they avoid costly medical errors, and they facilitate critical patient-provider communication (39,40). Additional research in understanding the level of provision of LS would also help in understanding not only factors that are associated with adoption but also factors associated with provision that is culturally competent and of true benefit to recipients.…”

Cultural Competence and Public Psychiatry

“…visible to both staff and individuals in their service area . Leadership, in large part, determines whether the organization's culture will embody quality, safety, and CLAS (Schyve & The Governance Institute, 2009), so much so that diversity in leadership has been found to be the single most significant predictor of adoption and adherence to the National CLAS Standards (Weech-Maldonado, 2007). This may be because support from governance and leadership enables the allocation These two questions are directly related to enhanced National CLAS Standards 8 and 3, respectively, and emphasize that the key strategy for embedding CLAS within an organization is engaging leadership.…”

“…Indeed, research has shown leadership commitment as one of the most significant elements for integrating cultural and linguistic competency and moving CLAS from theory to action (HHS OMH, 2004;Weech-Maldonado, 2007;. A multi-stakeholder expert panel convened by the American Medical Association and Health Research and Educational Trust in 2006 called on all health care organizations to regularly assess "leadership involvement; mission, goals and strategies; policies and programs; budget allocations; and workforce values" as they relate to culturally and linguistically appropriate services (AMA, 2006, pp.…”