Assessment of Organisational Cultural Competence - Essay Example

? Organisational Case Study - Assessment of organisational cultural competence Introduction The major focus of all discussions on organizational cultural competence in the health care context is to reduce “health disparities” (Srivastava, 2007, p.21). There have been many models proposed to this end. Organizational cultural competence is all about finding a perfect mix of individual cultural competence at the level of employees and also system level cultural competence. Also in a nursing context it is opined that, “cultural competence is not just about understanding client cultural values, but also about understanding ...(organization's) own limitations; valuing diversity; and managing the potential dynamics of systemic bias, racism, prejudice, and exclusion within client-health provider relationship” (Srivastava, 2007, p.20). Organisational cultural competence in a health care scenario is also described as “the ability to provide care with a client-centered orientation that both reflects the client’s cultural values and beliefs and recognizes the impact of marginalization in health care interactions and responses” (Srivastava, 2007, p.20). Rationale for the study What everyone forgets often is that disease has a social context. Cockerham (2007) has shown this by saying that “income and occupational status join education as the major components of social class” in how people select their health life styles (p.53). WHO has defined that “health is not only the absence of disease, but also complete physical, mental, and social wellness” (qtd. in Laverack, 2004, P.14). It is also a known fact that stress, poverty, low socioeconomic status, unhealthy lifestyles, and unpleasant living and working conditions” can cause ill health (Cockerham, 2007, p.1). Organizational cultural competency is an important aspect of an organization just because any organization would be functioning in a society which is heterogeneous, that is, culturally diverse, in terms of race, nationality, ethnicity and so on. Here, culture can be defined as “the unique behavioral patterns and lifestyles shared by a group of people that distinguishes that group from others” (Tseng and Streltzer, 2008, p.1). How people within an organization express their opinions, act in real life situations and hold attitudes to their practice are dependent on their culture, which again includes their social class, race, gender, and many similar factors. But a problem arises when these people have an interface with a culturally diverse group of clients. In such a context, there can be a clash of interests, attitudes and values which are culture-specific. For the smooth existence of a service provider-client interface, such conflicts have to be prevented from happening, and this is the realm in which discussions on cultural competency gain relevance. The concept of cultural competence is more than the actions and behavior of one or two individual practitioners but it has to work across the individual, organizational and systemic levels of an organization (Srivastava, 2007, p.20). As far as the people within an organization are concerned, cultural competence has to be ensured from policy and administration levels, through management and to service and support staff. Cultural competence is important in the health care context also because in a health care situation, there is a power relation involved which puts the client in a disadvantageous position in the hierarchy of that power equation. Power being “perceived as an authority and to engender willing compliance is, clearly, to exercise power,” the service provider can be understood to have power over the client (Fulford, Dickenson and Muray, 2002, p.280). And the exercise of this power has a possibility to be biased by the cultural values and prejudices of the service-provider. In this backdrop, gaining cultural competence through training, awareness and systemic measures can only ensure that non-discriminatory and ethical care is given to all in a health organization. An ideal cultural competency situation also has to include the synchronization between the people within an organization, the organization itself, the community and the individuals within the community. The different aspects of organizational cultural competency should in the end, reflect in delivering the client, safe, compassionate, ethical and culturally sensitive care.  Assessment of organizational cultural competence The assessment of organizational cultural competence can be carried out using different frameworks developed by different researchers. In this paper, the magnet framework developed out of a “1982 descriptive study conducted by the American Academy of Nursing’s Task Force on Nursing Practice” will be used to conduct the assessment of organizational cultural competence in the organization, Southern Health, Victoria (Andrews and Boyle, 2008, p.209). The magnet framework has defined “14 forces of magnetism” that ensure the quality in nursing care and these forces are further divided into 5 model components, namely, transformational leadership, structural empowerment, exemplary professional practice, new knowledge, innovations and improvement and empirical outcomes (Andrews and Boyle, 2008, p.209). The first force listed in the 14-strong list of magnetic forces is quality of nursing leadership and indicates that in the present scenario of complexities in nursing care, leadership is not only about providing “stabilization and growth”, but also about changing the “organization’s values, beliefs and behavior” ( American Nurses Credentialing Centre, 2008, p.4-5). The qualities involved here are, “vision, influence, clinical knowledge and a strong expertise relating to professional nursing practice” (American Nurses Credentialing Centre, 2008, p.4-5). In the organization, Southern Health, this criterion of magnet framework is fulfilled, as there exist an “evidence-based patient/client/resident centered care,” declared by the organization as its prime aim in the area of nursing (Southern Health, 2011). There is also a senior leadership team in the organization who leads the nursing practice under six separate areas of nursing, namely, critical care, medicine, specialty, surgery, women and children and mental health, each of this section being headed by a director of nursing (Southern, Health, 2011). The next magnetic force that comes under the model component, transformational leadership is, management style (Andrews and Boyle, 2008, p.214). The Board of Directors appointed by the Victorian Minister for Health, the highly skilled and professional senior level management which comprises of an executive management team, program directors and directors of nursing complete the management style of this organization (Southern Health, 2011). The style of management also involves having a strong sense of support imparted by the leadership towards the nursing staff as well as for the patient in this organization (Southern Health, 2011). The magnetic force #2, organizational structure, the force #4, personnel policies and programs, the force #10, community and the health care organization, the force #12, image of nursing and the force #14, professional development, come under the second component, namely, structural empowerment (Andrews and Boyle, 2008, p.214-215). In Southern health, organizational structure is a perfect balance between control and autonomy which is evident from the way this organization distributes its around 13,000 employees across a wide network of hospitals and educational institutions (Southern Health, 2011). The organization provides care for about 180000 hospital patients and 606000 out patients, the very enormity of the numbers indicating an organizational structure that succeeds (Southern Health). The institution, being a “registered health promoting health service with the World Health Organisation (WHO)”, proclaims its role in preventive health and promoting better health and wellbeing for …(the)… community (Southern Health, 2011). The personnel policies and programs of the organization is based on the concept that “employees want their work to be recognized…(and)… to be kept up to date about what is happening” (Southern Health, 2011). Quarterly and annual awards are given to the staff for good performance, proper communication is maintained across all levels of the organizational structure and also work flexibility in terms of shifts and holidays are provided to the staff (Southern Health, 2011). Salaries and benefits are competitive (Southern Health, 2011). The community is considered as the most important component of health care by this organization which caters to a community as diverse as including people “born in more than 180 different countries, speaking 100 different languages” (Southern Health, 2011). Each of this racial or language group have specific health beliefs (White, 2005, p.206). For example, a European American believes in “exercise” modified diets” but an African might have more faith in healing through religious rituals (White, 2005, p.207). Asians have a belief that hot and cold food can be taken to cure some ailment (White, 2005, p.207). Because of these cultural beliefs, a European American might be easier to be treated as an in-patient while, Africans and Asians might want to take their medicines at home along with some religious ritualistic treatment as well. Though it is practically unachievable to attain a perfect synchronization between the values and demands of such a diverse clientele, the hospital has put in a good effort towards this end through its community interaction devices. A translation service provided for the patients who are in need of it (Southern Health, 2011). It is also declared by the organization that “we celebrate our multicultural community as the source of both our consumers and our staff. Consultation with our consumers, carers and the community plays a significant role in the improvement of our health service” (Southern Health, 2011). There is also a community advisory committee which acts as an interface between the organization and the community (Southern Health, 2011). The advisory committee functions on the “recognition that the community has a democratic right to be involved in decisions regarding healthcare” and also acknowledges that “quality and safety in healthcare” is a very important constant consideration for the community (Southern Health, 2011). Community projects of the organization, inluding ‘community health nurses’ and ‘hospital in the home,’ gives the community a sense of belonging with the organization (Southern Health, 2011). As far as the image of nursing is concerned, the organization has a good track record which gets reflected in the success of its different activities again proved by the huge number of patients to whom it caters to every year (Southern Health, 2011). Professional development is also an important agenda of this organization as nursing and midwifery training is an ongoing process (Southern Health, 2011). Under the magnet framework component, exemplary professional practice, comes the magnetic forces #5, professional models of care, # 6, quality of care, ethics, patient safety and quality infrastructure, #7, quality improvement, #8, consultation and resources, #9, autonomy, #11, nurses as teachers, and #13, interdisciplinary relationships (Andrews and Boyle, 2008, p.214-15). Southern Health has adopted the evidence-based approach in health care (2011). The organization has published the rights of its patients, which include the right to: A high standard of health care Services which respect your culture and communication needs Receive only treatment for which you have provided consent Clear information about your condition and its management Dignity and respect in your care Privacy and confidentiality A safe environment A second opinion, if requested The support of a person of your choice in discussions about your care Be informed of any cost payable for health care services or supplies (Southern Health, 2011) The disparities involved in health care is one major factor that results in the violation of the above-said rights of the patients. For example, the immigrants who come to America might not be having a health insurance and hence they would be incapable of availing good health care (Cook and O’brien, 2009, p.386). In Southern Health also some culturally insensitive practices exist. For example, if a family member wnts to stay with the patient overnight,he/she has to pay certain amount as a fee (Southern Health, 2011). A European American might be comfortable with no family members around while in hospital but an Asian would want somebody to be there. In such a situation, the fee for relative’s night stay becomes a disparity when looked from the angle of multiculturalism (White, 2005, p.206). In this organization also, there are some prevailing disparities caused by the social atmosphere. The ‘arts in health program’ run by the organization is a unique quality improvement measure (Southern Health, 2011). The organization being registered under WHO, it has the obligation to fulfill the health profession standards prescribed by WHO, which again is a quality ensuing device (Southern Health). The organization, on an average, spends about $150 in its health services (Southern Health, 2011). The concept of nurses as teachers is fulfilled in this organization through its nursing and midwifery training program, the strong research wing, different platforms to register opinions, complaints and suggestion of the patients, the aged residential care facilities, the translator services provided for the patients and so on (Southern Health, 2011). Under the fourth component, new knowledge, innovations and improvements, the force #6, namely, quality of care: research and evidence-based practice and force #7, namely, quality improvement can be considered (Andrews and Boyle, 2008, p.216). Southern Health has a research directorate which aims to: Develop and facilitate the implementation of the Southern Health Research strategy Develop and facilitate research capacity building Serve as the central research administration office for all research projects conducted on the Monash Health Research precinct Foster a research culture as an integral and necessary part of clinical practice at Southern Health (Southern Health, 2011). The organization bases its all activities on evidence-based practice and also quality improvement is a constant agenda as has been discussed above. The fifth and final component of the magnet framework, that is, the empirical quality outcomes, include the force #6, which again is the quality of care. The organization is found to maintain quality in terms of “work force outcomes; patient and consumer outcomes; and organizational outcomes” (American Nurses Credentialing Centre, 2008, p.6). A report card is annually prepared by the organization in the form of ‘fast facts’ (Southern Health, 2011). Culltural competence has a proactive side which has to be understood in the sense of “challenging systemic barriers, and changing the existing structures and practices” (Srivastava, 2007, p.23). This is the most difficult task involved in acquiring cultural competence. There might be the oppressive structures, barriers of intolerance and also inequality embedded into the structure, present in an organization (Srivastava, 2007, p.23). Like any other organization, Southern Health also have many such barriers existing before it. Notwithstanding the commitment of the organization towards multiculturalism, the organization presently caters to a majority white patient group, (though its community has a greater proportion of other races) and also employs a majority white staff group. It is through better in-house training for cultural sensitivization and through employing people from different cultures on a larger scale, that this can be rectified. Also an effort has to be made to understand the health care system not simply as an eternally present system but as a culturally evolving social establishment (Gesler, 1992, p.19). Conclusion In total, organizational cultural competence is all about acquiring the “awareness, knowledge and skills to address diversity” (Srivastave, 2007, p.22). But this concept has been criticized as vague, having several internal inconsistencies, difficult to define precisely, and constantly shifting in content and this has led to organizations and individuals adopting varied practices (Srivastava, 2010, p.22). It is the “synergy that comes” out of the individual and organizational levels of cultural competence that finally makes the implementation of this concept useful (Srivastava, 2007, p.23). References American Nurses Credentialing Centre, (2008) Overview of ANCC magnet recognition program new model, ANCC, Viewed 30 August 2011, Retrieved from http://www.nursecredentialing.org/Documents/Magnet/NewModelBrochure.aspx Andrews, M. A., & Boyle, J. S. (2008). Transcultural concepts in nursing care (5 ed.). Philadelphia: Wolters Kluwer Health / Lippincot Williams and Wilkins. Cockerham, W.C. (2007) Social causes of health and disease, Cambridge: Polity. Cook, C.T. and O’brien, R.L. (2009) Cultural proficiency in addressing health disparities, Massachusetts: Jones & Bartlett Learning. Fulford, K.W.M., Dickenson, D. and Muray, T.H. (2002) Healthcare ethics and human values: an introductory text with readings and case studies, London: Wiley-Blackwell. Gesler, W.M. (1992) The cultural geography of health care, Pennsylvania: University of Pittsburgh Pre. Laverack, G. (2004) Health promotion practice: power and empowerment, London: SAGE. Southern Health (2011) Southern Health, Viewed 30 August 2011, Retrieved from www.southernhealth.org.au Srivastava, R. (2007) Healthcare professional’s guide to clinical cultural competence, Amsterdam: Elsevier Health Sciences. White, S. (2005) Foundations of nursing, Connecticut: Cengage. Read More