The impact of embedding cultural competence in the healthcare services in asia

Cultural competence builds and supports the participation of other groups with different cultural ba`ckgrounds and it is useful in diminishing undesirable issues that may disturb development within an organization. Cultural competence is a foundation that supports the expansion of creativity in critical thinking and problem-solving through new viewpoints, strategies, and ideas. This study looks into the effects of embedding cultural competence in the healthcare services and focuses on Korea Cancer Centre Hospital; to establish the extent to which cultural competence has impacted the quality of healthcare services; to establish how much cultural competence has improved health outcomes; and to establish how far cultural competence has affected the elimination of racial and ethnic health disparities. The study involved 40 participants; 28 (70%) nurses followed by 7 (17.

5%) respondents who were community health workers and finally 5 (12. In order to realize this goal, the hospital adopted radiology as a method of cancer diagnosis and treatment at a time when none of the other hospitals in Korea had tried it. The hospital actualized the radiology cancer treatment facility by introducing the cobalt remote treatment (Korea Institute of Radiological & Medical Sciences, 2018). The Korea Cancer Centre Hospital has also ventured in innovations and technologies such as blood-less cancer surgery through such platforms as the CyberKnife (Korea Institute of Radiological & Medical Sciences, 2018). Particularly, Korea Cancer Centre Hospital is proud of its effective and efficient diagnosis systems which bring together skilled and highly specialized experts in the field of cancer diagnosis and treatment (Korea Institute of Radiological & Medical Sciences, 2018).

The hospital is satisfied with the fact that the new paradigm of multidisciplinary integrated care system has been effective in cancer diagnosis and treatment. In this case, the culture of organization is a set of shared suppositions that manage what occurs in firms by characterizing proper conduct for different circumstances in their working environment. Introduction to Cultural Competence Cultural competence can be defined as the will and actions meant to develop an understanding amongst persons, ensuring respect and being open to different cultural aspects; fortification of cultural safety and ensuring equality in every chance. Schim et al. (2007) indicate cultural diversity recognizes differences amongst people in different groups with regards to gender, age, and mental status among other aspects. Building a relationship is essential to cultural competence and depends on establishing an understanding of other people’s desires as well as attitudes.

Moreover, such topics as mistrust, prejudice, and racism as well as their impact on cultural competence should be prioritised (Betancourt et al. Dimensions of cultural competence The Multidimensional Dimensions of Cultural Competence (MDCC) model analyzed by Sue (2001) brings out such aspects as awareness, skills, knowledge, and the recognition of the need to individualize counseling approaches are reflected in the definition of cultural competence. These constructs are part of the definition and analysis of the same would help to understand cultural competence more clearly. Cultural awareness, as noted in the definition, entails the attitudes and beliefs of the culturally diverse minority groups. Moreover, cultural awareness is about accepting multiculturalism and recognizing personal biases that have varied effects on the process of providing services to culturally diverse communities (Suk, Oh, & Im, 2018).

A culturally competent employee will weigh out the issues and values at stake before committing to handle the problem. Cultural competence involves having better communication skills that are essential in daily interaction with employees and other stakeholders. Employees with excellent communication skills will assess the communication needs in the organization and be aware of the diversified organizational culture to adopt the necessary non-verbal and verbal skills. Cultural competence is useful in diminishing undesirable issues that may disturb development within an organization. In most cases, an organization will want to have good relations with its customers and employees at large in order to ensure an environment conducive for development and effecting changes (Suk, Oh, & Im, 2018). Cultural competence has a significant impact on service delivery and the efficiency of an organization.

Culturally competent employees have adequate knowledge on the local people, an aspect that enables the health organization to invest much on the needs of the local people an aspect that enable the organization to win community loyalty (Suk, Oh, & Im, 2018). Community loyalty plays a crucial role in the success and achievement of organizational goals since good social relations furnishes the employees with relevant details and recommendation on how to improve service quality. Problem Statement Cultural competence is among the latest subjects in the study and practice of nursing and whose impact has not been precisely identified. The healthcare sector is drastically going global as the world embraces globalization; this means that there are increased interactions between people from diverse cultural backgrounds (Truong, Paradies, & Priest, 2014).

People from different cultural backgrounds are interacting at international levels, and thus it would require some cultural competence to ensure uncompromised healthcare services. Limitation of the Study The use of questionnaire only as a data collection tool to get information from the sample population is a factor that limits the study. Some information provided would be better sought through face-to-face interviews for verification purposes. However, in order to reduce the need for verification, the questionnaire was developed in a manner that would prompt the respondents to substantiate the information. The research applied a quantitative methodology which limits the scope of data that can be collected to explain the subject matter fully. These models are critical in ensuring the effectiveness of the application of the concept in healthcare and other sectors in the economy.

The incorporation of cultural competence in the provision brings about changes in the healthcare sector. Competence in culture entails the capacity of the healthcare service providers to deliver services that address the linguistic, social, and cultural needs of the patients in an effective manner (Like, 2011). Cultural competence calls for respect as well as fast response to the health needs of the patients (Echeverri, Brookover, & Kennedy, 2013). Thus, it is an important aspect of the healthcare sector. Health care providers deal with patients from different races and cultural backgrounds calling for the utilization of cultural competences. The emergence of cultural dynamics calls for health organizations to embrace cultural competence. Seemingly, failure to incorporate cultural competence in healthcare may be a challenge in service delivery.

Burch (2016) suggest that a healthcare system that is culturally competent helps to improve the outcomes and quality of the services. Moreover, it is very instrumental in eliminating ethnic and racial health disparities. Traditionally, workplace diversity entails the availability of various races and genders among other aspects (Ahmed et al. However, the notion is changing and becoming more of all-encompassing. Organizations have given considerations to other variables including skillsets, personality, education, social background and age among others. This helps to offset any deficits in cultural competence given that different age groups, races, education systems, and personalities attach value to different things and ways of life around them. For example, an American nurse working in an organization like the Korea Cancer Centre Hospital will help other employees to understand the American culture which would help them to handle American patients more effectively (Echeverri, Brookover, & Kennedy, 2013).

Theory and practice indicate that education and training are the core elements and the foundation for developing the quality of human resources to higher levels (De Almeida Vieira Monteiro & Fernandes, 2016). Therefore, education and training and human resources development are interrelated quite closely in almost all aspects. It is paramount that every human resources manager integrates education and training in a day to day activities as a measure to improve the quality of human resources (Hart & Moreno, 2016). Meanwhile, the quality of human resources needed in an organization is set as the guiding principle and prime objective while developing adequate education and training measures (Ahmed et al. In order to offer effective education and training the management has to consider several points. Sound policies should consider all aspects of the organization to reduce culture shocks by ensuring employees are prepared to handle individuals from diverse cultures.

The organization should ensure that all employees are aware of the policies to enhance its effectiveness. All departments should be involved in the formulation of cultural competence policies to ensure acceptability and implementation of the decisions. Generally accepted policies enhance organizational effectiveness in achieving its goal of providing quality services to all their customers. Organizational management has an obligation to ensure proper policies and procedures in order to realize cultural competence in the organization (Ahmed et al. Each person and each organization is engaged with settling on many choices and decisions consistently (Hart & Moreno, 2016). The choices made are an impression of the values and convictions, and they are constantly coordinated towards a particular purpose. That purpose is the fulfillment of an individual's or organizational needs (Ahmed et al.

Numerous organizations pay more attention to the specialized abilities while they frequently overlook what the hidden skills that make their organizations run easily — core values are. Setting up solid fundamental values gives both internal and external advantages to the organization (Lin, Mastel-Smith, Alfred, & Lin, 2015). Communication is a determining factor in cultural competence; effective communication fosters improvements in cultural competence while poor communication is detrimental to the development of cultural competence (Aragaw, Yigzaw, Tetemke, & Amlak, 2015). There are a number of ways that effective communication has been useful in the development of cultural competence within organizations. Improving workplace communication has a positive impact on productivity, engagement, employee satisfaction, and the bottom line. Organizations should focus on improving employee communication skills to help them in communicating with diverse groups of people.

Excellent communication skills entail both verbal and non-verbal communication cues to necessitate communication with patients and employees. The nurses would tackle critical issues with ease and determination in pursuit of organizational goals. Empowerment also makes nurses meaningful; an individual feeling that the duties of the job are valuable. After the accomplishment of a certain task developed from their choices, employees will always feel that they made an impact; a feeling that tasks produce intended results (Aragaw, Yigzaw, Tetemke, & Amlak, 2015). Empowered employees will give their best for the benefit of the organization because their efforts are recognized. An organization with the motive of achieving cultural competence must invest much in employee empowerment. Organizational infrastructure domain indicates how to distinguish and allot the assets expected to design, convey and assess socially equipped administrations.

Services and interventions domain shows how to convey or support clinical, general wellbeing or health-related services in a culturally competent way. Indicators of Cultural Competence Based on the Domains There are a number of cultural competence indicators in various organizations including hospitals that are based on the domains of cultural competence. Structure indicators are utilized to survey a firm's capacity to support cultural competence through sufficient and suitable settings, instrumentalities, and infrastructure, including staffing, offices and gear, money related assets, data frameworks, administration and management structures, and different highlights related to the hierarchical setting in which services are given (Loftin, Hartin, Branson, & Reyes, 2013; Shen, 2014). Structure indicators from the organizational values domain based on leadership, investment, and documentation as the focus areas would look into whether an organization has individuals at the top executive level bestowed with the responsibility to implement and/or monitor cultural competence plans and initiatives (Aragaw, Yigzaw, Tetemke, & Amlak, 2015).

In addition, an organization should ensure that there are resources to collect, manage, and report information related to cultural competence. Process indicators are utilized to survey the value and nature of activities, techniques, strategies, and interventions in practicing culturally competent medical services among others; and supporting the services in all cases (Dauvrin & Lorant, 2015). Processes indicators from the organizational values based on information relevance to cultural competence may point to conducting regular organizational self-assessments regarding cultural competence, demanding and facilitating regular individual provider assessments regarding cultural competence and obtaining client-level cultural competence-related information (Shen, 2014). Process indicators also point to conducting regular community/needs assessments as well as evaluating cultural competence-related activities within the organization (Hart & Moreno, 2016). Based on organizational flexibility, process indicators point to systematic, regular evaluation, and use of information that is relevant to cultural competence (Aragaw, Yigzaw, Tetemke, & Amlak, 2015).

The output indicators from the organizational values domain and based on leadership, investment and documentation may include the overall investment in cultural competence, structure of the mission statement and that it addresses cultural competence, strategic plans that take on cultural competence, a business plan addressing cultural competence and program plans addressing cultural competence (Aragaw, Yigzaw, Tetemke, & Amlak, 2015). In addition, the output indicators address staff awareness/acceptance regarding contents of relevant plans within the organization with special attention to cultural competence as well as the client awareness (Horvat, Horey, Romios, & Kis-Rigo, 2014). The output indicators may also show materials expressing the organization’s commitment to cultural competence. Based on information relevant to cultural competence, output indicators look into the flow of feedback of cultural competence-related to data used in program, policy, planning, operations, and implementation of various plans and decisions (Aragaw, Yigzaw, Tetemke, & Amlak, 2015).

Based on organizational flexibility, output indicators point out to administrative and service delivery adaptations tailored to meet the needs of the population in the service section such as adaptations to improve access to healthcare services. Appropriate management of selected chronic conditions at a higher rate Employee satisfaction Focuses on perceptions as regards: • cultural competence of providers/organization • how well organization meets their needs · Satisfaction with care. Knowledge on prevention, diagnosis, treatment plan. Agreement and compliance with treatment plan. Medication compliance and reduction in misuse of medications. Improvement on management of selected chronic conditions. The qualities will help an organization to determine the needed skills and knowledge while developing education and training programs and policies (Bednarz, Schim, & Doorenbos, 2010). Cultural diversity will also help the organization in raising possible alternatives for dealing with challenges that arise in the course of culture competence management.

Attached to this commitment is also an intention to nurture and develop the potential of each and education and training addresses the commitment. Policies and procedures are essential in ensuring cultural competence in an organization. As noted in the discussions above, they should be structured in a way that they can guide the process of developing cultural competence effectively. Effective communication of cultural competence requirements enhances adherence to the policies and procedures and consequently quality patient care. It is important for compliance officers to develop a communication procedure to enable employees to understand every policy and procedure correctly. There are five essential principles that should be observed while managing cultural competence within an organization. Valuing diversity in people and other aspects of the operation Valuing diversity is a case where an organization or individual accepts and respects the difference between their culture and those of other people around the world.

This can be done through embedding various factors within the culture of the organization including language choice and the intent to avoid any kind of bias during operations within and outside the organization. Conducting cultural self-assessment Another principle to consider while managing cultural competence within an organization is conducting regular cultural competence self-assessment. In addition, the organization should urge nurses and other employees to carry out self-assessment exercises to determine their capacity and progress in handling cross-cultural matters. The failure to reach high levels of cultural competence is taking for granted some of the small but very important actions that an organization and employees should be conscious about. For example, the physical distance between parties in official interaction differs from one culture to the other, and if an employee of an organization touches or brushes shoulders with whomever they are engaging might be misread in some cultures, leading to misunderstandings and possible conflicts.

Doing self-assessment on cultural competence could help to avoid such miscommunication by establishing the fine details on how employees interact with customers from various cultural backgrounds. For instance, Native Americans and African Americans have experienced discrimination and unfair treatment from dominant cultures. Mistrust coming out of these experiences may be passed on to the next generations of these groups, but ignored within the dominant culture. An oppressed group may feel mistrust toward the dominant culture, but members of the dominant culture may be unaware of it or not understand it. Organizations planning to interact with varying cultures need awareness of such dynamics if they want to be effective. Cultural dynamics have an impact on the success of the health center in the sense that one has to communicate effectively with all the stakeholders to gain relevant information.

Institutionalizing cultural competence knowledge and skills Cultural competence knowledge should be integrated into every facet of an organization in order to manage cultural competence effectively. It would be difficult to train staff members on cultural competence if they do not see its values within their department and line of work. However, if cultural competence is taken as part of an organization by staff members, it would be easy to manage it through education and training programs. Staff members ought to be trained and facilitated in their work to use the cultural competence knowledge effectively and skills gained. Research indicates that educating and training human resources accordingly triggers socio-economic development in the organization, from a personal level to the rest of the organization.

An organization that has effectively adapted to diversity has its values, practices, policies, and structures developed in a manner that makes it possible for cross-cultural communication in order to guide a culturally competent organization. Whenever an organization recognizes, respects, and values all cultures and integrate those values into the system, it becomes more culturally competent and can meet the needs of diverse groups. They assist organizations to create the future they need to experience. Each person and each organization is engaged with settling on many choices and decisions consistently (Hart & Moreno, 2016). The choices made are an impression of the values and convictions, and they are constantly coordinated towards a particular purpose. As indicated by the literature herein, health disparities could happen in cases where patients are not satisfied with the quality of health care provided to them resulting in poor health outcomes.

Mistrust of healthcare providers and lack of effective communication are some of the factors identified herein that influence the health disparities. Also, the lack of participatory decision-making style can contribute largely to poor health care outcomes. Ineffective communication is known to occur mostly at the provider-client level especially when the nurses use medical jargon and fail to give understandable instructions and explanations of assessments and tests. This literature, however, indicates that there is a lot more to be examined for a better understanding of the impact of embedding cultural competence in the health care services. Purposeful sampling gives the researcher an opportunity to use some particular purposeful sampling techniques including expert sampling and total population sampling among others (Williams, 2007). Purposive sampling has several advantages.

The sampling method gives the researcher and a number of techniques that would be useful in capturing a useful population for the subject matter. Also, these techniques can be used to draw generalizations which are either logical or theoretical (Williams, 2007). Finally, purposive sampling helps the researcher to engage various phases whereby the next phases help to build the previous ones. Forty questionnaires were filled and returned for analysis. However, some of the questionnaires had sections not filled. Data Analysis The data collected in this research would be easy to interpret and quite objective. The researcher summarized the data to allow generalizations. These generalizations are useful in getting answers about the general population. Activity Time/Duration 1. Preparation for the research • Application for permits • Establishing contacts on location • Assembling data collection, analysis, and presentation tools 1 week 2.

Population sampling 1 week 3. Data collection 3 days 4. Data assembling 1 day 5. At the end of the session, 40 questionnaires were filled and returned for analysis. Some of them had sections not filled. This is indicated as a missing value in the coding section of the questionnaires. The questionnaires were then sorted before they were analyzed in the SPSS. Data were coded and entered. 5%) of the total respondents. This shows that there were more women than men in the field of health. It might also imply that women were more willing to take up the research than men. There is a general notion that nursing is dominated by women. This was evident in the data collected. The ratio of doctors to nurses is also high.

The ratio of doctors to nurses is 5 to 28. This might have contributed to a low number of men who undertook this survey. Race and college attended Race or ethnicity * college attended Cross tabulation Count college attended Total Asian college international college Race or ethnicity Asian 37 2 39 Total 37 2 39 Table 3 From the above table, all the respondents are Asians. However, one of the respondents did not indicate their race. 5 missing 1 2. 0 Total 40 100. 0 Table 4 The table above shows similar information as before. There are few respondents who have lived in other countries other than Korea. 30(75%) of the respondents have never lived in any foreign country. To further test how well medical staffs have tried to embrace other cultures, respondents were asked if they speak any other language apart from Korean.

Any language apart from Korean Frequency Percent Valid Percent Cumulative Percent Valid English 16 40. 0 Korean 23 57. 5 Japan 1 2. 0 Total 40 100. Gender variable has two categories while Professional variable has got three categories. The gender categories are male and female. For Professional, there are three categories, Community Health Worker, Nurse, and Doctors. This implies that one can be either a male person who is a community Health worker, nurse or doctor. Contrary, one can be a female person who is a doctor, nurse or a community health person. 3 cells (50. 0%) have expected count less than 5. The minimum expected count is 1. Table 7 The Pearson Chi-Square value from the above table is 0. This is less than 0. 5 quite a bit 1 2. 0 Total 40 100. 0 Table 8 From the above table, 22 (55%) have “little” awareness of the health risks that are experienced by people of different races and ethnic groups.

5%) worker seems to understand the risk that is associated with diversity in culture. Health risks experienced by diverse racial groups Frequency Percent Valid Percent Cumulative Percent Valid Not at all 7 17. 0 Quite a bit 2 5. 0 Total 40 100. 0 Table 10 Only half of them (52. 5%) can try to take care of such patients. This can be attributed to previous results. 0 Total 40 100. 0 Table 11 From the above table, more than a half (52. 5%) of the physicians are not aware of the impact of non-verbal cues in other cultures. Such kind of staffs is likely to use some gestures words and signs which might have a different meaning to patients. Cross-cultural situations The survey also found out cross-cultural conflict among workers. The same way 14 (35%) of the respondents also stated that they are “a little” bit comfortable when people make pejorative statements on their background.

30% are not comfortable at all with comments from their patients on their culture. This is a common occurrence among religious health facilities. People of one religion may not be comfortable with the competence and ability of doctors who are handling their sickness. They may be against such kind of services depending on their faith perceptions. It implies that implies that although females tend to dominate, they study simple health professionals like Community Health workers while avoiding being doctors. Conversely, there are few men in professional like Community Health workers. This is in line with the study by the World Health Organization which reveals that there are more nurses and Community Health Workers than doctors in the world. This means that Korean society has been influenced by culture or a belief that some professionals are for women while others are male.

Just like other regions of the world, nurses and Community Health workers are mostly female while men tend to study to become doctors. It has been established that the majority of the staffs understand and speak one language. This also translates to how they are well acquainted with the culture of other people. Culture is mostly passed through communication. If one cannot speak a language other than theirs, then they also have limited knowledge of the different culture. The result has shown that for few who can communicate foreign language, they cited that they can speak in English and in extreme cases can also talk Japanese. Looking away implies a lack of interest in western culture. In other cultures, like in the Middle East, this might have a different meaning.

Here, eye contact is frowned between people of opposite sex is frowned upon since it is an indication of desire. Personal space might also have different meaning among people. For instance, in the United Kingdom and United States, people normally keep a distance of at least 4 feet between them while talking. It is therefore important that medical practitioners understand these differences so that they avoid cultural conflicts. Shaya and Gbarayor recommend that it is time to make full culturally competent. This is true especially now that there is international integration through immigration and emigration. The above cases that have been discussed show that it is important for health care centers to achieve competence alongside their operational goals in the dynamic working environment.

Failure to slot in these changes, it will even be a challenge in the delivery of services. According to Holyfield and Miller, policies can be a remedy for communication problems. The creation of policies can greatly help in minimizing linguistic and administrative hindrances to patients. The policies, in this case, do not mean barring people from speaking their native language. It can be in the form of having an interpreter at every hospital that should try and translate communication in a way in which it minimizes the change of original data. Conclusion The paper has shown that individual beliefs, values, and behaviors about well-being and health are shaped by several factors like ethnicity, race, nationality, and language among others. This is an indication of being conservative in their culture.

This explains why they also receive derogatory statements about their background from their patients. There is a need to go the extra mile to learn the culture of other people. Learning diverse cultures would imply that health care providers can cope with cultural dynamics in the health sector. They will also help the organization to develop cultural competence. Community health workers are also important in increasing interaction between people. Finally, it will be important to provide competency in linguistics which goes beyond encounters done at the clinics. These include advice lines, desks, written materials, and medical billing. This shows that it is important to appreciate the culture of all people who are served by a particular medical center. Recommendations The health care centers should allow their employees to move and socialize with other people.

This is in terms of the behaviors, gestures and even some racial words. One of the ways in which healthcare centers can minimize racial discrimination based on backgrounds is through regulations and policies. There should be policies of equal treatment in all institutions. This can be well achieved when enforced by the government. Administration of various hospitals can work in collaboration with the government in order to ensure that all people are treated equally and not judged by their race, religion or country of origin. , Barbosa, T. , Lantion, V. , … Santana, M. How to measure cultural competence when evaluating patient-centred care: a scoping review.  BMJ Open, 8(7), 1-9. , & Doorenbos, A. Cultural Diversity in Nursing Education: Perils, Pitfalls, and Pearls.  Journal of Nursing Education, 49(5), 253-260.

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