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A term used to describe an inevitable change taking place in American society based on the prediction that by the year 2050, in certain geographic areas in the United States, the majority populations will be Hispanics and Blacks and other minorities (combined), and Whites will be the minority group.

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An identity that can be defined by a person's place of legal birth or by a person's associational citizenship status governed by where an individual resides and works, which may defy national boundaries and sovereignty. (Borak, Fiellin, & Chemerynski, 2004)

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A group or individual's conception of cultural identity which includes a wide variety of learned behaviors that a human being uses in his or her natural and social environment to survive which may result in cultural demarcation between and within societies. (University of Wisconsin-Fox Valley, 2006)

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Biological variation including phenotypical differences in stature, skin color, hair color, facial shape and other inherited characteristics tha tmay or may not be mutually exclusive in each individual. (University of Wisconsin-Fox Valley, 2006)

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The makeup of of the workforce of a given healthcare organization. This includes ethnic and racial backgrounds, age, physical and cognitive abilities, family status, sexual orientation, socioeconomic status, religious and spiritual values and geographic location. (Betancourt, Green, & Carillo, 2002)

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When cultural beliefs or ideas ae either included or removed form the interpretation process by an interpreter, or in the process of translation of written materials. (Reynolds, 2006)

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The capacity of an organization and its personnel to communicate effectively, and convey information in a manner that is easily understood by diverse audiences including persons of limited English proficiency, those who have low literacy skills or are not literate, and individuals with disabilities. (Goode & Jones, 2004)

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A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations. (US DHHS, 2005)

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An integrated pattern of learned beliefs and behaviors that can be shared among groups.

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It's Time To Address The Role of Implicit Bias Within Health Care

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It's Time To Address The Role of Implicit Bias Within Health Care

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University Behavioral Health Care - Rutgers Health

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Cultural Competency at Rutgers University Behavioral Health Care

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Recognizing Diversity and Cultural Differences in Healthcare Organizations

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Recognizing Diversity and Cultural Differences in Healthcare Organizations

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Diversity and difference are considerations that will remain at the forefront of healthcare education for years to come. Learning about the production of difference and demographic diversity is an ongoing process and can be a lifetime journey.

It is imperative for organizations to support diversity and acknowledge individuals' differences in order to foster better morale, promote creativity and innovations, improve decision making, and create social justice that advocates equity ¹. It is essential to be respectful of diversity (requiring group interaction, dialogue, critical reflection, emotional support, and experiential learning, as well as meeting various learning needs by gender, class, and race).

People who differ in various ways are more likely to have diverse opinions and perspectives. This diversity of thought means there is a deeper base of ideas, opinions, and experiences for problem solving, creativity, and innovation ². If everyone thinks alike, the organization suffers. All employees must be judged based on their competence, and stereotypes and prejudices should be completely erased. Leaders need to recognize the validity of other ways of thinking and doing things. They also need to encourage diversity in organizations by recruiting diverse individuals and contribute to diversity of thought, which is a critical element for greater organizational learning, flexibility, and high performance. Leaders need to create opportunities for everyone to use their unique abilities. This represents the ideal leader and organization. Strong culturally sensitive leadership is the only way organizations can become inclusive. Although it may seem unreachable, many of today's best leaders are striving to achieve this stage of diversity awareness and acceptance.

It is vital to respect the beliefs and traditions of various ethnical and cultural groups, regardless of their origin. It is essential to establish, promote, and maintain a good safety culture, which will lead to a safe and effective environment. The goal is to acknowledge, respect, and explore cultural identities and challenge the assumption and work towards an equitable health care system. People should reflect on the values of relationships and cooperation and show respect for differences. Everyone has a role to play in fostering an ethical climate and integrating ethics into everyday practice, whether our role is in providing direct care or supporting the provision of care. With the help of multicultural attitudes, respect of cultural and religious practices, and a principle of procedural justice, we can create organizations that are gender-blind and color-blind.

It is significantly important to increase cultural competency in healthcare provision. Unfortunately, many healthcare organizations have not yet addressed the gender and cultural inequalities that currently exist. Change is always necessary if organizations are to survive. It is important not to maintain the status quo and create change.

It is imperative to initiate a process of promoting cultural safety and deal with cultural differences and conflicts. This attempts to respect the cultural and religious practices and a principle of procedural justice. It is critical to attempt integration and adopt cultural and religious practices that discourage racism and discrimination. Racism is still woven into the social fabric of everyday life and there is a need for action against injustices and inequalities. Leaders should create an environment in which members of different groups feel safe to express and discuss their identity.

Language, cultural, and gender differences are significantly important in maintaining communication between patients and healthcare professionals. When patients interact with clinical members who share a common gender, race, ethnicity, or language, there is a higher chance of rapport building ³. Conversing in the same language can instill and strengthen the needed cultural values and act as a bridge, linking such populations to healthcare society. This will lead to a greater interpersonal care, better medical comprehension, and higher chance of keeping follow-up appointments.

Different generations have different underlying motivators that influence job performance and satisfaction. Each generation offers a different sets of strengths; therefore, it is essential for leaders to embrace the generational diversity by recruiting a multigenerational workforce. Multigenerational employees contribute to diversity of thought. Older generations could offer support where there is a lack of experience.

The great need for dealing with and understanding challenges in cultural safety education will lead to a safe and effective environment. Organizations need to provide special training to help leaders identify their own cultural boundaries and develop the skills for leading in a diverse multicultural workplace and learning how to communicate and work effectively in a diverse environment.
References:
1. Gathers D. Diversity management: an imperative for healthcare organizations [published online 2003]. Hosp Top. doi: 10.1080/00185860309598023

2. Daft R. (2011). The leadership experience (5th ed). Mason, OH: South-Western.

3. Sethi D, Rani MK. Communication barrier in health care setting as perceived by nurses and patient [published online 2017]. Int J of Nurs Educ. 9(4), 30-35.

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Recognizing Diversity and Cultural Differences in Healthcare Organizations

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Diversity and difference are considerations that will remain at the forefront of healthcare education for years to come. Learning about the production of difference and demographic diversity is an ongoing process and can be a lifetime journey.

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Managing Cultural Differences in Healthcare

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Managing Cultural Differences in Healthcare

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Managing cultural differences in healthcare

Culture is a complex concept. It includes people's beliefs, values, behaviors, and ways of understanding their world. In medicine, managing cultural differences-including customs-is essential to providing high-quality health care. One challenge is that patients may not realize they have customs that could jeopardize their wellness. Culture is largely invisible to people who share it. But to outsiders, the customs and ways of life of different cultures are often obvious-and sometimes strange. Here's an example from my own experience:

I'm in Japan for a conference and I arrive at the house of my hosts. I knock on the door and they open it, greet me with short bows and smiles, and invite me in to the entry area. We stand and exchange pleasantries for quite a while. Eventually, it seems to me we should be making our way into the living room, but for some reason we aren't. I notice people glance at my feet occasionally and look uncomfortable. It finally dawns on me that I have my shoes on and everyone else is wearing indoor slippers. How strange to them that I would walk off the street into a house without removing my dirty-soled shoes.

What is cultural awareness?

Cultural awareness is the ability to perceive our own cultural beliefs, values, and customs, and to understand how they shape our decisions and behavior. Cultural awareness requires us to step back and look at ourselves as if through a stranger's eyes, and to open our minds to different ways of doing things. Margaret Mead described it best when she explained the core value of anthropology: "to make the familiar strange, and the strange familiar."

Cultural awareness-on the part of both practitioner and patient-is key to identifying cultural barriers to medical care.

The impact of customs on healthcare

Culture influences patients' responses to illness and treatment. In our multicultural society, different customs can lead to confusion and misunderstanding, which erode trust and patient adherence. Here are three examples from my career that show how deeply culture impacts medical care:

1. I once had a patient from Morocco who had to be hospitalized for pneumonia. When I arrived at the unit, several nurses, nursing assistants, and the ward clerk were engaged in a loud argument with a group of Moroccan friends and family members. The staff were trying to escort the visitors out of the patient's room. Back in Morocco, they wouldn't consider leaving a sick relative alone in a hospital room. The notion of 'visiting hours,' which is so normal for us, was completely foreign to them.

2. When I practiced in New York, Orthodox and Hasidic Jewish traditions helped shape our policies and procedures. The hospital had a Sabbath elevator (so no one had to do the work of running the elevator on the Holy Day), and healthcare professionals and patients were not supposed to make physical contact across gender lines. We also observed plenty of dietary customs from various cultures: Kosher, Halal, and vegetarian menus, seaweed soup being served to Korean women after giving birth, and attention paid to the hot and cold properties assigned to various foods in traditional Chinese healthcare.

3. One of my most memorable patients was Grace, an African-American Jehovah's Witness. Grace was in her late 70's and very sick. One of her heart valves wasn't working and she needed major cardiac surgery to replace it. Grace also had a bleeding tendency and would require blood transfusions during the operation. Jehovah's Witnesses usually decline transfusion of whole blood or blood components. This choice is not due to perceived risk but is based on interpretation of biblical texts. Grace refused to have the surgery. After a lot of introspection and discussion with her family and religious community, it became clear this really was her fully informed wish, so the medical team respected her decision.

Cultural Awareness Checklist

Communication and ongoing education are essential to promoting cultural awareness and providing culturally sensitive care. As you work to develop cultural awareness for yourself and your patients, use this checklist to make sure you're able to understand and negotiate any cultural differences that may directly impact care.

1. Establish clear communication
Make sure you know your patient's preferred method of communicating and arrange professional interpretation if necessary.

2. Be aware of non-verbal cues without jumping to conclusions
Non-verbal communication conveys a lot of critical information-but it may differ dramatically across cultures. Don't make any assumptions without knowing the person's customs.

3. Ask openly about potentially relevant traditions and customs
This includes exploring potential spiritual/religious practices, dietary considerations, and cultural norms that may be particularly important to the patient's clinical situation.

4. Use normalizing statements
A respectful way to ask about sensitive issues like cultural or religious customs is to first explain that they are very common. (e.g. "A lot of my patients have customs or practices that are important for me to know about so I can make sure to give you the best possible care.")

5. Examine your own biases
We all have unconscious biases and prejudices that impact our relationships with patients. Identifying and understanding these biases helps to control them, and is essential to achieving cultural awareness.

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Cultural Awareness in Healthcare: A Checklist

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Culture is a complex concept. It includes people's beliefs, values, behaviors, and ways of understanding their world. In medicine, managing cultural differences-including customs-is essential to providing high-quality health care. One challenge is that patients may not realize they have customs that could jeopardize their wellness. Culture is largely invisible to people who share it.

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Cultural Competence in Healthcare