Influence of Organizational Factors on Clinical Cultural Competence

This qualitative research used a case study method to study clinical cultural competence at one hospital located in a large city in Canada. The study explored the overarching central question: how does the organizational and practice environment influence the understanding and enactment of clinical cultural competence in an organization embarking on a deliberate process of organizational and practice change? Interviews with clinicians, administrators and organizational diversity consultants (N=40), along with field notes and a review of selected documents were used to: (a) examine clinical cultural competence from the clinicians' perspective; and (b) describe key factors and processes within the practice environment that support or limit the provision of such care. The research was situated within a theoretical framework for practice development proposed by Kitson, Harvey McCormack (1998) that identifies practice development to be a function of three key variables: evidence, context and facilitation. The philosophical stance of critical realism was used to analyze the findings. Results indicate that despite a significant organizational commitment to diversity, cultural competence in clinical care was largely limited to awareness and lacking in application in practice. Cultural competence was described in terms of adding a layer of cultural understanding to clinical care; however, this was accompanied by a feeling of inadequacy with respect to cultural issues. This study further revealed an overlap and a need to differentiate between cultural competence and client-centered care. The overall organizational approach was one of mandated change and included the development of various initiatives such as diversity policy and mandatory training for all staff. However, these initiatives were experienced both positively and negatively; indicating a need to examine not just what resources exists in an organization, but also how they are experienced. Although leadership was evident in the form of organizational commitment, it was not translated into care. The findings suggest a reconsideration of two of the most frequently recommended strategies--diversity training and enhancing workforce diversity. In addition, the findings also suggest enhancements to practice development framework to address complex phenomenon such as clinical cultural competence. These are further discussed in the dissertation report.

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