Diversity and Cultural Competence in Health Care

Janice L. Dreachslin, PhD, is a professor of Health Policy and Administration in the Management Division at the Penn State Great Valley School of Graduate Professional Studies in Malvern, Pennsylvania and co-professor-in-charge of the MBA program.M. Jean Gilbert, PhD, a medical anthropologist, is the principal of the consulting firm, Cultures in the Clinic, which advises health care organizations and conducts workshops for health care professionals.Beverly Malone, PhD, RN, FAAN, is the chief executive officer of the National League for Nursing.

• Figures and Tables ixPreface xiAcknowledgments xvThe Authors xviiPART ONE THE DIVERSITY IMPERATIVE 1Chapter 1 Systems Approach to Cultural Competence 3Dimensions of Diversity 7Health Care Diversity Challenges 19Health Care Disparities in the United States 20Changing the US Health Care System 21Systems Approach in the Health Care Delivery Organization 26The Importance of Leadership 27Summary 28Review Questions and Activities 29Chapter 2 Systematic Attention to Health Care Disparities 35What Are Health Care Disparities? 36Race and Ethnic Disparities in Health Status 37Disparities across Other Diversity Dimensions: Gender, Sexual Orientation, the Elderly 49Stakeholder Attention to Health Care Disparities 56Systematic Strategies for Reducing Health Care Disparities 60Summary 65Review Questions and Activities 66Chapter 3 Workforce Demographics 75Trends in the US Labor Force 76Diversity and the Health Professions 81Drivers of Disparities in the Health Professions 83Checklist of Recommended Organizational-Level Actions 90Workforce Diversity Challenges 96Summary 100Review Questions and Activities 101PART TWO THE DEVELOPMENT OF CULTURAL COMPETENCE 105Chapter 4 Foundations for Cultural Competence in Health Care 107What Is Cultural Competence in Health Care? 109Long Journey toward Cultural Competence 119Cultural Competence and the Health Care Provider Organization 126Cultural Competence and the Multicultural Health Care Workforce 133Summary 138Review Questions and Activities 139Chapter 5 Hallmarks of Cultural Competence in Health Care Professionals 143Personal Journey of Cultural Competence 145Framework for Role Development 153Journey of Self-Discovery 156Summary 167Review Questions and Activities 168Chapter 6 Training for Knowledge and Skills in Culturally Competent Care for Diverse Populations 171Eight Principles for Knowledge and Skills Training 173Cultural Competence Knowledge and Skills for Administrators and Directors 177Cultural Competence Training for Health Care Professionals in Direct Patient Care 183Cultural Competence Training for Support Staff 207The Role of Assessment in Cultural Competence Training 208Summary 211Review Questions and Activities 212PART THREE CULTURAL COMPETENCE AND HEALTH CARE DELIVERY 219Chapter 7 Cultural Competence in Health Care Encounters 221Models from Transcultural Nursing 225Giger-Davidhizar Transcultural Assessment Model (GDTAM) 238Being Culturally Responsive 251Summary 253Review Questions and Activities 254Chapter 8 Language Access Services and Crosscultural Communication 259Language Use in the United States 261Language Differences in Health Care Encounters 262Attitudes toward Limited-English Speakers 266Changing Responses to Language Barriers in Health Care 268An Expanding Profession: The Health Care Interpreter 278Translation in Written Health Care Communication 284Communication Is More than Words 286Summary 290Review Questions and Activities 291Chapter 9 Group Identity Development and Health Care Delivery 299Research Highlights 301Minority Status Group Identity Development 305Majority Status Group Identity Development 313Using the Models 325Summary 328Review Questions and Activities 329PART FOUR CULTURAL COMPETENCE AND THE HEALTH CARE ORGANIZATION 333Chapter 10 The Centrality of Organizational Behavior 335The Science of Organizational Behavior 338Organizations as Contexts for Behavior 339OB Research Highlights 341Can Culturally Competent Health Care Professionals “Go It Alone”? 350Summary 356Review Questions and Activities 357Chapter 11 The Business Case and Best Demonstrated Practices 361Evolution of the Business Case 363The Business Case for Cultural Competence in Health Care 364Workforce, HRM, and the Business Case 373Best Demonstrated Practices 376Assessment and the Systems Approach 386Benchmarking 389Role of Metrics in the Systems Approach 390Summary 397Review Questions and Activities 399Chapter 12 The Future of Diversity and Cultural Competence in Health Care 405Trends That Support Widespread Adoption of the Systems Approach 406The Sustainability Movement and the Systems Approach 419Change Management and Force Field Analysis: Tools to Envision and Shape the Future 420Summary 425Review Questions and Activities 426Glossary 429Index 439