Diversity and Cultural Competence in Health Care A Systems Approach

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.

Tables and Figures

Preface

Acknowledgments

The Authors

Part One The Diversity Imperative

Chapter 1 Systems Approach to Cultural Competence

Introduction

Dimensions of Diversity

Health Care Diversity Challenges

Health Care Disparities in the United States

Changing the US Health Care System

Systems Approach in the Health Care Delivery Organization

The Importance of Leadership

Summary

Review Questions and Activities

Chapter 2 Systematic Attention to Health Care Disparities

Introduction

What Are Health Care Disparities?

Race and Ethnic Disparities in Health Status

Disparities Across Other Diversity Dimensions: Gender, Sexual Orientation, the Elderly

Stakeholder Attention to Health Care Disparities

Systematic Strategies for Reducing Health Care Disparities

Summary

Review Questions and Activities

Chapter 3 Workforce Demographics

Introduction

Trends in the US Labor Force

Diversity and the Health Professions

Drivers of Disparities in the Health Professions

Checklist of Recommended Organizational-Level Actions

Workforce Diversity Challenges

Summary

Review Questions and Activities

Part Two The Development of Cultural Competence

Chapter 4 Foundations for Cultural Competence in Health Care

Introduction

What Is Cultural Competence in Health Care?

Long Journey Toward Cultural Competence

Cultural Competence and the Health Care Provider Organization

Cultural Competence and the Multicultural Health Care Workforce

Summary

Review Questions and Activities

Chapter 5 Hallmarks of Cultural Competence in Health Care Professionals

Introduction

Personal Journey of Cultural Competence

Framework for Role Development

Journey of Self-Discovery

Summary

Review Questions and Activities

Chapter 6 Training for Knowledge and Skills in Culturally Competent Care for Diverse Populations

Introduction

Eight Principles for Knowledge and Skills Training

Cultural Competence Knowledge and Skills for Administrators and Directors

Cultural Competence Training for Health Care Professionals in Direct Patient Care

Cultural Competence Training for Support Staff

The Role of Assessment in Cultural Competence Training

Summary

Review Questions and Activities

Part Three Cultural Competence and Health Care Delivery

Chapter 7 Cultural Competence in Health Care Encounters

Introduction

Models from Transcultural Nursing

Giger-Davidhizar Transcultural Assessment Model (GDTAM)

Being Culturally Responsive

Summary

Review Questions and Activities

Chapter 8 Language Access Services and Crosscultural Communication

Introduction

Language Use in the United States

Language Differences in Health Care Encounters

Attitudes Toward Limited-English Speakers

Changing Responses to Language Barriers in Health Care

An Expanding Profession: The Health Care Interpreter

Translation in Written Health Care Communication

Communication is More Than Words

Summary

Review Questions and Activities

Chapter 9 Group Identity Development and Health Care Delivery

Introduction

Research Highlights

Minority Status Group Identity Development

Majority Status Group Identity Development

Using the Models

Summary

Review Questions and Activities

Part Four Cultural Competence and the Health Care Organization

Chapter 10 The Centrality of Organizational Behavior

Introduction

The Science of Organizational Behavior

Organizations as Contexts for Behavior

OB Research Highlights

Can Culturally Competent Health Care Professionals “‘Go It Alone”?

Summary

Review Questions and Activities

Chapter 11 The Business Case and Best Demonstrated Practices

Introduction

Evolution of the Business Case

The Business Case for Cultural Competence in Health Care

Workforce, HRM, and the Business Case

Best Demonstrated Practices

Assessment and the Systems Approach

Benchmarking

Role of Metrics in the Systems Approach

Summary

Review Questions and Activities

Chapter 12 The Future of Diversity and Cultural Competence in Health Care

Introduction

Trends That Support Widespread Adoption of the Systems Approach

The Sustainability Movement and the Systems Approach

Change Management and Force Field Analysis: Tools to Envision and Shape the Future

Summary

Review Questions and Activities

Glossary

Index

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