Cultural Diversity and Leadership
The country and the world witnessed the death of George Floyd on May 25, 2020. Racism, racial inequities, and biased views are nothing new in the United States (U.S.), however this time was different. This time a cell phone captured the events leading up to the death of George Floyd, sparking a new civil rights movement for racial justice. The goal of this paper is to show the values of multicultural people as healthcare workers and patients in need.
Leaders are the key to understanding how diversity plays into the care delivery system in the United States. Awareness turns into action and action leads to change. This paper will focus on different cultural patient cohorts, health care worker cohorts, and inject emotional intelligence in leading the necessary levels of awareness needed to impact change. Placing people into categories comes with risk, mitigating these risks can lead to improved teamwork and patient outcomes.
Cultural Values of Diverse Workforce Cohorts
Diverse healthcare professionals experience a set of struggles uncommon to Caucasian healthcare workers. Each workforce cohort brings different cultural values and assumptions to the health care team. Cohort groups examined are Latino Immigrants, African Americans, and Native Americans. Leaders must become familiar with the large cultural cohorts to help navigate teamwork and use of motivational factors in goal attainment and patient care processes.
Immigration to Expand the Workforce
As the demand for healthcare workers increases, so does the demand to match the cultures within the healthcare system to patient diversity. Latino immigration to the U.S over the past 30 years has increased by 233%, while Latino physicians and nurses have decreased (Nevarez, Castan, Rodriguez, & Reynoso, 2019). The value of Latino healthcare workers entering the healthcare field is enormous. Nurses and physicians are in critical demand and this cultural cohort is a way to help fix the need for motivated, passionate care providers in the U.S.
To value of the Latino healthcare provider is essential to match the Latino patient experience. The literature shows patients value interdisciplinary teams and customer service such as wayfinding and parking (Mazurenko, Zemke, & Lefforge, 2016). Latino healthcare workers can connect with fellow Latino patient cohorts and help drive the patient experience. These connections can help drive the overall care experience in the Spanish speaking community.Roughly one-third of the U.S. population is comprised of Hispanic, Native American, and Black ethnicity (Osseo-Asare et al., 2018). The value of these cultural cohorts to improve the workforce and increase cultural diversity can’t be stressed enough. Physicians belonging to these cultural groups want to make difference and help improve care, however, experience racial and stereotypical segregation. Those entering the workforce show true dedication to wanting to help their fellow human being.
Research identified the additional hardships these cohorts face in post-medical school training. Of the 27 black, Hispanic, and native American physicians interviewed, themes emerged based on views of being a foreigner or transplant (Osseo-Asare et al., 2018). These workgroups must work harder to be successful, showing a level of commitment that is invaluable to the healthcare field.
Assumptions include the likelihood that these cultural cohorts will avoid the workforce due to the barriers they face, while those who do is based on cultural reasons for support. In a qualitative study involving 19 black, 3 Hispanic, and 4 Native American physicians, additional burdens such as being a racial/ethnic ambassador were not well received (Osseo-Asare, et al., 2018). Those entering the workforce, if able to work past the added pressures, may not want to take on the role nor be placed in this category.
Physician: Primary Customer Sustainability
The role of the leader is to hire staff who will make a difference to the patient at the front-line, where it truly matters. Performance management processes identify those staff provide great services and exhibit positive attitudes (Kennedy, Anastos, & Genau, 2019). Immigrant physicians bring additional solutions to help meet the challenge. The qualities they bring include strong purpose, innovation, openness to see people as people, while embracing their professional image and desire to do well.
Research looking at patient experience and satisfaction based on language and cultural likeness revealed strong correlations in the Latino community. One study from a systematic review revealed 97% of Spanish speaking patients experienced higher satisfaction if the provider spoke Spanish, where P=0.0001 for patients who didn’t speak English (Diamond et al. 2019). The less English a Latino patient speaks, the higher the patient satisfaction when cared for a Latino provider. Cultures connecting with like cultures in the healthcare system can make a difference to patient satisfaction.
Physicians help set the tone for the patient, family, and staff. The Native American culture views all health conditions as impacting the mind and the body, making them receptive to counseling (Cohen, 1998). Cultural values, traditions, and views of this culture allows for greater diversity into the physician and healthcare workforce. Not only will Native American providers improve the demand, but they can also add value to the patient versus a single ailment or disease. Follow-up care and health and wellness improvements are critical to healthcare today.
Connecting with a Diverse Patient Population
Native Americans, Latino, and African American health care workers bring cultural values and diversity to the team. A qualitative study involving critical interpretive synthesis of 51 articles identified critical patient themes in balancing care between two cultures based on expectations, prayer, and spirituality (Degrie et al., 2017). Increasing the workforce is necessary to provide basic care, while increasing the workforce with strong cultural advocacy can provide stronger patient connections.
When patients who view themselves as minorities see other minority healthcare team members, this can provide a sense of security. One example is seen with Chinese immigrant women. Read and Smith (2018) showed 14.0% of Chinese women were seen by a physician in the past year, showing a significant difference with P-value<0.05 compared to other immigrants. Chinese healthcare workers in the U.S. add presence that can help improve the acceptance of western medicine care.
Multilingual Benefits
Language barriers impact patient’s healthcare behaviors and outcomes. One study revealed that 25 out of 33 studies involving patients who received language-concordant care experienced better outcomes (Diamond et al., 2019). The increase of Spanish speaking households by 233% in 2016 (Nevarez, 2019), has increased the value of the Latino immigrant healthcare worker. Latino immigrant healthcare workers bring the value of speaking Spanish to the healthcare system.
The assumption is the multilingual healthcare worker will connect with the patient and provide high quality communication. The level of the healthcare workers must be considered before provided medical care communication. Patient connection and ease of fear can be made through mutual language (Diamond et al., 2019). Leaders must be cognizant that what is being translated to patients is accurate. This can be mitigated though interpretation policy and validation methods such as having two healthcare workers able to speak the language present.
Cultural Values of Diverse Patient Cohorts
Care providers interactions with different cultures bring forth new experiences. Care givers generally want to help the fellow human, regardless of values, beliefs, and cultural heritage. Embracing the values from diverse patients opens the healthcare worker to new worlds. Connecting with cultural beliefs, spirituality, and family interactions allows exposure to healthcare workers. The patient culture cohorts reviewed are Hmong population and Immigrant cohorts from Mexico, China, and India.
Dynamic Cultural Humility
The theme of cultural humility includes understanding complex identities within same and different cultures, such as aware of biased beliefs and how thinking may shift based on the setting or environment (Khan, 2021). Understanding the values of these cultural cohorts help the healthcare worker incorporate them into their care delivery, approach, and interactions. Humility and humanity can blend when belief systems are understood. Learning what drives and motivates a cultural group is invaluable to healthcare workers as they seek the best care for their patients.
The Hmong population brought traditional heritage, values and beliefs to the U.S. following immigration from China and Laos in the 1970’s and 1980’s (Lor et al., 2017). Traditional Hmong beliefs look very different from western medicine practices. For example, shamans are known for their spiritual healing based on the belief of the soul during illness or events (Lor et al., 2017). Understanding what motivates a Hmong person to seek healthcare versus traditional care is vital. Providers must incorporate these motivational factors when providing instruction and treatment plans.
Research involving 11 Hmong participants with limited English, looked at the decision to follow western medicine practices or followed traditional methods (Lor et al., 2017). Hmong patients in a hospital may vary between these two variables, offering the spiritual side to the health care staff. Two themes emerged from the qualitative study, illness classification and treatment options and perception (Lor et al., 2017). Knowing when a Hmong person views the need to go the hospital versus following the care of a shaman is essential for public health leaders in dealing with population care.
Understanding the cultural and belief system of the Hmong provides value to western medicine. It provides insight and can prevent healthcare workers from viewing traditional beliefs as non-compliant to western medicine treatments. Hmong view pain as a decision maker for accepting U.S. healthcare, meaning severe pain resulted in a trip to the hospital while mild pain means the illness is slow and the shaman can help (Lor et al., 2017). This value in pain shows a different story when a Hmong patient enters in pain versus another culture due to this variable.
People from Mexico, China, and India make up the largest immigration population in the U.S. (Read & Smith, 2017). These groups add patient value in healthcare visits and dependence on the health care system. Research to understand how gender plays a role in U.S. healthcare adds additional value in promoting or establishing care. Motivating those reluctant to seek care can help public health leaders increase population health outcomes.
A study involving 2244 immigrants from Mexico, China, and India to establish the use of health care services in the U.S. based on gender. P values less than 0.05 indicated more females than males used U.S. health care services for immigrants from Mexico (Read & Smith, 2017). The value of Mexican female immigrants is that they accept and use health care services and can be viewed as a way to help increase adoption in the future years for male Mexican immigrants. Indian males were the opposite, where more males (27.9%) use healthcare services versus females (26.9%) (Read & Smith, 2017).
New Experiences and Values
The value of interacting with cultural cohorts provides new experiences, new cultural exposure, and new values. Wholistic approaches to care opens the mind for new belief systems. Hmong belief systems include spiritual medicine, the role of the family, and spiritual insights (Lor et al., 2017). Handling and interpreting what is taking place in the human body provides new insights to healthcare workers.
Healthcare Seeking Behavior
Cultures are often unfamiliar with the benefits of the U.S. healthcare system. This leads to avoidance or irregularity in use. Understanding the values of the cultural cohorts helps identify who is more likely to seek western medicine. Read and Smith (2017) broke down these behaviors based on characteristics such as insurance, gender, household earnings, children in the household, age, and need. Leaders can focus on groups with positive care seeking behaviors to help motivate other cultures or genders within the cultures.
Indian male cohorts were identified as having enabling characteristics that improve healthcare seeking behaviors such as having health insurance (56.8%) and greater English proficiency (82.3%) (Read & Smith, 2017). Living in the U.S. longer seems to add value to the cultural cohort’s acceptance to use health care services. The value of insurance and English leads to system use, while those without avoid. Leaders can focus on this quality as a means of helping increase the language and insurance disparities in hopes of increasing healthcare seeking behaviors.
Research conducted among 9 Hmong people revealed when illness was too great for the spirit to handle, such as breaking both legs, they relied on traditional western medicine for solutions (Lor et al., 2017). The Hmong value pain and the onset of pain as a reason to go to the hospital, versus the thinking the spirit will help resolve the issue. Health care providers must respect this and enable this behavior. This can trickle over to post-acute care. Nurses and physicians can use this value to help motivate proper care to avoid high spikes of pain in the future.
Applying EI to Team Based Conflicts
Interdisciplinary teams with multicultural members can provide deep insight and difference of attitude and opinions. Emotional intelligence is imperative in moving forward in objectives, goals, and team-based outcomes. Leaders must apply EI to address team conflicts. The goal of this section is to understand how to manage and lead those with different cultural and language back grounds.
Leaders must understand the impact emotions have on the organization and team. Emotions can result from external or internal situations and determine if an outcome will be positive or negative (Clark & Polesello, 2017). Motivation and drive can look different between the cultures, leading to false pretenses and attitudes among team members. The literature shows that leaders with higher multicultural management abilities also show great stress management and interpersonal skills (Clark & Polesello’, 2017).
Team-Based Conflicts and Roadblocks
The greatest conflict found in the literature is based on language and belief variances. Effective communication is required in healthcare, however when this does not take place, conflicts arise. Scott (2016) discusses the 179 language and 544 dialects of the Indian language, creating conflict and barriers within this single cohort. These barriers add challenges for team members to fully understand their roles, goals, and meeting notes (Scott, 2016).
Teamwork requires member acceptance and tolerance between views. Factors impacting cultural empathy can lead to lack of trust and team breakdown. Scott (2016) identifies five cultural orientations in communication competency as: richness of content, power distance, individualism, uncertainty avoidance, and performance orientations. Breakdown in one or more of these competencies within the team can lead conflict. The concept of cultural intelligence (CQ) is discussed in the literature as having an impact team conflict management. The four components of CQ are: metacognition, cognition, motivation, and behavior (Clark & Polesello, 2017). Roadblocks can occur in any instance impacting these four components, as well as what is referred to as core features of CQ: the head, the heart, and the body (Clark & Polesello, 2017). People from different cultures know different things and are motivated and passionate by different reasons.
Using EI across cultures brings the roadblock of motivating others who feel strongly based on their belief system. Cultural beliefs may block team members from carrying out the goals of a team when they are conflicting. Leaders must not allow emotions to take over, rather help members explore their views to compromise resolutions.
Team dynamics between Latino healthcare workers and U.S. workers may arise due to false beliefs, racial or discriminatory views. Leaders may need to resort past EI and inject human resources to resolve conflict. Leaders view multicultural cohorts as improving the workforce in number and diversity, while others on the team may be threatened or fear losing a promotion or position. Scott (2016) discusses the importance of human resource management to help with diversity conflicts to improve and ensure strong organizational performance.
Advantages and Disadvantages within a Culturally Diverse Workforce
Unfortunately, all the cultural values identified within the cohorts discussed can be viewed as a disadvantage. The U.S. may be the melting pot of the world however diversity issues create struggles. In the goal of improving patient satisfaction, sometimes difference can lead to dissatisfaction. There are advantages of multicultural teams that leaders can exploit to push a positive image.
Diverse teams may create racial tensions and struggles when the patient population is not diverse. The qualitative study among 27 Black, Hispanic, and Native American resident physicians discussed how patient’s view these groups as outsiders who use resources intended for U.S. born citizens (Osseo-Asare et al., 2018). The disadvantage is in negative patient experience or complaints based on this factor alone.
Teams may contain members who are multilingual, and these members may use languages other than English in their daily communications. This can be a disadvantages as other team members may perceive the use of the second language to speak negatively of other members. In 108 people surveyed in Sydney, Australia, trends between English speaking and non-English speaking staff emerged (O’Callaghan, Loukas, Brady, & Perry, 2018).
Multilingual staff have the opportunity and ability to communicate with staff who do not speak English. Out of 108 people surveyed, only 20% felt it was appropriate for nurses to translate to patients in another language (O’Callaghan, Loukas, Brady, & Perry, 2018). Multilingual staff provide an advantage unless the interpreted information to the patient is not correct. Use of a different language within a team can be viewed as a disadvantage to other members and advantage to those able to use it. Leaders can mitigate this by applying team rules and boundaries to help ensure all feel included.
Scott (2016) describes the global nature of the hospital due to the diversity found in the hospital staff and patients. It can be advantageous to match diverse patients with a diverse workforce. Workers who understand different cultures can ease fear and provide insight to other members of the healthcare team. The ultimate advantage for diversity in the healthcare team is to the patient. Leaders can rely on the universal patient as the center of care to mitigate the disadvantages.
Leader use of EI to remind staff of why another team member communicated with a patient or another team member in their native language can help reduce the perception this causes and creates. Leaders can help create policies for staff as interpreters or around communicating with patients in their native language. Policy can support workers as they rely on their cultural heritage to connect with patients.
The Impact of Categorizing People
When healthcare workers or patients are categorized into cultural cohorts, they are seen as the cohort and not as individuals. This limits the potential of the worker and patient in certain ways. If the Hmong patient is viewed as a spiritual person against western medicine, then this may prevent nurses and physician’s from fully engaging in care options. Black physicians may avoid fully engaging with Caucasian patients to avoid racial or biased comments. People of color experienced a lack of confidence, increased stress, and psychological burdens (Snyder & Schwartz, 2019). When people are categorized based on skin color, race, religious beliefs, they are not fully seen and embraced for what they are able to bring to the healthcare team. Snyder and Schwartz (2019) describe the negative impact black physicians and nurses receive in leadership growth when their skin color is viewed first, and they are seen second.
Nurse leaders must adopt systems to create nursing assignments based on equity and patient needs. The literature shares the perception of Latino and Black nurses receiving harder assignments after white nurses pick their assignments first. Systems and processes around patient needs remove the variability of race, color, or preferences. Leadership opportunities and positions can be based on peer interview strategies and team selection versus single promotions by senior leaders.
Leaders must create diverse teams and harness the strengths of all members. This is based on understanding and knowing them. The value of building relationships helps leaders go beyond the categorization of their skin color, race, ethical heritage. Validating other’s views and offering to the team helps remove these barriers. This must go both ways, thus navigating around when a team member uses the culture to make excuses. Leaders must use EI to motivate team members to keep the patient at the center while applying scholarly literature to goals and strategies.
References
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