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Hospital cultural competency as a systematic organizational intervention: Key findings from the national center for healthcare leadership diversity demonstration project

Weech-Maldonado, Robert; Dreachslin, Janice, L.; Epané, Josué, Patien; Gail, Judith; Gupta, Shivani; Wainio, Joyce, Anne

doi: 10.1097/HMR.0000000000000128

Background: Cultural competency or the ongoing capacity of health care systems to provide for high-quality care to diverse patient populations (National Quality Forum, 2008) has been proposed as an organizational strategy to address disparities in quality of care, patient experience, and workforce representation. But far too many health care organizations still do not treat cultural competency as a business imperative and driver of strategy.

Purposes: The aim of the study was to examine the impact of a systematic, multifaceted, and organizational level cultural competency initiative on hospital performance metrics at the organizational and individual levels.

Methodology/Approach: This demonstration project employs a pre–post control group design. Two hospital systems participated in the study. Within each system, two hospitals were selected to serve as the intervention and control hospitals. Executive leadership (C-suite) and all staff at one general medical/surgical nursing unit at the intervention hospitals experienced a systematic, planned cultural competency intervention. Assessments and interventions focused on three organizational level competencies of cultural competency (diversity leadership, strategic human resource management, and patient cultural competency) and three individual level competencies (diversity attitudes, implicit bias, and racial/ethnic identity status). In addition, we evaluated the impact of the intervention on diversity climate and workforce diversity.

Findings: Overall performance improvement was greater in each of the two intervention hospitals than in the control hospital within the same health care system. Both intervention hospitals experienced improvements in the organizational level competencies of diversity leadership and strategic human resource management. Similarly, improvements were observed in the individual level competencies for diversity attitudes and implicit bias for Blacks among the intervention hospitals. Furthermore, intervention hospitals outperformed their respective control hospitals with respect to diversity climate.

Practice Implications: A focused and systematic approach to organizational change when coupled with interventions that encourage individual growth and development may be an effective approach to building culturally competent health care organizations.

Robert Weech-Maldonado, MBA, PhD, is Professor and L.R. Jordan Endowed Chair, Department of Health Services Administration, University of Alabama at Birmingham. E-mail:

Janice L. Dreachslin, PhD, is Professor Emerita of Health Policy and Administration, Penn State Great Valley School of Graduate Professional Studies, Malvern, Pennsylvania.

Josué Patien Epané PhD, MBA, is Assistant Professor, Department of Health Care Administration and Policy, School of Community Health Sciences, University of Nevada, Las Vegas.

Judith Gail, MSOD, is Owner and Principal, Gail Consulting LLC, Washington, DC.

Shivani Gupta, PhD, is Assistant Professor, College for Public Health and Social Justice, Health Management and Policy, Saint Louis University, Missouri.

Joyce Anne Wainio, MHA, Vice President, National Center for Healthcare Leadership, Chicago, Illionis.

This project was supported by the National Center for Healthcare Leadership (NCHL) with funding from Sodexo and member health systems. Dreachslin, Weech-Maldonado, Epané, and Gail were reimbursed by NCHL as consultants to the project.

The authors have disclosed that they have no significant relationship with, or financial interest in, any commercial companies pertaining to this article.

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