Organizational advocacy of cultural competency initiatives: lessons for public administration.

AuthorCarrizales, Tony
PositionReport

INTRODUCTION

The concept of cultural competency is relatively new in the historical development of public administration research. However, the practice of cultural competence is firmly rooted in broader public administration values of diversity and effectiveness. Cultural competence reflects and aids good government as it promotes effective delivery of services (Norman-Major and Gooden 2012). Given the benefits and impacts of cultural competency, it is not surprising that initiatives within public administration continue to grow.

Cultural competency can be characterized as specific organizational actions and policies that enable the organization to more effectively serve its culturally diverse populations. That definition can also be broadened to actions and policies that help a diverse workforce feel more engaged with their workplace. Local municipalities, where cultural differences have become most evident due to shifting demographics, are able to adapt and provide proactive responses (Benavides and Hernandez 2007).

Cultural competence can be found in practice as early as the 1800s, but it wasn't until the 1980s that a collective effort to promote culturally competent practitioners emerged in health and social services (Satterwhite et. al. 2007). This study reviews current advocacy in health care, social work, and other public sector organizations. Specifically, the study reviews public service academies, associations and accrediting bodies that can apply themselves to informing, guiding and advocating cultural competency initiatives in public administration. International cultures require cultural competency for public servants working abroad as well (Imoh 2012), but the focus of this paper will be on U.S. organizations and public administration within the country. Ultimately, the paper intends to outline current guiding principles and policies that service organizations use in advancing cultural competency. To this end, the paper aims: 1) to provide a reference framework for public administration entities and their respective policies, and 2) underscore the breadth and the beneficial potential in a culturally competent service organization.

Literature Review--Cultural Competency

Cultural competency can be approached in various ways; however, a common factor emphasized across each approach is organizational change so that the organization can better serve its customers/public and workforce. One example refers to cultural competency as the "ability of organizations and individuals to work effectively in cross-cultural or multicultural interactions" (Fernandopulle 2007, 16). Moreover, Lonner (2007) outlines cultural competency as a continuum "with no absolute fixed endpoints; that is, there is neither an exact bottom for total cultural incompetence nor an exact top measure" (6). The National Center for Cultural Competence (NCCC), a federally funded institution, was founded as a means for advancing a more consistent understanding of cultural competency and as a resource for the health sector. The NCCC defines cultural competency as "having the knowledge, skills, and values to work effectively with diverse populations and to adapt institutional policies and professional practices to meet the unique needs of client populations" (Satterwhite et al. 2007, 2).

In terms of operationalizing various approaches to cultural competence, some scholars have developed models for practice and assessment. Brach and Fraser (2000) develop a conceptual model for reducing racial/ethnic health disparities in order to avoid ignoring cultures and opportunities. The Purnell Model of Cultural Competency (Purnell 2002), developed for health care, underscores major assumptions for cultural competency implementation. These assumptions include: cultures change slowly over time; differences exists among, between, and within cultures; individuals and families belong to several cultural groups; and culture has powerful influence on one's interpretation of health care (Purnell 2002).

Wu and Martinez (2006) identify six principles and recommendations for cultural competency implementation: community representation and feedback at all stages of implementation; cultural competency integration into all systems of the organization, particularly quality improvement efforts; ensuring that changes are manageable, measurable, and sustainable; making the case for implementation policies; commitment from leadership; and on-going staff training. Mayeno (2007) highlights how organizational leaders are required in order to "overcome resistance from staff members and forces in social, institutional, and organizational environments that reinforce the status quo" (7). In addition, some of the challenges for having a culturally competent health sector include a lack of diversity in leadership and the workforce; systems that are poorly designed to meet the needs of diverse populations; and poor communication between providers and patients (Betancourt, Green and Carrillo 2002).

Varying fields of practice. As Berry-James (2012) notes, public administrators and public sector advocates have struggled with defining and measuring cultural competency. However, as Berry-James points out, the concept of and practice of cultural competency has long been rooted in health care practice. Kleinmen et al (1978) underscored the importance of cultural awareness in health care nearly four decades ago. Betancourt, Green, and Carrillo (2002) define cultural competence in health care as the "ability of systems to provide care to patients with diverse values, beliefs and behaviors, including tailoring delivery to meet patients' social, cultural, and linguistic needs" (p. v). Fox (2005) characterizes cultural competence in health care as a method to "deliver 'sensitive,' 'empathetic,' 'humanistic,' care that is 'respectful' of patients" (1316). Fox (2005) calls upon health care education to take a broader look at cultural competence in order to effectively teach practitioners. To this end, Fox suggests a systematic acquisition of an in-depth knowledge of one society other than one's own. Similarly, Pacquiao (2007) suggests there is a need for cultural competence education for all health care professionals and students, regardless of background, given the good evidence of improved outcomes in patient care.

Social workers have also called for cultural competence to be an integral part of the practice. Abrams and Molo (2009) promote critical race theory as an additional perspective in social work education in advancing cultural competence. They underscore limitations in cultural competence. Similarly, Parrott (2009) proposes a distinct approach toward cultural competence education to address some of the limitations. Parrott notes anti-oppressive social work education helps in developing awareness of differences and proficiency in addressing the "negative effects of differences as experienced through social divisions such as race and gender" (618). However, Parrott calls for a more complete conceptualization of how cultures are constituted to enable social work to be more effective.

In addition to health care and social work, other areas of public service have adopted cultural competence initiatives and practices. McAllister and Irvine (2000) highlight and review various models of cross-cultural competence in teaching education. They note that in order for teachers to be effective with diverse students, they must first recognize their own worldviews. They find that process models of cross-cultural competence do provide some conceptual insight into how teachers can be more effective with their culturally diverse students. Reger et al. (2008) outline how an understanding of Army language, manners, norms of behavior, and belief systems are critical for implementation of psychological services for soldiers. Formalized cultural competency training procedures may be required as the demand for non-veteran civilian psychologists grows (Reger et al 2008).

Nunez (2000) furthers the call for cultural competence education in health care to underscore gender differences and an expanded understanding of needs when aiding female patients. Specifically, Nunez prefers the term cross-cultural efficacy over cultural competence, as the former "implies that the caregiver is effective in interactions that involve individuals of different cultures and that neither the caregiver's nor the patient's culture is the preferred or more accurate view" (2000, 1072). A similar call is made by Burnier (2012) for increased training, teaching, and scholarship of gender-competency in public administration. Kumagai and Lypson (2009) suggest that cultural competency health care education should go beyond traditional notions of competency such as knowledge, skills and attitudes, but should also involve critical awareness and consciousness of self and others.

Stiff (2010) highlights how lesbian, gay, bisexual and transgender families often face discrimination in accessing the healthcare system. To this end, the National Coalition for LGBT Health (2014) has outlined guiding principles for effectively addressing health care needs of lesbian, gay, bisexual, and transgender people,. The principles include gender identity sensitive illness prevention and treatment, and wellness services. The advocacy of the National Coalition further underscores the varying aspects of health and public services. As Swan, French, and Norman-Major (2012) note, cultural competency is driven by the United States evolving from one predominant culture to one that includes "a wide range of racial, ethnic, and sexual orientation groups" (141).

Public administration and cultural competency. The changing demographics of the country, White and Rice (2005) suggest, will require public sector organizations "to develop more inclusive work cultures that have a better understanding of the many ways people are different from one another and/or...

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