Quantitative and qualitative findings and implications of an intercultural sensitivity assessment among employees at a large health system

Background: As our nation welcomes people from many cultures, it is essential that healthcare providers understand the cultural background of their patients. In response to this diversity, community hospitals are systematically strengthening and improving services to address the cultural needs of their multi-cultural patient populations. As part of a multi-faceted, system-wide cultural awareness initiative, our health network conducted a baseline intercultural sensitivity assessment of its employees.

Research Objectives: To establish measures of intercultural sensitivity among employees through the use of a validated instrument.

Population: 9,000+ physicians, nurses, technicians and non-clinical employees of a large health network in mid-Eastern Pennsylvania.

Methods: All employees were invited to complete the IRB-reviewed, web-based Intercultural Sensitivity Scale (Chen and Starosta 2000). The ICS scale measures attitudes about interacting with people from different cultural backgrounds. The five sub-scales include: 1) interaction engagement, 2) respect for cultural differences, 3) interaction confidence, 4) interaction enjoyment, and 5) interaction attentiveness. Three open-ended questions asked how the network could enhance cultural sensitivity. Two other questions asked for learning preferences (i.e., e-learning, Grand Rounds) and topic information (i.e. diet, religious practices). Demographic information (i.e., age, position, years of service hospital) was also acquired.

Results and Conclusions: A 35% (n=3446) response rate was achieved. Characteristics of the respondent sample were highly similar across age, length of employment, racial and ethnic status, gender and proportions of staff positions. With regard to two of the five sub-scales, the survey revealed relative strength in interaction enjoyment while respect for cultural differences exposed an interesting bi-modal distribution – with many staff achieving perfect scores in this area and another large contingent scoring well below the mean.

Baseline measures informed educational interventions, assessed training needs, enabled evaluation of interventions, and revealed individual and/or institutional factors that impeded or enhanced responses to patient experiences of healthcare disparities. Initial findings suggest general staff preferences for diversity workshops and cultural fact sheets as the preferred mode of instruction. Employees requested information about religion, attitudes about death and dying, and attitudes about health care institutions relevant to cultures represented in our local community.

Practice Implications: Baseline results are used to direct network initiatives (i.e. creating health information repository, ensuring language-appropriate services, and strengthening educational programs) and to measure intervention outcomes. Along with obtaining uniform racial/ethnic patient data, this information is essential in comprehensive organizational change regarding culturally-appropriate service delivery and will ensure the delivery of equitable health care.