Socio-cultural relational coordination (SCRC): Implications for organizational cultural competence

Cultural competence, a component of patient centered care has been proposed as a mechanism by which to alleviate disparities in health care. However, the ability to operationalize cultural competence at the organizational level poses challenges including, barriers to training implementation and funding limitations. The specific aim of this research was to explore the ways in which providers coordinate around socio-cultural and environmental factors that influence chronic disease management, with the hopes of informing organizational cultural competence initiatives as well as the development and implementation of training.

The Socio-Cultural Relational Coordination Scale (SCRCS) was used for the first time during this research. The scale is an adaptation of the Relational Coordination Scale (RCS), and measures frequent, timely accurate and problem-solving communication with other team members related to socio-cultural and environmental factors that impact care. In addition, the SCRCS explores team member knowledge of and respect for their colleagues' understanding of patient contextual factors, as well as shared goals for addressing said factors that influence care. Indices for SCRC were constructed and tested for reliability based on 18 responses from two centers.

Diabetes care team members were the population of study. Team members included, physicians, nurses, medical assistants administrative assistants, health educators, nutritionists and social workers. Ambulatory care sites serving linguistically diverse new immigrant communities were targeted.

There was no statistically significant difference in overall SCRC at the two centers, although differences on specific dimensions of SCRC did approach significance. Respondents at Center 1 reported strong ties with physicians, nurses, medical assistants and administrative assistants, respectively. At Center 2, however, strong ties were only reported with physicians and medical assistants, this difference may be the result of team structure. The strongest SCRC ties were between medical assistants and other medical assistants, between medical assistants and physicians, and between administrative assistants and physicians, respectively, all reporting ties greater than 4.0 on a five-point scale. Overall, the strongest socio-cultural relational coordination ties reported were with physicians and medical assistants, suggesting that both physicians and medical assistants play a central role in socio-cultural coordination in these two centers.

The study of socio-cultural coordination provides a systematic way of examining the ways in which care team members coordinate around contextual factors that influence care. Identifying coordination ties and measuring their strength may be a useful tool in the assessment of organization cultural competence and the development and implementation of training that utilizes existing organizational assets.