Department of Health Services Administration, University of Alabama at Birmingham, AL, USA.
Soc Sci Med. 2012 Sep;75(5):815-22. doi: 10.1016/j.socscimed.2012.03.053. Epub 2012 May 5.
Cultural competency has been proposed as an organizational strategy to address racial/ethnic disparities in the healthcare system; disparities are a long-standing policy challenge whose relevance is only increasing with the increasing population diversity of the US and across the world. Using an integrative conceptual framework based on the resource dependency and institutional theories, we examine the relationship between organizational and market factors and hospitals' degree of cultural competency. Our sample consists of 119 hospitals located in the state of California (US) and is constructed using the following datasets for the year 2006: Cultural Competency Assessment Tool of Hospitals (CCATH) Survey, California's Office of Statewide Health Planning & Development's Hospital Inpatient Discharges and Annual Hospital Financial Data, American Hospital Association's Annual Survey, and the Area Resource File. The dependent variable consists of the degree of hospital cultural competency, as assessed by the CCATH overall score. Organizational variables include ownership status, teaching hospital, payer mix, size, system membership, financial performance, and the proportion of inpatient racial/ethnic minorities. Market characteristics included hospital competition, the proportion of racial/ethnic minorities in the area, metropolitan area, and per capita income. Regression analyses were conducted to assess the relationship between the CCATH overall score and organizational and market variables. Our results show that hospitals which are not-for-profit, serve a more diverse inpatient population, and are located in more competitive and affluent markets exhibit a higher degree of cultural competency. Our results underscore the importance of both institutional and competitive market pressures in guiding hospital behavior. For instance, while not-for-profit may adopt innovative/progressive policies like cultural competency simply as a function of their organizational goals, linking cultural competency with organizational performance may be essential to attract more profit driven hospitals.
文化能力被提出作为一种组织策略，以解决医疗保健系统中的种族/族裔差异；差异是一个长期存在的政策挑战，随着美国和全球人口多样性的增加，其相关性只会越来越大。我们使用基于资源依赖和制度理论的综合概念框架，研究了组织和市场因素与医院文化能力程度之间的关系。我们的样本由位于加利福尼亚州（美国）的 119 家医院组成，使用以下数据集构建：医院文化能力评估工具（CCATH）调查、加利福尼亚州全州卫生规划与发展办公室的医院住院患者出院和年度医院财务数据、美国医院协会的年度调查以及区域资源文件。因变量由 CCATH 总得分评估的医院文化能力程度组成。组织变量包括所有权状况、教学医院、支付者组合、规模、系统成员、财务业绩以及住院患者种族/族裔少数民族的比例。市场特征包括医院竞争、该地区少数民族的比例、大都市地区和人均收入。进行回归分析以评估 CCATH 总得分与组织和市场变量之间的关系。我们的结果表明，非营利性医院、为更多样化的住院患者服务、位于竞争更加激烈和富裕的市场的医院表现出更高的文化能力。我们的结果强调了制度和竞争市场压力在指导医院行为方面的重要性。例如，非营利性组织可能会出于组织目标的简单原因而采用文化能力等创新/渐进政策，但是将文化能力与组织绩效联系起来对于吸引更多利润驱动的医院可能至关重要。
