Schuster Michal, Elroy Irit, Rosen Bruce
Unit for Language Facilitation and Empowerment, University of the Free State, POB 339, Bloemfontein, 9300, Republic of South Africa.
Myers-JDC-Brookdale Institute, Jerusalem, Israel.
Isr J Health Policy Res. 2018 Nov 19;7(1):61. doi: 10.1186/s13584-018-0255-7.
Cultural competence (CC) in health systems is the ability to provide care to patients with different values, beliefs and behaviors, and to match the care to their social, cultural and linguistic needs. In 2011, the Director-General of Israel's Ministry of Health issued a cultural competence directive to health care providers that sought to minimize health inequalities caused by cultural and linguistic gaps. This study assesses the status of organizational CC in Israeli general hospitals in the wake of the 2011 directive.
Organizational CC was assessed using a 75-item structured questionnaire based on the 2011 directive and on international standards. Data were gathered via interviews conducted between December 2012 and February 2014. 35 of Israel's 36 general hospitals participated in the study, for a response rate of 97%. A composite CC score was calculated for each hospital as the average of the 75 items in the questionnaire.
The average composite score of all the hospitals was low to moderate (2.3 on a scale of 0-4), the median score was 2.4, and the range of composite scores was large, 0.7-3.2. The interquartile range was [1.94, 2.57]. Hospital CC is positively associated with non-private ownership status and location in the southern or central districts. Still, these differences are not statistically significant and immutable hospital characteristics such as ownership status and location account for only 21% of the inter-hospital variation in CC. This suggests that hospital leaders have significant discretion in the priority to be given to CC. Dimensions of CC with relatively low average scores include hospital connections with the community (1.28), staff training on CC (1.35), oral translation (i.e. interpreting) during treatment (1.62), and CC adaptation of human resources recruitment and evaluation (1.64). These areas appear to be particularly in need of improvement.
The study findings suggest that hospitals and policy-makers can take significant steps to improve CC; these include setting more concrete and measurable implementation guidelines. We conclude with suggestions for policy and practices to improve cultural competence in the health system.
卫生系统中的文化能力（CC）是指为具有不同价值观、信仰和行为的患者提供护理，并使护理符合其社会、文化和语言需求的能力。2011年，以色列卫生部总干事向医疗服务提供者发布了一项文化能力指令，旨在尽量减少因文化和语言差距导致的健康不平等。本研究评估了2011年指令发布后以色列综合医院的组织文化能力状况。
基于2011年指令和国际标准，使用一份包含75个条目的结构化问卷对组织文化能力进行评估。数据收集于2012年12月至2014年2月期间进行的访谈。以色列36家综合医院中的35家参与了该研究，回复率为97%。为每家医院计算一个综合文化能力得分，作为问卷中75个条目的平均值。
所有医院的平均综合得分较低至中等（0至4分制下为2.3分），中位数得分为2.4分，综合得分范围较大，为0.7至3.2分。四分位间距为[1.94, 2.57]。医院文化能力与非私立所有制状况以及位于南部或中部地区呈正相关。然而，这些差异在统计学上并不显著，所有制状况和地理位置等不可改变的医院特征仅占医院间文化能力差异的21%。这表明医院领导在文化能力的优先程度方面有很大的自由裁量权。文化能力得分相对较低的维度包括医院与社区的联系（1.28）、员工文化能力培训（1.35）、治疗期间的口译（即翻译）（1.62）以及人力资源招聘和评估的文化能力适应性（1.64）。这些领域似乎特别需要改进。
研究结果表明，医院和政策制定者可以采取重大措施来提高文化能力；这些措施包括制定更具体、可衡量的实施指南。我们最后提出了一些政策和实践建议，以提高卫生系统中的文化能力。
