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Diversity and Cultural Competence in Health Care: A Systems Approach

Diversity and Cultural Competence in Health Care: A Systems Approach

Janice L. Dreachslin , M. Jean Gilbert , Beverly Malone

ISBN: 978-1-118-06560-0

Dec 2012, Jossey-Bass

480 pages

In Stock



Major changes are occurring in the United States population and the nation's health care institutions and delivery systems. Significant disparities in health status exist across population groups. But the health care enterprise, with all its integrated and disparate parts, has been slow to respond. Written by three nationally known scholars and experts, Diversity and Cultural Competence in Health Care: A Systems Approach is designed to provide health care students and professionals with a clear understanding of foundations, philosophies, and processes that strengthen diversity management, inclusion, and culturally competent care delivery.

Focusing on current practice and health care policy, including the recently passed Patient Protection and Affordable Care Act of 2010 (ACA), this textbook integrates strategic diversity management, self-reflective leadership, and the personal change process with culturally and linguistically appropriate care into a cohesive systems-oriented approach for health care professionals. The essentials of cultural competence and diversity management covered in this text will be helpful to a wide variety of students because they encompass principles and practices that can be realistically incorporated into the ongoing work of any health care field or organization.

Each chapter contains learning objectives, summary, key terms, and review questions and activities designed to allow students to understand and explore concepts and practices identified throughout the text.

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Figures and Tables ix

Preface xi

Acknowledgments xv

The Authors xvii


Chapter 1 Systems Approach to Cultural Competence 3

Dimensions of Diversity 7

Health Care Diversity Challenges 19

Health Care Disparities in the United States 20

Changing the US Health Care System 21

Systems Approach in the Health Care

Delivery Organization 26

The Importance of Leadership 27

Summary 28

Review Questions and Activities 29

Chapter 2 Systematic Attention to Health Care Disparities 35

What Are Health Care Disparities? 36

Race and Ethnic Disparities in Health Status 37

Disparities Across Other Diversity Dimensions: Gender, Sexual Orientation, the Elderly 49

Stakeholder Attention to Health Care Disparities 56

Systematic Strategies for Reducing Health Care Disparities 60

Summary 65

Review Questions and Activities 66

Chapter 3 Workforce Demographics 75

Trends in the US Labor Force 76

Diversity and the Health Professions 81

Drivers of Disparities in the Health Professions 83

Checklist of Recommended Organizational-Level Actions 90

Workforce Diversity Challenges 96

Summary 100

Review Questions and Activities 101


Chapter 4 Foundations for Cultural Competence in Health Care 107

What Is Cultural Competence in Health Care? 109

Long Journey Toward Cultural Competence 119

Cultural Competence and the Health Care Provider Organization 126

Cultural Competence and the Multicultural Health Care Workforce 133

Summary 138

Review Questions and Activities 139

Chapter 5 Hallmarks of Cultural Competence in Health Care Professionals 143

Personal Journey of Cultural Competence 145

Framework for Role Development 153

Journey of Self-Discovery 156

Summary 167

Review Questions and Activities 168

Chapter 6 Training for Knowledge and Skills in Culturally Competent Care for Diverse Populations 171

Eight Principles for Knowledge and Skills Training 173

Cultural Competence Knowledge and Skills for Administrators and Directors 177

Cultural Competence Training for Health Care Professionals in Direct Patient Care 183

Cultural Competence Training for Support Staff 207

The Role of Assessment in Cultural Competence Training 208

Summary 211

Review Questions and Activities 212


Chapter 7 Cultural Competence in Health Care Encounters 221

Models from Transcultural Nursing 225

Giger-Davidhizar Transcultural Assessment Model (GDTAM) 238

Being Culturally Responsive 251

Summary 253

Review Questions and Activities 254

Chapter 8 Language Access Services and Crosscultural Communication 259

Language Use in the United States 261

Language Differences in Health Care Encounters 262

Attitudes Toward Limited-English Speakers 266

Changing Responses to Language Barriers in Health Care 268

An Expanding Profession: The Health Care Interpreter 278

Translation in Written Health Care Communication 284

Communication Is More Than Words 286

Summary 290

Review Questions and Activities 291

Chapter 9 Group Identity Development and Health Care Delivery 299

Research Highlights 301

Minority Status Group Identity Development 305

Majority Status Group Identity Development 313

Using the Models 325

Summary 328

Review Questions and Activities 329


Chapter 10 The Centrality of Organizational Behavior 335

The Science of Organizational Behavior 338

Organizations as Contexts for Behavior 339

OB Research Highlights 341

Can Culturally Competent Health Care Professionals “Go It Alone”? 350

Summary 356

Review Questions and Activities 357

Chapter 11 The Business Case and Best Demonstrated Practices 361

Evolution of the Business Case 363

The Business Case for Cultural Competence in Health Care 364

Workforce, HRM, and the Business Case 373

Best Demonstrated Practices 376

Assessment and the Systems Approach 386

Benchmarking 389

Role of Metrics in the Systems Approach 390

Summary 397

Review Questions and Activities 399

Chapter 12 The Future of Diversity and Cultural Competence in Health Care 405

Trends That Support Widespread Adoption of the Systems Approach 406

The Sustainability Movement and the Systems Approach 419

Change Management and Force Field Analysis: Tools to Envision and Shape the Future 420

Summary 425

Review Questions and Activities 426

Glossary 429

Index 439