Page 198 - Cultural Competence in Health Education

176 Cultural Competence in Health Education and Health Promotion

A common barrier to cultural competence in the work environment involves
institutionalized policies and procedures that revolve around time and productivity.
Some health educators work with large client populations where the urgency of needed
services imposes a stressful demand for time efficiency. A systems - oriented approach

to organizational productivity can entail the development of time - regimented proce-
dures such as rigid appointment scheduling and abbreviated client interviews. Though
this practice often does increase the number of clients seen per day, the cultural compe-

tence of an organization and its employees can be significantly compromised when time
rigidity is an institutionalized norm. In addition, differences in time orientation across
cultures often result in extensive frustration and negative interactions between health
educators and their clients (Spector, 2004).
An example of time orientation conflict lies in the common expectation in many

health service organizations that a client will arrive on time for an appointment and
must be ushered through a series of sequential procedures (sign - in, insurance confi r-
mation, preliminary interview with a nurse, follow - up visit with a physician). If a client

is “ late for an appointment, ” it can highly stress the office personnel and cause a sched-
uling backlog. In addition, office personnel whose own cultural norms cause them to

view a late arrival as lack of respect can feel insulted and resentful toward the client.
The client, in contrast, may be operating out of an entirely different time orientation
norm and may not view punctuality as a necessity and may actually feel devalued by
the rushed approach to the appointment process (Spector, 2004).

Developing a Strong Professional Development Plan

The Office of Minority Health (OMH, 2001) began work in 1997 to establish national
standards for culturally and linguistically appropriate services (CLAS) in health care.
The resulting fourteen CLAS standards were designed to render health services “ more
responsive to the individual needs of all patients/consumers ” and, ultimately, “ to con-
tribute to the elimination of racial and ethnic health disparities and to improve the
health of all Americans ” (OMH, 2001, p. ix). Standards 1 through 7 represent criteria
for cultural competence in direct care (involving client respect, staff recruitment and
training, and language access), and Standards 8 through 14 promote the organizational
support (structure, policies, and processes) needed for implementing the fi rst seven
standards.
Establishing the CLAS standards was a groundbreaking effort that launched the
development of practical guidelines organizations can use for implementing the CLAS
standards (Salimbene, 2001), conducting organizational self - assessments (COSMOS
Corporation, 2003), engaging in research (OMH, 2004), and implementing language
access services (American Institutes for Research, 2005). These guidelines and other
helpful documents are available for public access on the OMH, Web site ( www.omhrc
.gov ). These resources can be used as a practical guide for enhancing the cultural com-
petence of organizations in which health educators work. The following sections
describe some models used for developing culturally competent organizations and
training the employees who work in them.

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