Management Organizations: Managing Healthcare in Multicultural Organizations
The provision of quality healthcare is an integral part in the management of all progressive societies. The existence of multicultural societies presents a big challenge in the provision of equitable healthcare. Culture is a complex aspect of life which incorporates language, sexual orientation, socio/professional status, gender, socio/economic status, race among other factors. These cultural aspects are intertwined with healthcare needs such as varied prevalence of certain diseases among certain cultures and cultural influences on dieting and nutrition among others (Muller & Haase, 1994). Healthcare management theories which healthcare managers can apply in the management of multicultural healthcare are attribution theory, evidence-based management theory and utilization management theory. When healthcare managers are equipped with skills to handle multicultural healthcare organizations; the multiplier effects of poor management will be lessened and hence the importance of this topic. The study would be beneficial to students undergoing training about the management of healthcare organizations as it offers them sound understanding on management and provides practical ways to overcome those challenges and ensure equitable healthcare for all. The implementation of effective leadership and management traits and theories is necessary in managing a multidisciplinary and multicultural health care organization in order to promote organizational effectiveness. Statement of the Issue to be investigated
Health care management is a rapidly growing field with the US. The US Bureau of Labor Statistics states that the job market for healthcare managers will grow by 16% by 2018 (Campinha-Bacote, 2002). These managers affect the effectiveness of healthcare facilities since they are charged with spearheading healthcare for a diverse population. These managers have for instance to deal with immigrant healthcare needs, marginalized groups such as Lesbians, Gays, Bisexuals and Transgender (LGBT), minority communities among other diverse groups. The demand for quality health care is increasing and so are the complexities of the American culture due to, immigration and intermarriage (Muller & Haase, 1994). The issue to be investigated in this case is the effectiveness of the aforementioned healthcare management theories in the provision equitable healthcare. Additionally it is imperative to look at the traits and trends that can complement the management theories and enhance provision of equitable healthcare. In case healthcare managers are unable to have proven management theories that they can implement, the provision of quality healthcare to all people will be definitely hampered. The failure to understand and manage healthcare organizations to respond to cultural and social differences may have adverse consequences especially for minority groups. Healthcare Management Theories, Traits and Trends
The skilled use of cross-cultural understanding and communication increases the likelihood that the processes and the outcomes of multicultural care are satisfactory to all the parties involved. Healthcare managers can implement the following theories; the utilization management theory, evidence-based management and attribution theory.
- The attribution theory
Attribution means attaching meaning to the behaviors and traits of others to suit present conditions. It involves gathering information and using it to arrive at a causal judgement. In the management of healthcare it involves accessing the successes and failures of a healthcare program or system and implementing those that lead to the expansion of equitable healthcare (Baugh & Graen, 1997).
This theory can be applied as a conceptual framework to promote a positive and safe working environment for a multicultural healthcare organization. For instance the observance of a high prevalence of a certain medical condition in one culture as opposed to the others can give healthcare managers a sound basis to institute medication plans. For example the prevalence rate of stroke among African-Americans is 3.2% as compared to the national average of 2.9% (Campinha-Bacote, 2002). Healthcare managers handling a high population of African-Americans will therefore be in a position to use such statistics to prepare adequately to handle medical conditions that are highly prevalent in his/her region. According to Rijamampianina and Maxwell, (2002) the attribution theory provides a cognitive rationale to explain the organizational processes that contribute to an industry-wide culture. This helps to not only absolve the managers of adverse patient eventualities but also helps them to offer effective healthcare effective to cultural medical trends.
- Evidence-based management theory
This theory requires healthcare professionals to make decisions based on the best available evidence. When handling multidisciplinary and multicultural healthcare organizations some of the decisions made based on this theory are not always popular but since they are backed by scientific evidence healthcare manager can rightly adopt, enforce and even champion the adherence to certain medical procedures (Rijamampianina & Maxwell, 2002). A good example is the adoption and acceptance of Bidil as a cure for congestive heart disease exclusive for African Americans. Though controversy greeted the discovery and release of this medication, it has been proven to be effective. The drug was approved by the Food and Drug Administration (FDA) in 2005 and has been proven to reduce mortality due to congestive heart failure by 43% and reduced hospitalization cases by 39% among African Americans. In line with this healthcare managers can adopt and enforce other policies, rules and procedures so long as evidence abounds as to the effectiveness of those developments. Baugh & Graen, (1997) advice healthcare managers to follow the work ethics and strict procedures similar to those adhered to by nurses and doctors in the management of healthcare organizations. Evidence-based management requires all healthcare workers from the managers to the nurses and physicians apply all measures to promote equitable healthcare as long as there is significant evidence to back their decisions.
- The utilization management theory
This is the most popular among the three. It is a proactive approach that is based on preset guidelines to manage health. The American College of Medical Quality (ACMQ) identifies several sequential tasks to make the utilizations management suitable for multicultural healthcare organizations. The first guideline is the determination of organizational priorities. This is followed by the research and determination of the people (factoring in cultures) that are bound to benefit from the decisions being made. Research in this stage is bound to reveal trends and traits in healthcare needs among diverse cultures that a healthcare organization is mandated to serve. Using this information, healthcare managers can then set goals and determine how to implement further research. When data is collected and evaluated the healthcare manager then engages a team to develop and implement policies, procedures and guidelines (). Based on the fact that the implementation of this theory is preceded by gathering of evidence about trends, prevalence, workable solutions among other data, this management theory is therefore a wholesome combination of the other two.
According to Baugh and Graen, (1997) once healthcare managers are significantly conversant with the healthcare needs of their populace, they should engage a multidisciplinary team in order to provide holistic healthcare. Bearing in mind that the multicultural composition of an organization encompasses both staff and patients, it is imperative for the healthcare manager to organize and address diverse issues. These include stress and conflict management, group dynamics, perceptions and attitudes, managing organizational changes and team building. Overall the theory that a healthcare manager adopts should also open him/her up to understanding workplace problems and dynamics (Muller & Haase, 1994).
Understanding the socio-economic needs unique to Hispanic nurses as opposed to Caucasian nurses enables the manager to act accordingly and ensure smooth working relationships between the two cultures. It would also be appropriate to establish whether patients respond better or worse when entrusted to caregivers of their own cultural affiliation.
In the implementation of whichever theory that befits a given organization each model follows four main areas of accountability and responsibility.
- Specific goals: - The theories guide the managers to decide what is to be achieved in the collective planning and interest of the majority of the organization’s stakeholders.
- Explicit goals: - the division of roles among the healthcare personnel as well as the handling of resources, patients, suppliers among other stakeholders is also an important aspect in the implementation of management theories to suit multidisciplinary and multicultural healthcare organizations.
- Clear Processes: - Healthcare managers should ensure that they set frameworks and support structures to ensure effectiveness and attainment of agreed goals.
- Open relationships: - Healthcare managers ought to cultivate open relationships with a diverse populace and cultures. Maintenance of open relationships helps the managers to keep abreast with the cultural developments and prepare ways and means to handle those upcoming challenges. (Muller & Haase, 1994)
Traditionally decision making in many organizations rested with a few selected individuals. In healthcare organizations such narrowed decision-making has hampered change, control and innovation. Hierarchical management approaches to multicultural and multidisciplinary healthcare impacts negatively to the delivery of equitable healthcare. A 2011 report by the Institute of Medicine titled Crossing the Quality Chasm noted that healthcare system’s failure to recognize interdependence among disciplines and cultures out rightly compromises patient care. For instance the physician is usually the highest authority in a given medical unit. Medical schools do not incorporate leadership training in their programmes thereby leaving physicians to assume the roles to control teams. Although some nursing schools provide some leadership training it is inadequate to equip them to lead multidisciplinary and multicultural healthcare organizations.
The provision of multicultural healthcare at times has fundamental attribution errors. These result when situational constraints are underestimated in the process of assigning meaning to trends and traits in culture-based healthcare needs. When an adverse event is noted, it brings about a causation which triggers the management to assign responsibilities. The assignation of responsibilities can be management response or clinical response. The combination of these responses leads to promotion of organizational effectiveness.
- Setting direction entails political astuteness, intellectual flexibility, broad scanning, drive for results and seizing the future
- Personal qualities fir for leadership of healthcare organizations include: - self awareness, self-belief, self-management, personal integrity and a drive for achievement.
- Delivering the service: when a leader delivers services s/he empowers others, can be held accountable, initiates change among people, collaborates with other people and effectively influences people to adopt his/her visionary plans. (Baugh & Graen, 1997)
In order to combat certain medical conditions, it is also imperative for healthcare managers to form strategic partnerships with Non-Governmental institutions and universities. The partnerships with universities aid in research and training on multicultural healthcare while the non-governmental institutions could fund the provision of culture-oriented care. In an effort to inform healthcare providers with cultural needs of minority populations, a web-based cross cultural training program to CareFirst’s internal staff where more than 300 physicians and nurses were trained in December 2005 (Muller & Haase, 1994). Where healthcare managers organize for their staff to be trained in such programs, they increase caregiver-patient relationships and therefore improve service delivery.
There have been other programs aimed at eliminating health disparities and improve healthcare among minority groups. These include the Health Awareness Program for Immigrants (HAPI). This program was launched in September 2005 and it targeted at reducing the prevalence of cervical cancer among Vietnamese women. The prevalence rate of cervical cancer among Vietnamese women is five times more than that of Caucasians women. The HAPI-CC was a media an outreach campaign initiated to increase awareness and screening rates. The information was disseminated through television, radio, public service announcements, health fairs and newsletter publications.
In 2005, a program dubbed the Heart, Hair and Health program was implemented by CareFirst in collaboration with the University Of Maryland School Of Medicine. The program was aimed to address the high prevalence of Coronary Heart Disease (CDH) among African Americans. Under the program CareFirst conducted screenings heart diseases and hypertension among the multicultural community of Baltimore (Muller & Haase, 1994). A grassroots advocacy group now trains outreach workers, hair stylists and barbers to provide heart-healthy education as well as blood pressure screenings to the Baltimore community. When healthcare managers organize such programs they increase the effectiveness of their organizations to handle multicultural healthcare needs.
The healthcare needs of the American population are increasing due to the complexities arising from multicultural aspects such as language, socio-economic status, race, sexual orientation among others. Health care management is therefore a prominent professional field in the US with the BLS estimating that the number of healthcare managers will grow by 16% by 2018. In an effort to implement effective leadership, healthcare managers implement certain management traits and theories to manage multidisciplinary and multicultural healthcare organizations and thereby promote organizational effectiveness. The three commonest theories of managing healthcare organizations are attribution theory, evidence-based management and utilization management theory. Healthcare managers who follow the attribution theory access the successes and failures of healthcare programs and systems and implement only those leading to expansion of equitable healthcare. They can follow prevalence rates of certain diseases to institute appropriate care needs of the affected populations. The evidence-based management theory urges healthcare managers to make decisions based on the best available evidence. The research, development and acceptance of using Bidil in the treatment of congestive heart disease exclusively among African Americans is a good example of application evidence based management. The Utilization management theory on the other hand roots for the presetting guidelines and organizing research to come up with guidelines, procedures and policies to address diverse health care needs. Healthcare managers can also form partnerships with non-governmental institutions and educational institutions in order to address multidisciplinary health care needs. CareFirst for instance held partnerships with the University of Maryland School of Medicine, Health Awareness Program for Immigrants (HAPI) and the Heart, Hair and Health programs from 2005. The organization was doing this in order to address the healthcare needs of the multicultural community of Baltimore. Healthcare managers should champion such collaborations and training programs of their staff in order to come up with holistic ways to address health care needs of a diverse populace.
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