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. 2018 Nov 19;7(1):61.
doi: 10.1186/s13584-018-0255-7.

How culturally competent are hospitals in Israel?

Michal Schuster  1 , Irit Elroy  2 , Bruce Rosen  2
Affiliations

How culturally competent are hospitals in Israel?

Michal Schuster et al. Isr J Health Policy Res. .

Abstract

Background: 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.

Method: 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.

Results: 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.

Conclusion: 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.

Keywords: Cultural competence; Equality; Health policy; Language accessibility; Standards.

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Conflict of interest statement

Authors’ information

Michal Schuster is a research associate at the University of the Free State, where she held her post-doctoral research project. She holds a PhD in translation and interpreting studies from Bar Ilan University where she is also a lecturer. Her fields of interests include language accessibility and cultural competence of public services, language policy, linguistic landscape and academic service learning.

Irit Elroy is a researcher at the Smokler Center for Health Policy Research at the MJB institute. She holds a BA and an MA in psychology. Irit specializes in researching health issues in women, children and the Arab-Israeli sector. Other fields of interest include cultural competence of services and qualitative research in health.

Bruce Rosen is Director of the Smokler Center for Health Policy Research at the Myers-JDC-Brookdale Institute, as well as co-editor of the IJHPR.

Ethics approval and consent to participate

The authors received a written approval to conduct the study from the Deputy Director of Ministry of Health and the Director of the Hospital Division at Clalit Health Services.

An exemption to submit the study to an ethics committee was obtained from the legal consultant of Myers-JDC-Brookdale institute.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Comment in

References

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    1. Betancourt JR, Green AR, Carrillo, JE. Cultural competence in health care: emerging frameworks and practical approaches: a field report, the Commonwealth Fund. 2002. https://www.commonwealthfund.org/sites/default/files/documents/___media_.... Accessed 11 Sept 2017.
    1. State of Israel, Ministry of Health . Directive regarding the cultural and linguistic adaptation and improving of access to health care (no. 7/11) 2011.
    1. State of Israel, Ministry of Health, Department of Health Economics and Insurance Coping with Health Inequalities: A roadmap for developing a national plan The Israeli Experience.2011. https://www.health.gov.il/PublicationsFiles/HealthInequalities_roadmap04.... Accessed 13 May 2017.
    1. Elroy I, Schuster M, Elmakias I. The cultural competence of general hospitals in Israel. Research report. Jerusalem: Smokler Center for Health Policy Research; 2016.

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