Can Hospital Cultural Competency Reduce Disparities in Patient Experiences with Care?

Published in: Medical Care, v. 50, no. 11, suppl. 3, Nov. 2012, p. S48-S55

Posted on RAND.org on October 29, 2012

by Robert Weech-Maldonado, Marc N. Elliott, Rohit Pradhan, K. Cameron Schiller, Allyson Hall, Ron D. Hays

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Research Question

  1. Does a hospital's cultural competency affect inpatient experiences with care on dimensions such as communication with doctors and nurses, staff responsiveness, pain control, cleanliness of patient rooms, and overall hospital rating?

BACKGROUND: Cultural competency has been espoused as an organizational strategy to reduce health disparities in care. OBJECTIVE: To examine the relationship between hospital cultural competency and inpatient experiences with care. RESEARCH DESIGN: The first model predicted Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores from hospital random effects, plus fixed effects for hospital cultural competency, individual race/ethnicity/language, and case-mix variables. The second model tested if the association between a hospital's cultural competency and HCAHPS scores differed for minority and non-Hispanic white patients. SUBJECTS: The National CAHPS Benchmarking Database's (NCBD) HCAHPS Surveys and the Cultural Competency Assessment Tool of Hospitals Surveys for California hospitals were merged, resulting in 66 hospitals and 19,583 HCAHPS respondents in 2006. MEASURES: Dependent variables include 10 HCAHPS measures: 6 composites (communication with doctors, communication with nurses, staff responsiveness, pain control, communication about medications, and discharge information), 2 individual items (cleanliness and quietness of patient rooms), and 2 global items (overall hospital rating, and whether patient would recommend hospital). RESULTS: Hospitals with greater cultural competency have better HCAHPS scores for doctor communication, hospital rating, and hospital recommendation. Furthermore, HCAHPS scores for minorities were higher at hospitals with greater cultural competency on 4 other dimensions: nurse communication, staff responsiveness, quiet room, and pain control. CONCLUSIONS: Greater hospital cultural competency may improve overall patient experiences, but may particularly benefit minorities in their interactions with nurses and hospital staff. Such effort may not only serve longstanding goals of reducing racial/ethnic disparities in inpatient experience, but may also contribute to general quality improvement.

Key Findings

  • Hospitals with higher cultural competency ratings had better scores on multiple dimensions of care as assessed by the Consumer Assessment of Healthcare Providers and Systems survey.
  • Greater cultural competency may particularly benefit minorities in interactions with hospital staff, but may also contribute to general quality improvement.

Research conducted by

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