How culturally competent are hospitals in Israel?

The research also included in-depth interviews and structured field observations on cultural adaptation, and findings from those components of the study are reported elsewhere [5, 6]. This paper discusses the findings from the structured questionnaire.

The study team considered using the Cultural Competency Assessment Tool for Hospitals (CCATH) that was developed by Weech-Maldonado et al. (2012). The team decided not to use that tool as it was designed for health systems at a more advanced stage of cultural competence implementation. It would not have been appropriate for the Israeli health system in 2012, when it was just beginning to take cultural competence seriously. Some of the items in that tool would not even have been understood by Israeli respondents in 2012 and the tool would not have differentiated well among Israeli hospitals. Having said that, we note that both the CCATH and the tool we developed make serious use of the CLAS standards.

Table 3 displays the topics that comprised the various scales, while Appendix 2 indicates a reliability measure for each scale. Cronbach’s alpha was over 0.75 for 4 of the scales, between 0.50 and 0.75 for 4 of the scales and between 0.33 and 0.50 for two of the scales. Not surprisingly, the scales with the lowest reliability scores (human resources CC and religious services CC) were scales with very few items. We retained those two as scales despite their low reliability scores because conceptually the items clearly address related issues.

As the study’s unit of analysis is the hospital (and not the patient or population), all findings presented in the main text give equal weight to all participating hospitals. As a sensitivity analysis, we examined how the findings would have been affected by weighting the hospitals by size (using bed count as the size indicator). The weighting had only a minor effect on the key results. For example, the average CCCS increased from 2.24 to 2.38. Moreover, it had only minor effects on the coefficients of the regression

It is worth noting that the relationship between CC and hospital size is somewhat complex. For the analyses presented below, the sample was split into two approximately equal-sized groups (Medium-Large for those over 400 beds and Small for those up to 400 beds). In those analyses, almost no bivariate difference was found in average CC level for the two groups, and the size variable was also not significant in the multivariate analysis.

JCI – Joint Commission International is a U.S. non-profit organization that accredits and issues a hallmark to health organizations worldwide, focusing on topics of patient safety.

The impact of CC on patient outcomes, which is a main goal the JCI accreditation process, was not addressed in the current study. It should be a high priority for future research.

In several hospitals, the study team interviewed more than one hospital manager. Even in those hospitals, it was the interview with the CC coordinator that was used in the study reported here. The other interviews contributed to related studies reported elsewhere.