My research looks at cultural competence not from a provider perspective but from a commissioning perspective. Do we design services with cultural diversity in mind. What are the challenges and opportunities for doing so?
Health services that do not compromise the cultural integrity of service users require a multilayered approach in their design, practices, personnel and approach. For example, it is not possible to work on the knowledge and ways or working of the staff if the service itself is located on massacre site or has a past history of being actively involved in forced removal of children. So your question is good but a holistic whole of service / system approach needs to be applied I think that starts before construction through to the physical infrastructure (colours, windows that open or not, artwork and naming) and layout (is gender separation possible?) and the knowledge, skill and ways of working of the staff. All of this is very contextual depending on the location so local consultation, input and power over decisions and implementation will be importation. All the best in your work, Dave
Should we do so given the additional expense involved? Should we merely streamline services and only consider diversity at strategic points?
If you're thinking of healthcare in the United States, then no. The largely privatized system is designed with profits in mind. Cutting costs and passing these benefits to shareholders not for the public good. Some infrastructure is designed for accessibility required by law, and maybe a few local public clinics in urban centers like Brooklyn or Harlem have services layered with multiracial and multilingual diversity, but it is not widespread.
Yes, profit motives overrule equity ... for best outcomes, whole of service approach is the way to go.
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