Cross-Cultural Training in the Healthcare Sector

Globalization and evolution of information features the contemporary world, coupled with an ever-changing political systems and, multicultural workplaces and communities (Wurtz, 2014). Thus, the globalisation process has enhanced operations across cultures and borders. However, there are obstacles that global corporations have to encounter with for them to be successful. To illustrate, the intensity of cross-cultural interaction and the potential challenges in societal differences create a need for companies to undertake thorough preparation of their staff with international proficiency coaching and cross-cultural training (CCT) (Wurtz, 2014). Undertaking business operations in a cross-cultural setting need a robust understanding and effective communication with the people from different nationalities and backgrounds (Wurtz, 2014). Hence, CCT is incontrovertible for maximum positive outcomes of intercultural interactions and in minimising the dangers of social faux-pas. Consequently, there is increasing recognition of adequate management of human resource at the global level as the strategic basis of gaining competitive advantage (Hollenbeck and Noe, 2018). The research work is a presentation of an adaptation of cross-cultural training in the healthcare sector.

Classifications of CCT

Pre-Departure Training

Customarily, scholars and practitioners viewed the preparation process of employees to undertake global projects like that which would familiarize the workers with the differences in community relations between the two cultures (Gerstein and Hurley, 2015). However, modern researchers have recognized the necessity of training programs to be beyond orientation of assignees to dwell in foreign settings. Pre-departure training permits the workers to; handle the assignment having already gained realistic anticipation and essential understanding of the destination culture, gain practical knowledge in connection to living in the environment, acquire effective methods of managing cultural shock and, possess relevant work insights upon arrival. Thus, training in the CCT requires thorough understanding and acceptance of cultural differences and, an ability to embrace the destination culture (Gerstein and Hurley, 2015). However, companies invest in CCT due to uneconomical running-in periods which are extensive and expensive (Gerstein and Hurley, 2015). The challenge with pre-departure training arises when the worker is undertaking the first assignment because the concept of what is real is related to the home setting.

Post-Arrival Training

The program addresses the actual issues that global assignees contend with (Gerstein and Hurley, 2015). For instance, making an individual gain insight into what to expect in a different cultural system is not enough as such an awareness do not translate into proficiency into the host setting. Due to the complexity of living in a foreign nation, pre-arrival training may offer global assignee information on survival in such an environment but not to excel (Gerstein and Hurley, 2015). Consequently, companies should embrace post-arrival training as a means of equipping the assignees with real-life experiences and challenges in the host culture. Thus, post-arrival training tends to be reactive and results to an enhanced probability that the assignee will have a deep insight and understanding on practical challenges in the host setting before such problems erupt (Gerstein and Hurley, 2015).

Transition Adjustment to Culture Shock

Cultural shock is a condition in which the international assignees experiences due to anxiety and the consequences of parting with familiar symbols and signs. The state is also precipitated by the experiences of working in a new, volatile and uncertain settings. However, cultural shock does not inexorably lead to incompetence (Huff and Song, 2014). By divergence, it reflects the point that if an emigrant experiences culture shock, the work becomes an avenue for failure. In most cases, trained personnel responds and adjusts faster in both intercultural setting and possible social problem-solving position (Huff and Song, 2014). Thus, knowledge on ways of coping with cultural shock is crucial, as establishing and upholding morale is especially puzzling in cases of adjustment difficulties (Huff and Song, 2014). However, CT offers the international assignee proper resources in identifying the symptoms of culture shock and in dealing with its consequences whenever it happens (Huff and Song, 2014).

CCT effectively helps in minimising the adjustment period and in lessening some of the indicators of culture shock. Such training is crucial in removing misunderstandings and also in providing the appropriate structure for adequate behavior (Naeem and Nadeem, 2015). Also, the enhanced cultural consciousness advances interpersonal relationships particularly with those holding different social values and behavioral patterns (Naeem and Nadeem, 2015). In overcoming the cultural shock, it is appropriate to embrace an approach of a social-learning theory that integrates behavioural and cognitive strategies in facilitating effective CCT (Naeem and Nadeem, 2015). Besides, effective regulation of experiences from culture shock relies on sentient sensitivity to the setting, a psychological orientation that enhances adaptation and, acquisition of behavioural skills that repudiate the condition (Naeem and Nadeem, 2015). Thus, CCT is essential because it evaluates an individual’s propensity to adaptation and, in helping expatriates prepare for challenges through using available resources that promote mechanisms for coping and adjustment (Naeem and Nadeem, 2015)

Forms of CCT

Experiential Training

The fundamentals of the experiential approach lie in the notion that people, particularly adults, learn effectively through doing rather than listening (Kolb, 2014). The worth of the plan depends on the learner’s discernment that the strategies and procedures within the method are crucial and the belief that they can consequently apply them. Experiential training implies that the learner must embrace that their reactions to the strategies, procedures and consequent conduct will result in a positive outcome (Kolb, 2014). Also, the approach of training triggers behavioural and effective reactions which are the core of intercultural efficacy skills and hence lead to emotional fine-tuning (Kolb, 2014). Therefore, experiential training is critical to the extent that it uses actual experiences to reinforce assimilated information. Besides, the approach focuses on specific features in contrast to situational ones (Kolb, 2014). Such forms of training include behavioural modelling, role plays and, interactional learning (Kolb, 2014).

Cognitive Training

The approach relies on the hypothesis that engagement and cognitive understanding is a vital requirement of active interaction with people from a different culture (Saxe, 2015). Hence such training enhances social-cultural amendment by encouraging rational reactions, particularly on interpersonal and societal skills (Saxe, 2015). The approach to training addresses the assignee’s requirement for both behavioural and information skills. Consequently, the approach to learning is profitable and produces limitless and sustainable outcomes as it instructs the expatriate on how to undertake their learning and use the information while exceeding the limits of the program (Saxe, 2015). The cognitive approach has dominated the domains of CCT primarily in the fields of area studies as the means of obtaining pertinent information (Saxe, 2015). The forms of the approach which have received various considerations include audio-visual, lectures, cultural orientation programs and, environmental briefings (Saxe, 2015). As such, the approaches reflect a belief that offering information that enables an individual to comprehend the host culture and its people prepares them with appropriate tools that help in intercultural competency (Saxe, 2015).

The Integrated Approach

CCT endeavors to facilitate changes in the global assignee through applicability of behavior, stage of mere adequacy and clarity of the psychological frame of reference (Albrecht and Bakker, 2015). Consequently, the newcomers can uphold their sense of identity while amending values, peculiar assumptions, reasoning styles, ideas and behavioral patterns in line with those prevalent in the new setting (Albrecht and Bakker, 2015). Innovative abilities should be developed to guarantee their effective transmission; such skills should be persistent at least occasionally after the assignee’s arrival in the new cultural environment (Albrecht and Bakker, 2015). Thus, a gradual adaptation process would be formed where the mind gains understanding and awareness while the sentiments are prohibited from attaining levels where the assignee loses self-control (Albrecht and Bakker, 2015).

The integrated approach relates to the purpose of the assignment, and thus, its classification should be based upon the four distinct categories namely; technical, developmental, strategic and, functional (Albrecht and Bakker, 2015). The training policies are subject to the four classifications provided that the competencies of CCT necessary for each type are diverse (Albrecht and Bakker, 2015). A point in case, a trainee on special assignment, may just need information on living basics in the host culture. Contrary, an assignee who is tasked with a high potential obligation requires training in real relations with nationals apart from that on language acquisition.

The Retention Process in CCT

Through social learning theory, the acquired conduct and its impacts can be assimilated onto an available perceptive map (Kassar and Rouhana, 2015). Once integrated, the innovative symbolic representations emerged as a constituent of and retained in, the previous cognitive maps. Thus, presenting culturally divergent and new behaviour and its impacts in a way that permits the trainee to recognise them as similar to known conducts would enable the learner to gain retention for the responses, consequently possessing a positive impact on the proper execution in the cross-cultural setting (Kassar and Rouhana, 2015). Social learning theory also stipulate that novel conduct is preeminently acquired through successful molding estimates of the ultimate behavior (Kassar and Rouhana, 2015). Subsequently, the trainee can build associations within each successive estimation and the previous one. After the construction of symbolic representations, there is ease of retention of the modelled behavior rather than through description of the complex behavior model (Kassar and Rouhana, 2015).

Social learning theory also stipulates that behavioural and cognitive rehearsal of the modelled conducts that are fitting for foreign setting facilitates its retention Kassar and Rouhana, 2015 (). Once an assignee exhibit the unique cognitive associations between the constituents of related impacts and the behavior, there is enhanced reinforcement through rehearsal which refines the perceptive map, thus serving in the facilitation of the behavior retention (Kassar and Rouhana, 2015). For better support, a combination of experiential and cognitive approaches may be better than an application of lecture method (Kassar and Rouhana, 2015). Also, gradual and participative modelling should be integrated so that the learners can easily understand the new conducts, its impacts. Ultimately, the combination of the strategies would enable the assignee in attaining the highest desirable level of retention (Kassar and Rouhana, 2015).

The Efficacy of CCT

A critical issue in the delivery of CCT from the standpoint of the organization is to what level is such training makes an apparent transformation in the realization of international assignments (Chen, 2017). However, it is unlikely those accountable for global staffing to embrace CCT unless firms see the fiscal benefits of such an outlay in a realization of international assignments (Huff and Song, 2014). In most cases, CCT has positive outcomes on self-confidence, mental preparedness and, social and cognitive skills. Besides, CCT has a quantifiable effect on expatriate and skill development and the performance of the expatriate (Chen, 2017The assignees who get an integration of relational and documentary training, attain the most remarkable remarks in their evaluations from their assessors relative to their work performance and adjustment in diverse cultures than those who are devoid of such training (Huff and Song, 2014). Thus, there is a need for the application of a variety of strategies to realize the highest potential of CCT and, enhancement of international experience that ensure value addition to the organizations.

CCT in the Healthcare Sector

The Need for CCT

The contemporary American society is getting more diverse than earlier before. The expansion is due to a growth of ethnic groups coupled with immigration influx (Truong, M., Paradies). However, the success of a nation rests on its ability to handle the challenges of diversity and, exploiting the strengths it offers. Various sectors have reacted practically to the demographic evolution, comprehending that there are economic and market necessities to indulgent, collaborating, partnering and, servicing with those from different ethnic backgrounds (Truong, M., Paradies). Consequently, there are significant efforts in education through corporate development and training, on how to effectively manage diversity at workplaces particularly in the healthcare sector. Practitioners are not safeguarded from the challenges of diversity due to the existence of patients with divergent perspectives, values, behaviors and beliefs on wellbeing and health. For instance, there are variations among patients on verges of pursuing healthcare, capacity to communicate symptoms and, loyalty to prescriptions and preventive measures (Truong, M., Paradies).

Cultural Disparities in Health Sector

Ethnic differences between the practitioner and the patient thwart communication and decision-making process (Nolan and Morley, 2014). Conversely, physician-patient communication is key to patient adherence, satisfaction and ultimately, positive health outcomes. Hence, improper appreciation, comprehension and dissemination of social, cultural differences in medical issues result in poor adherence, patient dissatisfaction and adverse healthcare outcomes (Nolan and Morley, 2014). Correspondingly, failure to account for social, cultural dynamics may consequently facilitate to stereotyping and inopportunely, discriminatory or biased patient treatment on the grounds of culture, race, social status and proficiency in the language (Nolan and Morley, 2014). Also, attitudes on ethnic minorities relate to devoid in prior exposure, implying that there is a need for CCT for healthcare professionals (Nolan and Morley, 2014). Disparities in healthcare adversely impact on the victimized groups and also limits the entire progress in standards of health and care for the general population due to increment in excessive costs (Ubri and Artiga, 2017). The Alaska natives, the blacks and the American Indians are the most affected due to low-income status and, People of color face extra obstacles in accessing health care and consequently receives improper and worse health results (Ubri and Artiga, 2017)

The emergence of CCT in the Health Sector

Sociocultural aspects are imperative to therapeutic encounter, and their goal is to enable assignee’s consciousness about influences on behaviors and believes in health and, to equip the trainees with appropriate skills and understanding to better manage the factors during an encounter (Eisenbeiß and Brodbeck, 2014). The knowledge includes that of peculiar disease prevalence and ethnopharmacology. Some of the reasons for the recent approval of CCT on health sector are a common call for responses to diversity in health beliefs, language, attitudes and conduct (Eisenbeiß and Brodbeck, 2014). In modern times, there is a widespread call for an intersection between health and culture with significant work getting done in the USA, UK, Canada and Australia (Eisenbeiß and Brodbeck, 2014). However, specialists in the field are cynical on the issue and thus show a typical CCT, and emphasize how effectually the factors are catered for during medical training.

Three factors have facilitated the emergence of CCT in the health sector. To start with, CCT has been deemed essential in the preparation of practitioners in attaining health requirements of the diverse and ever-growing population (Evans, 2017). Secondly, it has been postulated that CCT can improve physician-patient communication and thus help in minimizing the pervasive ethnic disparities in the modern society (Evans, 2017). Thirdly, a proper understanding of the cultural belief system assists in the facilitation of an effective health care delivery and, ethnic sensitivity should be a component of educational experiences for every trainee (Evans, 2017). Correspondingly, leaders in nursing education have identified the need for an understanding of culture in the provision of medication to patients and populations.

Approaches to CCT in Health Sector

Like the axiomatic three-legged stools, there are three crucial conceptual approaches to CCT where it is difficult to measure the weight of either in the absence of the other two. The methods are namely; awareness, categorical and, cross-cultural approach (Reiche and Lee, 2014).

Awareness approach

The basis of cross-cultural attention is crucial to expertise and entails empathy, curiosity, humility, respect, awareness and sensitivity of all external influences on a patient (Reiche and Lee, 2014). There is a great need for the attitudes in health encounters where the craving to negotiate and explore different medical theories is supreme and has led to rising to syllabus formulated to shape or instil them to the trainees. The awareness approach integrates techniques and exercises that endorse self-reflection, proper understanding on ones and other’s cultures, biases, propensity to typecast and, appreciation of different health conducts, believes and values (Reiche and Lee, 2014). For illustration, open conversations discover the influence of classism, homophobia, racism and other discrimination forms in healthcare. Besides, open conversation determines the effectiveness of health care providers in dealing with feelings of divergence and determines the society’s reaction to many visuals of a patient from different ethnic backgrounds (Reiche and Lee, 2014). Therefore, efforts to modify attitudes are labor-oriented, complex and difficult to gauge, and are abstract to the clinically-oriented personnel. Also, attitudes which include respect, humility, empathy and curiosity are practical in the process of effective communication during health encounter, disregarding whether the patient is from different or similar ethnic background (Reiche and Lee, 2014).

Categorical Approach

Customarily, CCT in health sector emphasized on categorical or multicultural approach in imparting knowledge, skills and attitudes, believes and conducts in distinct ethnic groups (Achenbach, 2017). A point in case, methods for caring for Hispanic or Asian patients would entail a list of common medical beliefs, ethical and unethical practices (Achenbach, 2017). Due to limitless cultural, ethnic, religious and national groups in the USA, and various influences such as socioeconomic and acculturation status that make intra-group variability, it is challenging to impart a combination of cultural norms or unifying elements (Achenbach, 2017). However, the efforts can lead to cultural oversimplification or categorizing without regard for its fluidity.

There are two instances which makes focus on knowledge-oriented approach fruitful. The first one trails the essential doctrines of community and primary care where the trainees and practitioners get aware of their environment (Muntinga et al., 2016). Contributing factors includes the historical and social context of the ethnic groups, predominant socioeconomic background, nutrition habits, immigration status, housing patterns and, healing practices. Such models exist mainly in the towns around US-Mexican border, Intuitive-American reservation and, societies with a new influx of a distinct immigration group (Muntinga et al., 2016). The other instance where a categorical approach is practical is in the dissemination of knowledge that is an evidence-based and specific influence on medical delivery (Muntinga et al., 2016). For illustration, such knowledge entails ethnopharmacology, prevalence and disease outcomes in distinct populations.

Cross-Cultural approach

The approach imparts to the assignees applicable skills that merge with those of health interrogating with ethnographic implements of remedial anthropology (Klein, 2014). The frameworks accentuate communication skills and in training practitioners some of the useful awareness to cross-cultural matters, health beliefs and social issues. Within the curricula, there are natural methods for provoking patient’s agendas and explanatory models, negotiating and recognizing of multiple communication styles, evaluation of decision-making process, identification of gender issues and getting aware of prejudice and racism (Klein, 2014). For example, the practitioners are imparted with actual health beliefs of the ethnic group and as such, frameworks comprising of questions appropriate in obtaining information are taught. Through patience, the assignees are taught on ways of adjusting their style of practice to meet the peculiar requirements of the patients (Klein, 2014). Thus, a cross-cultural approach is useful in clinical applicability and in caring for targeted or diverse groups.

Weaknesses and Opportunities

Weaknesses in CCT on Health Sector

There are various weaknesses behind CCT. For instance, it is difficult to assess variation in practitioner’s attitude considering the latent societal prestige bias on surveying, and the challenge in observing the encounters in actual settings (Hart and Mareno, 2014). Nonetheless, evaluation of knowledge is easier, and tools such as essays and pretest-post assessments can be used. The methods are not comprehensive enough to measure the impact of CCT on assignees in international missions (Hart and Mareno, 2014). Besides, in the biomedical emphasis of proficient health training, there is a general resistance to curricula that is devoid of evidence. Moreover, there is a limited timeframe for practitioners to negotiate and explore multifaceted sociocultural issues of patients effectively. Correspondingly, there is minimal consensus on a core and theoretical approaches to teaching methods and, insufficient institutional support (Hart and Mareno, 2014). Similarly, despite the existence of incidental evidence that would validate the claim that advancing cross-cultural assignee’s communication is vital in the eradication of health care disparities, there exist insufficient formal publications in support of the hypothesis (Hart and Mareno, 2014).

Opportunities in CCT on Health Sector

Despite the weaknesses, various possibilities exist in the CCT field in the health sector. For illustration, the government has recognized the need for instructive initiatives in the health sector. Considering the evidence that enhances the communication between the doctor and the patient which leads to satisfaction, loyalty and results, there is inherent promise within CCT as a single effort of a diversified approach towards eradicating disparities in healthcare (Betancourt and Corbett, 2014). Besides, the extensive curricula on CCT comprise of the teaching of specific and relevant information on ethnic differences in the provision of health care and potential causative influences. Also, there is an increasing acknowledgement of the effects of cultural cognitive dynamics on how practitioners should make rational decisions and, what adverse consequences can the factors cause on minority or victimized groups (Betancourt and Corbett, 2014).

Conclusion

The contemporary evolution of cultural diversity and needs necessitates for corporations to engage in CCT. There are two classifications of CCT which are namely; pre-arrival and post-arrival training. In most cases, culture shock deters the effectiveness of global assignees and thus, there is a need for preparedness through experiential, cognitive and integrated approach. Such measures can enhance retention in CCT as behavioral and cognitive rehearsals. However, CCT is influential in the attainment of international experiences that is economical to organizations. In the health sector, cultural disparities necessitate CCT. The most popular approaches to CCT in the health sector includes an application of awareness, categorical and, cross-cultural approach. However, CCT in health sector faces challenges such as in evaluating its impact on the practitioner’s attitudes. De f CCT as a tool for eradicating cultural disparities in the provision of healthcare.

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