Organisational systems’ approaches to improving cultural competence in healthcare: a systematic scoping review of the literature

Noting that the scope of cultural competence has expanded beyond the interpersonal domain to address system-level factors, the authors of this study set about to determine the evidence base for a systems approach to eliminating inequities in health care. A systems approach "requires an amalgamation of attitudes, practices, policies and structures to enable healthcare organizations and professionals to work effectively in culturally diverse situations." A review of the literature from 2002 to 2015, examining health care interventions in Australia, Canada, New Zealand, and the United States, produced nearly 3,000 studies touching on cultural competence in healthcare settings. However, only 141 studies appeared to focus on systems-level approaches, and of those studies, only 15 studies included evaluation measures and were deemed worthy of inclusion in the study.  Three approaches that seemed particularly efficacious were: user engagement in the development or implementation of strategies, organizational readiness, and delivery across multiple sites. However, there is a clear need for additional studies in order to bolster the case for systemic approaches to cultural competence. "...There is little guidance for healthcare organisations about how to identify what mix of cultural competence strategies works in practice, when and how to implement them properly, or whether their investment in cultural competence interventions will have the intended effects on client experiences or health outcomes." (American Immigrant Policy Portal)

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