Managing Diverse Expectations in the Hospital

Culture shock is the anxiety that people feel when they are cut off from their own cultural cues in a completely different environment. With multicultural, multi-ethnic workforces and patient populations, cultural differences can affect hospital patient care. The problem can be particularly acute in states such as California, where foreign nurses are aggressively recruited to fill severe staffing shortages. The simplest example of the problem would be language barriers, but more often problems arise from subtler cultural differences that create a disconnect between staff members' and patients' expectations for care.

Meeting Expectations

Across industries, large businesses face the challenge of becoming more culturally sensitive as their customers and employees grow more diverse, and hospitals are no different. Employees and patients from different cultures and ethnicities enter the workplace and inpatient care environments with varying expectations.

The good news is that Gallup's employee engagement surveys indicate that 56% of all healthcare employees "strongly agree" that they know what is expected of them at work. This percentage is relatively high in comparison with other employee engagement items.

But even though many healthcare employees feel confident they know what is expected of them at work, their take on those expectations are filtered through cultural experiences as they are translated into job performance. In turn, ethnic and cultural backgrounds also influence patient expectations.

Cultural Differences in Expectations on Pain Management

Patient pain management, which has become a major focus of care delivery in U.S. hospitals, provides a good example. Satisfaction with pain management, according to Gallup's patient loyalty database, definitely has room for improvement, as scores on this item are below that of overall inpatient satisfaction.

Well-documented differences in cultural expectations may be a component of the problem -- Asian and Northern European cultures, for example, tend to foster a more stoic reaction to pain than others do.

An example I ran across at an East Coast hospital may help clarify: A surgical patient had suffered a chemical burn on his leg. The nurse, who recently moved to the United States from another country, observed the burn and decided it was necessary to trim away the dead skin. The patient, who was raised in the pharmaceutical-oriented culture of the United States, expected a pain-free experience. But in the nurse's home culture, which emphasizes a stoic response to pain, such a procedure would be considered nothing more than minor discomfort; therefore, the nurse did not administer pain medication. As a result, a major dispute occurred between the patient and the nurse, and a physician eventually had to intervene.

Was the nurse wrong and the patient right, or vice versa? Neither. More simply, the culturally based expectations of each party were different. The problem arose from a failure to align expectations.

How to Solve the Problem

In the case of pain management, it is important for healthcare managers to make staff members aware of possible cultural barriers, and ask staff members the following questions:

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• At what point on the pain scale is a medical pain management response required?

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• If medical pain management is not necessary, does the patient need non-medical pain management behaviors, such as education, support, and compassion?

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• How should staff members interpret physician pain medication orders?

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• Should staff members be proactive in providing pain management intervention, or wait until the patient asks for it? How should staff members be proactive?

By asking these questions, managers can assess whether their staff members are on the same page with the hospital's expectations regarding pain management. They can also head off potential gaps between expectations of patients and staff members from differing cultures. If managers observe serious differences based on ethnic or culturally derived perceptions, cultural sensitivity training may be required.

Bottom Line

Many healthcare providers routinely conduct cultural sensitivity training for newly hired foreign staff members. But such training only addresses part of the issue. U.S. natives can also experience culture-clash issues when dealing with multicultural patients. To avert this potential problem, great managers and supervisors will regularly conduct rounds and discussions with patients and their families to determine their expectations, and document these expectations in a care plan to be shared with staff members. Ignoring these issues will result in patient/staff culture shock and decrease satisfaction among both groups.