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Health Economics and Management Review, Issue 3, 2024
ISSN (print) – 2786-4626, ISSN (online) – 2786-4634
Copyright: © 2024 by the author. Licensee AR&P (Germany). This article is an open access article
distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license
(https://creativecommons.org/licenses/by/ 4.0/).
53
Organizational Behavior and Multicultural Strategies in Healthcare
Organizations
Desiree N. Green, ORCID: https://orcid.org/0000-0002-7475-8522
D.B.A., Professor of Business Administration, Averett University (the USA)
Corresponding author: Desiree N. Green, dgreen@averett.edu
Type of manuscript: review paper
Abstract: African Americans, Native Americans, and Hispanics face a higher risk of health disparities
because of under-representation in the healthcare workforce. Despite the existence of established protection
of ethnic groups through political modifications and legal structures, implementation requires deeper
enforcement and consistent training to ensure adequate compliance and acceptance. The lack of ethnic
representation contributes to the critical importance of multiculturalism in both healthcare delivery and
medical education. This paper employs a narrative literature review to address the persistent absence of
diversity and cultural competence. This review method allows for a comprehensive and integrative approach
to synthesizing current research and identifying gaps, trends, and critical insights pertinent to the research
question. The Contact Hypothesis, the Acculturation Theory, and Pluralism were discussed to provide
theoretical support for implementing an inclusive environment. Key findings suggest a continuous decline in
an inclusive environment towards diverse populations, which leads to increased discrimination, poor
communication, and suboptimal patient care. Critical practices to combat health disparities include
consistent and comprehensive diversity training with focus on cultural competence and sensitivity that
decreases known and unknown biases. Additionally, organizations must establish guidelines promoting equity
and inclusion with patient-centered care practices focusing on positive interactions and outcomes. The impact
on industries and workplace challenges was also discussed to highlight business strategies that build cohesive
teams with employees trained in intercultural competency and high emotional intelligence. A greater
understanding of identity dimensions is detected to provide a comprehensive approach to alleviating
discriminatory practices. Staff are culturally competent to manage diverse linguistic needs of the patient
population at better rates. Such capability is critical for precise diagnoses, accurate treatment adherence,
and applicable patient education. Through a comprehensive literature review and specific notations on
improving the overall competitive advantage in organizations, this paper not only identifies the challenges
but also presents solutions. By promoting multiculturalism within healthcare to address equity and inclusion
concerns, organizations can significantly enhance patient care and satisfaction for diverse population.
Keywords: multiculturalism, ethnic patient satisfaction, healthcare delivery disparities, diversity training,
cultural competence
JEL Classification: I0; I1; I3
Received: 20 July 2024 Accepted: 25 September 2024 Published: 30 September 2024
Funding: There was no funding for this research
Publisher: Academic Research and Publishing UG (i.G.) (Germany)
Founder: Academic Research and Publishing UG (i.G.) (Germany)
Cite as: Green, D. N. (2024). Organizational behavior and multicultural strategies in healthcare organizations.
Health Economics and Management Review, 5(3), 53-65. https://doi.org/10.61093/hem.2024.3-04
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INTRODUCTION
The COVID-19 pandemic strongly illuminated the critical importance of multiculturalism in healthcare
organizations and cultures. Health disparities have been exacerbated during the pandemic, disproportionately
affecting African American, Hispanic, and Native American communities. Such ethnic groups have
experienced higher rates of infection, hospitalization, and death (Burrell, 2021). The under-representation of
these groups in the healthcare workforce has contributed to the disparities, as culturally competent care is less
likely to be provided by homogenous healthcare staff (Burrell et al., 2023). Providers from diverse
backgrounds are often more adept at understanding and addressing the unique social determinants of health
that impact minority communities, thus improving patient outcomes.
Without such diversity, the healthcare system struggles to meet the needs of all its patients equitably.
Effective communication is another area where multiculturalism proves essential, particularly
highlighted during the COVID-19 crisis. Facilities with heterogeneous language capabilities and culturally
competent staff are better equipped to handle the diverse linguistic needs of the patient population. This
capability is crucial for appropriate communication, accurate diagnoses, treatment adherence, and patient
education, all of which are vital during a pandemic (Springs, 2021). Miscommunication in a diverse workforce
can mitigate these risks by ensuring that patients receive care in their preferred language and cultural context,
fostering trust and improving health literacy.
Furthermore, the pandemic has underscored the broader implications of a lack of diversity and emphasis
on multiculturalism within healthcare settings, including increased discrimination, and a negative impact on
both employee morale and patient trust. Discrimination, whether experienced by healthcare workers or
patients, can lead to a toxic work environment and suboptimal patient care. It can diminish the overall
effectiveness of healthcare delivery by creating a culture of mistrust and fear. Promoting multiculturalism and
diversity within healthcare not only addresses these issues but also enhances the resilience and adaptability of
the healthcare system (Springs, 2022). By fostering an inclusive environment, healthcare facilities can better
support their staff, improve patient satisfaction, and ensure that all patients receive compassionate, competent,
and culturally sensitive care, particularly during global health crises (Burrell, 2021).
A preliminary review of diversity in the healthcare workplace highlights several key findings:
• African Americans, Native Americans, and Hispanics were the groups being significantly under-
represented in the review, and in the health care workforce compared to their representation in the
general population;
• The lack of multiplicity in the healthcare workforce insinuates declining health inequalities, since
diverse providers are more inclined to discuss matters in a culturally competent manner;
• Facilities with heterogeneous language capabilities may experience smoother communication among
employees but could face challenges in serving the patient population effectively;
• The review highlighted the potential for discrimination among employees, administration, and the
community in healthcare facilities that lack diversity;
• Improper management of chronic conditions, and undetected diagnoses are indications of disparities in
healthcare, which result in unnecessary costs.
Such findings suggest that diversity management is necessary to ensure an inclusive and impartial
healthcare environment that fosters empathy and respect (Agrawal et al., 2024). Absence of diversity and lack
of multiculturalism in the healthcare workforce can have several implications (Hernandez & Kumar, 2018):
• A homogeneous healthcare workforce may struggle to address diverse needs of patients from different
cultural backgrounds, which leads to health disparities and unequal access to quality care;
• Without a diverse workforce, communication barriers may arise, hindering effective interactions
between healthcare providers and patients, which potentially impacts the quality of delivered care;
• Lack of diversity can contribute to discrimination within healthcare settings, affecting employee morale,
patient trust, and overall workplace dynamics;
• A non-diverse workforce may lack the cultural competence needed to provide personalized
consideration respecting the morals, principles, and practices of diverse patient populations.
Diversity in workplace follows overall governance, which results in opposing dialogue (Elloukmani et
al., 2024). To address the issues and promote diversity and multiculturalism, some strategies are carried out:
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• Executing targeted recruitment and retention programs can attract and retain a diverse workforce,
including individuals from under-represented minority groups;
• Providing cultural competency training to healthcare providers can enhance their ability to understand
and address unique needs of diverse patient populations;
• Establishing mentorship and support programs for minority students and professionals in healthcare can
decrease disparaging concerns while also promoting diversity;
• Advocating for policy changes at educational institutions and healthcare organizations can promote
diversity, equity, as well as inclusion in recruitment, admissions, and hiring practices.
By actively addressing the lack of diversity in the healthcare workforce through these strategies and
initiatives, patients may expect an environment that highlights inclusivity and cultural competence
(Hernandez & Kumar, 2018).
Higham (1993) described multiculturalism as a direct resistance to discrimination toward gender,
ethnicity or race, all disabilities, and distinctive physical features. Gomarasca (2013) regards multiculturalism
as an established term that exemplifies intercultural methods, with clear considerations toward cultural
exchanges and all associations.
Perceptions of group identities are a known challenge as an overall focus of multiculturalism is to
provide protection for minority groups (Johansson, 2022). Such groups continue to face health disparities at
an increasing rate because of inadequate programs and practices (Goode & Landefeld, 2018).
Developed in earlier centuries, the term of multiculturalism was recognized as a direct approach to
decrease bureaucracy through the reversal of all unethical practices against individuals with distinct cultural
differences or hereditary inheritances. Since political attention is warranted, there continues to be wide-spread
remonstrations and rallies seeking redemption. Multiculturalism also focuses on the process of creating
equality, while highlighting substandard business practices and inadequate societal norms.
Problem statement
The healthcare sector faces critical challenges regarding multiculturalism and diversity within health
and medical education, and healthcare delivery. Despite efforts to promote inclusivity, substantial clinician
enrollment disparities persist, with over 80% of students in medical schools and allied health programs being
White, while African Americans, Hispanics, and Native Americans each constitute only about 7% (Hernandez
& Kumar, 2018). This lack of diversity among healthcare professionals has profound implications for health
disparities in underserved and under-resourced communities.
The under-representation of minority groups in health education and medical professions contributes to
a healthcare workforce that may not fully understand or effectively address the culturally diverse or social
elements of health affecting some populations. Poor cultural competence may cause a breakdown in
communication, distrust, and subpar health care for patients from marginalized communities. Consequently,
as health disparities persist, there is an increase in chronic diseases and improper diagnoses among minority
populations.
Furthermore, the lack of multiculturalism within the healthcare workforce can hinder development and
implementation of inclusive health policies and educational curricula that reflect needs of diverse populations.
This systemic issue not only perpetuates inequities but also stifles innovation and advancement of culturally
sensitive healthcare practices.
Addressing these disparities requires a concerted effort to enhance diversity and multiculturalism in
health education and medical training. By fostering an inclusive environment that encourages enrollment and
retention of minority students, we can cultivate a more culturally competent healthcare workforce. This, in
turn, will improve healthcare delivery and outcomes for underserved and under-resourced communities,
ultimately contributing to reduction of health disparities and promotion of health equity.
The pressing need for greater diversity and multiculturalism in health and medical education is crucial
for addressing the profound health disparities that disproportionately affect underserved populations. By
recognizing and addressing these enrollment disparities, we can create an unbiased healthcare system that
serves the needs of all communities. This paper explores a complex nature of diversity and multiculturalism
in healthcare and makes practical recommendations for healthcare organizations.
Significance, novelty, and originality of the study
This paper addresses the persistent lack of diversity and multiculturalism in health education, medical
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education, and healthcare delivery. This imbalance is not merely a matter of representation. It directly impacts
health disparities in underserved and under-resourced communities.
The novelty of this study emerges from its comprehensive examination of how under-representation of
minority groups in healthcare education contributes to a workforce that may lack the cultural competence
needed to address the unique social determinants of health affecting diverse populations. By highlighting the
link between workforce diversity and health outcomes, this research underscores the critical need for cultural
competence in healthcare professionals. The study further explores how miscommunication and mistrust,
stemming from a lack of cultural understanding, can lead to suboptimal care for marginalized communities,
thereby perpetuating health disparities.
The originality of this research is reflected in its dual approach. It not only identifies the systemic issues
hindering the development and implementation of inclusive health policies and educational curricula, but also
provides practical recommendations for fostering diversity and multiculturalism in health education and
medical training. By advocating for an inclusive environment that promotes the enrollment and retention of
minority students, the study offers a pathway to cultivate a more culturally competent healthcare workforce.
This, in turn, is posited to improve health care provisions and conclusions for underserved people, contributing
to reduction of health disparities and promotion of health equity.
Moreover, this study stands out by addressing the broader implications of diversity within healthcare
organizations. It goes beyond the immediate educational context to consider the long-term benefits of a diverse
workforce on healthcare innovation and advancement of culturally sensitive practices. By recognizing and
addressing these enrollment disparities, the study aims to move towards a more unbiased healthcare system
that adequately serves all populations.
This inquiry is significant in its focus on an urgent issue, novel in its approach to linking workforce
diversity with health outcomes, and original in its practical recommendations for fostering inclusivity in
healthcare education and practice. Through this study, healthcare organizations are provided with a roadmap
to address diversity challenges and improve health equity, ultimately leading to a more just and effective
healthcare system.
ANALYTICS, THEORETICAL AND CONCEPTUAL FRAMEWORK
It is common to characterize organizations that implement multiculturalism through means of
multiplicity, prohibitions of discriminatory procedures, and when applicable, fundamental amalgamation
(Cox, 1991). Organizational leaders must implement business strategies focused on diversity to ensure
building cohesive teams where multicultural employees possess morale (Alonso & Wang, 2014). Political
parties and organizations heavily rely on intercultural competency for developmental growth, which highlights
a need for multiculturalism (Green et al., 2018).
Focusing on the political philosophy aspect, multiculturalism acknowledges hereditary, economic, and
power differences to describe disadvantaged populations (Kucheryavaya et al., 2020). Although roughly two-
thirds of the migrating population preserve their original citizenship, such movements are increasing,
emphasizing a greater need for diversity management (Gražulis & Markuckienė, 2014). Multiculturalism is
not simply a political principle, or a metaphysical opinion, but rather a distinct theory on an appropriate view
of mankind (Parekh, 2006).
Both health care organizations and political extremists must acknowledge the factual veracity and
objectives of multiculturalism. Democracy will become more apparent, by epitomizing basic human rights
and employing diversity policies. When multiculturalism is absent, there is also a lack of cultural humility
where one is unable to ethically self-evaluate behaviors (Tervalon & Murray-Garcia, 1998). Moreover, self-
awareness, knowledge of ethical skills, and the overall desire to adhere to diversity policies are predictive to
accepting multiculturalism (Burns, 2020). Implementing multiculturalism will eliminate diversity issues.
Additionally, there is a high possibility of establishing favorable societal and psychological consequences for
diverse populations (Ward et al., 2020).
Current theories and areas of debate
Professor Manuel Ramirez advanced a concept of multiculturalism, the Multicultural Personality
Theory (MPT), which focuses on theoretical consolidation (Ponterotto, 2010). Both social relations and self-
fulfillment are additional factors that contribute to a psychological well-being (Feliana et al., 2024). Professor
Ramirez insists people with evidence of the MPT portray inclusive performance with high emotional
intelligence toward the established intercultural requirements:
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• Approximal factors, commonly referencing cultural identity, concern toward intercultural employment
and relationships, bias points, and multinational guidance;
• Intermediate factors, referencing the expansion of societal connections via compassion, comedic relief,
endurance, self-efficacy, and survival capabilities;
• Distant factors, referencing a quality of life, emotional welfare, life gratification, and physical health
(Ponterotto, 2010).
Created by both Henri Tajfel and John Turner, the Social Identity Theory, is a concept of
multiculturalism. The theory considers how individuals classify others by means of varying opinions or
experiences (Turner et al., 1987). The Social Cognitive Theory, another concept of multiculturalism created
by Albert Bandura during the 1960s, focuses on interactions and behavioral influences towards decision-
making, and individual motivation (Bandura, 1986). Often, continuous actions can lead to normalizing
behaviors. Acknowledging the varying multicultural theories, and implementing all-inclusive methods, allows
health care organizations the ability to create thriving business strategies aimed at decreasing:
• Recognizing prejudgment;
• Eluding dysfunctional adjustment manners;
• Evading gender variances;
• Diminishing distinctive partialities;
• Improving intercultural interactions.
Although there is sufficient evidence to support the need for multiculturalism, there is still high scrutiny.
Many politicians and researchers highlight the possibility of failure to support both inclusion and further
separation of cultural trends, linguistic biases, and religious tolerance (Morales-Gálvez & Stojanović, 2017;
Polak, 2013).
Postmodernism and governmental regulatory guidance were considered as false principles of
multiculturalism. However, both entities do not sufficiently address racial multiplicity. Multiculturalism
functions at the immediate emblematic level through existing socio-political conditions, with migrants
circumscribed to neo-assimilation (Reid, 2019). Another contentious problem is the lack of a cultural
protector, because of government authenticity hindrances and poor textbook literature representation.
Disavowing proper acknowledgement of cultural ideas jeopardizes removal of specific policies while
generating fabricated stabilities (Polak, 2013).
There are also several additional theories from research that offer a broad context to complexity and
dynamics of multiculturalism and its lack in healthcare workplace.
The Contact Hypothesis
The Contact Hypothesis speculates that in suitable circumstances, interactive communication can lessen
biases among both majority and minority groups (Marletta et al., 2015). Created originally to confront cultural
and racial challenges, the theory suggests severely reduced partiality during and after intergroup connections
(Pettigrew & Troop, 2006).
Personality factor is a large component of the Contact Hypothesis, where favorable changes in ethnic
relations subsequent to cross-group contact could occur creating positive dynamics and healthy cultural
attitudes (Amir, 1969). Xenophobia becomes quite evident and contributes to social disparity when there is a
lack of contact between cultures (Paluck et al., 2019). The notable positive result of intergroup contact is a
decline in anxiety, improved empathy, established trust, and overall clemency for past misbehaviors
(Pettigrew et al., 2011).
In the context of healthcare education, this theory suggests that increasing interactions between students
of diverse backgrounds can foster mutual understanding and respect. The elements of this hypothesis include
ensuring equal status among participants, working towards common goals, promoting intergroup cooperation,
and having institutional support.
All training should involve an intensive course on cultural emphasis to highlight the needs of diverse
patients, while exploring innovative methods that ensure cultural competence and reduced bias (Mukhalalati
et al., 2023). Cultural competence includes both behaviors and established policies that intertwine to ensure
organizations maintain a setting that acknowledges diversity through appropriate interactions (Greene-Moton
& Minkler, 2020). Through implementation, medical schools and allied health programs can create
environments where diverse students feel valued and integrated, thereby addressing disparities in clinician
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enrollment.
In healthcare settings, applying the Contact Hypothesis involves structured initiatives that bring together
students and professionals from various racial and ethnic backgrounds in collaborative settings. For example,
mixed-group projects and clinical rotations can provide opportunities for minority and majority students to
work towards shared objectives, such as patient care and research. When students of different backgrounds
collaborate on these common goals, they can develop a deeper appreciation for each other’s perspectives and
reduce biases.
Moreover, these interactions must be supported by institutional policies that emphasize equality and
cooperation, ensuring that all students have equal opportunities to contribute and lead.
The Contact Hypothesis also underscores the importance of institutional support in fostering a
multicultural and diverse healthcare workforce. Medical schools and allied health programs must implement
policies and practices that not only encourage diverse enrollments but also facilitate positive intergroup
activities. This includes creating inclusive curricula that reflect needs of diverse populations, promoting
cultural competence training, and providing resources for minority student support. By institutionalizing these
practices, healthcare education can move towards a more equitable system, ultimately improving healthcare
delivery and outcomes for underserved and under-resourced populations. Not only does this method address
the immediate disparities in clinician enrollment but also advances the established goal of diminishing health
inequalities and promoting health equity across all populations.
The Acculturation Theory
The Acculturation Theory examines the conditions set to embrace cultural characteristics or social
norms of others (Zambrana & Carter-Pokras, 2010). The theory investigates how people adapt to and accept
aspects of a varying culture while preserving their own cultural identity. According to the theory,
circumstances such as family, employment dynamics, education, and the overall socio-political atmosphere
can influence the acculturation process (Ward & Geeraert, 2016). This is particularly relevant to addressing
the diversity challenges in healthcare education.
The theory posits four main strategies: amalgamation, absorption, separation, and marginalization.
Amalgamation involves maintaining the original culture while implementing parts of the new culture, which
is the most beneficial for fostering a culturally competent healthcare workforce. By encouraging integration
among minority students in medical schools, these institutions can ensure that students retain their cultural
identities while effectively engaging with the dominant culture. This dual engagement can enhance their
ability to understand and address the cultural and social factors of health affecting diverse populations.
In practical terms, applying the Acculturation Theory in healthcare education involves creating
supportive environments that value and incorporate diverse cultural perspectives. For instance, medical
schools and allied health programs can implement mentorship programs that pair minority students with
culturally competent faculty members who can guide them through the acculturation process. Additionally,
curricula that include multicultural education and training in cultural competence can help students from
different backgrounds learn to navigate and integrate the dominant healthcare culture while preserving their
cultural identities. This approach not only helps minority students feel included and supported but also
enriches the study environment for all students by exposing them to a variety of cultural perspectives.
The Acculturation Theory also highlights the need for institutional policies that promote cultural
integration rather than assimilation or marginalization. Policies that support cultural diversity, such as
inclusive admission practices, financial aid for under-represented groups, and cultural competence training
for all students and staff, are crucial. By fostering an environment that values and integrates diverse cultural
identities, healthcare education institutions can develop a more culturally competent workforce. Such
workforce is better equipped to address health disparities and provide high-quality care to underserved and
under-resourced communities.
Ultimately, by applying the Acculturation Theory principles, healthcare education can establish higher
equity and inclusivity, improving health results and reduced disparities for all populations.
Pluralism
Pluralism is a theoretical framework that advocates for co-existence and mutual respect of diverse
cultural groups within society, emphasizing that no single group should dominate or suppress others (Sulmasy,
2019). Superiority thinking is often created by implanted psychological units, meaning learned behavior (Horst,
2024). The framework suggests that there be a distributed and non-associative pattern of authority to avoid
disharmony (Grant, 2024).
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In the context of healthcare education, pluralism underscores the importance of creating an inclusive
atmosphere where diverse cultural views are valued and incorporated into curriculum and practice. This
approach ensures that students from minority backgrounds feel respected and included, thereby enriching
educational experience for all students and promoting a more comprehensive understanding of diverse health
needs. By embracing pluralism, healthcare institutions can enhance students’ knowledge to serve an
increasingly diverse group, ultimately enhancing cultural competence and improving healthcare outcomes.
The elements of pluralism include cultural maintenance, mutual respect, and institutional support which
are crucial in addressing disparities in clinician enrollment and subsequent impact on healthcare delivery.
Cultural maintenance involves encouraging students and professionals to retain their cultural identities while
engaging with others, which can be achieved through multicultural education programs and support groups.
Mutual respect requires fostering an environment where all cultural perspectives are valued and considered in
decision-making procedures. This can be facilitated through procedures that endorse inclusivity and diversity
training programs that sensitize all members of the institution to importance of cultural differences.
Institutional support is vital in ensuring that these practices are not just theoretical but are actively
implemented and maintained. This includes providing resources for minority student recruitment and
retention, as well as creating platforms for diverse voices to be heard and respected within the institution.
By applying pluralism in healthcare education and medical training, institutions can address the
systemic issues that hinder development of a culturally competent workforce. Pluralism promotes the idea that
diversity is not a challenge to be managed but an asset to be leveraged. This perspective can lead to the
development of inclusive health policies and educational curricula that reflect the needs of diverse populations.
As healthcare organizations embrace pluralism, they can foster innovation and advance culturally sensitive
healthcare practices, which is essential for reducing health disparities. Ultimately, pluralism can help construct
an impartial healthcare system that desires to serve all communities, particularly those that have been
historically underserved and under-resourced.
Impact on industries
Healthcare organizations and academic training medical centers that implement multiculturalism are
more susceptible to expansions in modern strategies that improve globalization. Such improvement may
generate innovative opportunities for competitive growth through the decrease of organizational cost while
potentially enhancing the consumer market.
Thoumrungroje and Tansuhaj (2007) categorized different elements of globalization:
• Macro-economic elements (rapid populace growth);
• Political elements (liberation and commerce guidelines);
• Technological elements (increase in industry trades);
• Organizational elements (global corporations).
Organizations can expect an increase in worldwide solutions and growth when elevated prominence is
placed on multiplicity perspectives (Alonso & Wang, 2014). Efficient policies to advance business strategies
require changes toward multicultural management. Doing so will enhance the overall competitive advantage,
while creating sufficient internal capabilities. Organizations will notice a positive shift in the overall societal
well-being when implementing multicultural strategies in operations (Kane et al., 2014). Healthcare
organizations, specifically, will gain the benefit of cooperative employees and efficient collaboration when
they implement multicultural business practices (Celebrating Teamwork, 2014).
By expanding proficiencies and employing technological advances, organizations could create a better
competitive advantage and have a reduction in overall costs (Porter & Millar, 1985). Though operative
synchronization is fundamental to calculating internal performance, the results could enhance economic
benefits, including expansion in technological advances that are socially supportable. Creating permanence
between social accountability and organizational commitment may boost the overall competitive advantage
(Epstein & Buhovac, 2014).
With the lack of diverse professionals, technological advances could help identify common issues in
communication barriers. Through so much evolution and technological advancement, the continuous concern
of diversity is alarming because the faces in the healthcare industry have not changed much (McKinney,
2007). Multiculturalism has numerous helpful influences for companies through the reduction of separation,
while supporting diversity and enhancing the competitive advantage.
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Workplace challenges
Although there has been vast evolvement with the implementation of multiculturalism, there are still
notable concerns of respecting global sensitivities and integrating different cultural aspects (Alonso & Wang,
2014).
Immigration is on the rise, which establishes a need for regulatory guidance and government
involvement (Lundin et al., 2018). Immigrants face forced interactions with others that are unfamiliar with
their cultures because of a specific need, which highlights the challenges of acceptance, mutual respect, and
appropriate accommodations (Jackson & van de Vijver, 2018).
There is a strong correlation between multiculturalism and cultural intelligence. If the acceptance of
diversity is low, cultural intelligence will be the same, with a decrease in sensitivities (Katıtaş et al., 2024).
Although multiculturalism appears standardized in certain medical fields (Clayton et al., 2016), government
involvement is still required to enforce morality.
Moreover, there are serious apprehensions concerning multiculturalism and the political concept of
authority (Keddie, 2014). Lastly, there are concerns with the cost and frequency of diversity training, an
increase in masked discrimination or simple defiance, minimizing cultural differences by forcing the
behavioral patterns of the dominant culture, and the overall increase in interpersonal conflicts (Zane, 2023).
Resistance toward change initiatives can cause wide-spread fear, impacting productivity and retention (Umble
& Umble, 2014).
Future impact of topic
The improvement of social justice initiatives and actions, establishing precautionary discrimination
measures, and focused promotion of equality and equity are impending influences for multicultural business
strategies. The concept of multicultural competency and social justice associates developing strategies in
healthcare organizations to suitable behaviors in business practices, and toward improving social actions
(Arredondo & Perez, 2003). One may reject change because of the strong sense of closeness to culture,
which could hinder progression (Coulson-Thomas, 2014).
Some may not comprehend diverse approaches, so to mitigate discriminatory practices, organizations
should require employees to understand identity dimensions (Fitzsimmons, 2013). Likewise, multicultural
policies could emphasize appropriate strategies, including the demand for consistent obligation (Vera &
Speight, 2003).
Another impact is positive societal developments that further enhance business operations. Such
developments highlight and modify both human and social conditions. One must consider that effective
management is a vital factor for executing change.
Businesses should implement multicultural strategies for effective social change. Goel and Ramanathan
(2014) stated that effective social change and business integrity is not a nebulous notion, but a basic element
that medical training facilities and healthcare organizations should contemplate. Multiculturalism effectively
addresses and corrects the modern association regarding social justice and social change (Constantine et al.,
2007). Additionally, connecting multicultural strategies to social change will accentuate the competence to
accept ethnic compositions, thus creating a multicultural society.
Process and strategy recommendation
Improving multicultural unity and competency is recommended to warrant equity and inclusion. The
world is rapidly becoming more globalized with an increase of mixed populations, resulting in intercultural
competences becoming a prominent goal in organizations (Figueroa & Hofhuis, 2024). There is much evidence
that suggests merely attending intercultural training does not completely improve or reverse challenging attitudes
and behaviors towards multiculturalism (Ott & Michailova, 2016). Organizational solidity is vital to employ
during all multicultural efforts to combat organizational, societal, and political concerns (Jones, 2014).
Milton Gordon, a sociologist, coined the philosophy of detecting assimilation to describe how to
incorporate ethnic populations. He created a distinction among historical identity, which discusses fate
interdependence, and participant identity, which highlights subculture identity. As mentioned by Gordon
(1964), the below seven dimensions indicate how to properly combine cultural heritages that healthcare
organizations and medical training centers should employ:
• Identifying and accepting other cultural and social norms;
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• Providing underlying integration, incorporating pluralism;
• Ensuring cross-group unions, containing minimal cultural segregation;
• Defining bias, classifying and alleviating prejudice;
• Detecting bias, incorporating diversity and tolerance;
• Identifying a predominant group of the host society to establish power;
• Providing intergroups, minimizing power concerns.
Human resources should modify policies in support of multiculturalism. Previously, intercultural
practices were not comprehensible. Albeit new human resources guidelines were developed for overseeing
diversity. Meena and Vanka (2017) contended that the below seven methods focus on establishing diversity
management practices for both medical training centers and healthcare organizations:
• Fairness-minded selection methods that consider fair procedures;
• Fairness-minded performance assessment methods that consider fair appraisal and counseling
techniques;
• Fairness-minded benefit methods that consider equal compensation;
• Identity-free methods that consider bias-free decision-making;
• Control-minded methods that consider the authority to defy performance assessment results;
• Team-minded methods that consider motivation in groups;
• Training-minded methods that incorporates diversity training.
CONCLUSIONS
To ensure healthcare organizations, as well as the cultivation of organizational cultures that support
multiculturalism, equity, inclusion, and diversity, several best key practices can be implemented.
Firstly, healthcare institutions must prioritize comprehensive diversity training for all staff members.
This training should include cultural competence education, sensitivity training, and workshops that address
unconscious biases. By providing appropriate skills that ensure ethical comprehension, healthcare
professionals will learn how to navigate cultural disparities, creating an inclusive environment towards diverse
perspectives, respect, and morality.
Secondly, healthcare organizations should actively work to diversify their workforce by implementing
targeted recruitment and retention strategies for minority groups. This includes creating pipeline programs
that encourage students from under-represented backgrounds to pursue careers in health professions, as well
as offering scholarships, mentorship programs, and career development opportunities. By building a labor
force that reflects multiculturalism, healthcare organizations can enhance ethnic competence and patient care.
Thirdly, establishing policies and practices that promote equity and inclusion is essential. Healthcare
organizations should adopt hiring practices, ensure equal opportunities for advancement, and create support
for employees. This involves setting up diversity committees or task forces that regularly assess the
organization’s progress towards diversity goals and make recommendations for improvement.
Besides, implementing patient-centered care practices can consider the ability of health determinants
to enhance patient interactions and outcomes. This includes developing culturally sensitive communication
strategies, providing translation services, and involving patients and their families in care decisions.
By embedding these practices into their organizational culture, healthcare institutions can not only
address the existing disparities in health education and delivery but also enhance overall effectiveness and
societal well-being. A diverse and inclusive workforce is better equipped to understand and meet needs of a
diverse patient population, leading to improved health outcomes and reduced disparities in underserved
communities.
Multiethnic team solidarity and competency are fundamental business strategies that support unity and
effective practices. However, there are a few cultural hinderances to the overall competitive advantage, so
diversity training is necessary. There will be a positive impact to societal well-being, as multiculturism
continues to progress.
Recommendations for future research
To address the persistent challenges regarding multiculturalism and diversity within health and medical
education, and healthcare delivery, future research should employ both Delphi research methods and
qualitative case study approaches to gain deeper insights and develop actionable strategies.
Health Economics and Management Review, Issue 3, 2024
ISSN (print) – 2786-4626, ISSN (online) – 2786-4634
62
The Delphi method, which includes the controlled procedures of collecting and synthesizing expert
opinions through multiple cycles of surveys, is well-suited for exploring complex issues such as diversity and
multiculturalism in healthcare. This method can be employed to achieve consensus on the best practices and
strategies for enhancing multiculturalism in health education and training programs. Future research via the
Delphi method could focus on the following areas:
• Identifying key competencies. You engage experts in multicultural education, healthcare
delivery, and policy-making to identify key cultural competencies that healthcare professionals
should possess to effectively serve diverse populations;
• Developing inclusive curricula. You solicit input from educators, practitioners, and cultural
competence specialists to develop and refine curricula that integrate multicultural perspectives
and address social health determinants;
• Formulating policy recommendations. You gather insights from a diverse panel of shareholders,
which should include healthcare employees, teachers, and political leaders, to formulate
comprehensive policy recommendations aimed at increasing diversity in health professions and
ensuring equitable healthcare delivery.
A qualitative case study research method could provide an in-depth understanding of specific contexts
and experiences of individuals within them. This method is particularly useful for exploring the nuanced
dynamics of diversity and multiculturalism in healthcare settings. Future research via qualitative case study
methods could investigate the following areas:
• Case studies of successful programs. You examine healthcare education programs and
institutions that have successfully implemented strategies to increase diversity and
multiculturalism. You also identify factors contributing to their success and lessons that can be
applied to other settings;
• Barriers to diversity. You conduct case studies of institutions that struggle with diversity and
inclusion to uncover systemic and organizational barriers that hinder progress. This could include
exploring experiences of minority students and faculty, as well as institutional policies and
practices that impact diversity efforts;
• Impact on patient care. You investigate how the presence or absence of cultural competence
within healthcare teams affects patient care and outcomes in underserved and under-resourced
communities. This could involve interviewing patients, healthcare providers, and administrators
to understand the link between workforce diversity, cultural competence, and health disparities.
Author Contributions
Conceptualization, D. N. G.; methodology, D. N. G.; software, D. N. G.; validation, D. N. G.; formal
analysis, D. N. G.; investigation, D. N. G.; resources, D. N. G.; data curation, D. N. G.; writing - original draft
preparation, D. N. G.; writing - review and editing, D. N. G.; visualization, D. N. G.; supervision, D. N. G.;
project administration, D. N. G.; funding acquisition, D. N. G.
Conflict of Interest
The author declares no conflicts of interest.
Data Availability Statement
Not applicable.
Informed Consent Statement
Not applicable.
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