Recognising cultural diversity in children's hospitals : managers, staff and families

Abstract

This research examines how staff at two children's hospitals in metropolitan Sydney NSW negotiate cultural diversity with child patients and their families from culturally and linguistically diverse (CALD) backgrounds. It specifically investigates the impact of systemic constraints, health and multicultural policies and organisational, professional and individual cultures on the practice of hospital staff. In this research approach, the limitations of 'politics of recognition' theory are critically reviewed, as it focuses on difference and ethnic identity rather than on the way mainstream institutions can address disadvantage. The study involved hospital personnel across all levels and professional categories in a qualitative approach to analyse the discourses of working with cultural diversity. The approach consisted of structured surveys, in-depth interviews, focus groups and participant observation over a period of 22 months. This analysis was augmented by in-depth interviews with three multi-disciplinary health teams with responsibility for the care of children with chronic illness, within both hospitals. The interviews with hospital managers reveal that cultural diversity is peripheral to daily practice, as efficiency and evidence-based medicine are a priority. Mainstream Australian and western biomedical ways of working with patients and families are the norm, and systemic processes to identify and meet the needs of families from CALD backgrounds appear inadequate. There is also inadequate provision of institutional support for staff working with cultural diversity. One of the ways managers assist families from CALD backgrounds is through the use of culturally diverse staff; however, there is a lack of organisational systems in place to support the use of their skills. The way that doctors and nurses care for families demonstrates the effect of professional cultures of biomedicine and liberalism which operate to treat all families the same, and in an individualised way. These staff tried to accommodate cultural differences if, and when, they became unavoidable but in those situations they were reliant mostly on allied health staff. While staff lacked formal support, informal practices assisted staff in working with families from CALD backgrounds. Some managers and staff recognised the culturally different behaviour of families as normal for their background, applying a form of cultural relativism which made non-mainstream behaviour non-problematic. Allied health staff also recognised when families were disadvantaged in relation to the dominant institutional values and needed extra material support. My argument is that current health care practice for families from CALD backgrounds does not adequately take into consideration the broader social context of health care and multiculturalism in Australia, and this in turn influences the organisational and professional cultures of working with diversity, where cultural difference is outside mainstream health practice. Staff appeared to lack systemic support and this reduced their capacity to accommodate cultural diversity. They addressed inequities as an afterthought, rather than as core business of the organisation.

Date of Award	2011
Original language	English