Cultural diversity in healthcare – the role of leadership and education

Published: 13.06.2024 / Publication / Blog

The shortage of nurses is a global issue that already threatens the ability to deliver safe and effective care. According to the World Health Organization (WHO), this gap in the healthcare workforce, especially in Europe, could be characterised as a ‘ticking time bomb’ that could worsen health outcomes and, in extreme cases, lead to system collapse (WHO, 2022).

The reasons for this nurse shortage and an overall insufficient workforce are complicated and multifaced, including an ageing population, poor working conditions, low pay, high workloads and the fact that a lesser amount of young people choose nursing careers. One, in the recent years, widely practiced solution for this workforce crisis is international recruitment, which has been estimated to lead to a more diverse and multicultural nursing workforce (Cheng et al., 2022; Tevameri, 2021). This action again, poses new challenges, especially from the perspective of support and inclusion. In this blog post, that is based on a master’s thesis, we will present one possible solution to the problem.

The cornerstone of successful inclusion of a multicultural workforce is open and authentic communication as well as respect (Le, 2021; Debesay, 2022). Nursing managers have a key role in creating an atmosphere of trust. Our thesis focuses on the inevitably multicultural future of nursing in Finnish healthcare organisations, benefits and challenges of a culturally diverse workforce and suggests practical solutions for nursing managers who are in position to implement diversity strategies in practice. In the current climate, with the nursing workforce becoming more and more multicultural and diverse, many nursing leaders and managers are faced with new situations and do not have enough tools to lead a diverse and multicultural team (Kamau, 2023). As a part of our master’s thesis, we created a Massive Online Open Course (MOOC) on how to lead a multicultural team, to provide leaders and managers in healthcare organisations with knowledge and tools to better manage these new challenges. The MOOC consists of 4 parts, an Introduction, Module 1: Cultural diversity in Finnish healthcare, Module 2: Practical solutions for leading a culturally diverse team in healthcare and a Workshop. To overcome challenges and reach for practical solutions, the MOOC focuses on cultural diversity in healthcare and provides evidence-based knowledge to support leaders in their daily work. To effectively overcome the above-mentioned challenges, new leadership competencies and lifelong learning processes are needed, and for this, MOOCs are a viable and accessible option.

Online learning has many forms and one of these, more open, educational possibilities are MOOCs (Bates, 2022). A massive open online course is aimed at an unlimited number of students and is suitable for a topic that can potentially interest a wide audience. Enrolling in MOOCs is accessible to every potential learner and courses may have students with different backgrounds and cultures (AlDahdouh & Osório, 2016). For the development of nursing leadership, online courses such as MOOCs, offer a practical tool. The online format allows nurses to access education remotely, providing flexibility in scheduling and location. This kind of flexible and job-related opportunities to develop individuals’ expertise enables career advancement for more demanding tasks and can increase the quality of services (The Ministry of Social Affairs and Health, 2023). As nurses advance into leadership positions, educational programs and courses offered online provide a path for the needed professional growth.

The results of the literature review in our study were solid and united in conclusions, that in healthcare, diverse teams perform better and increase innovations (Wills, 2023; Miller, 2023; Narayan et al., 2021). Promoting diversity has shown to have a positive impact on overall performance, decision making and innovations. Diverse teams have doubled their chance of finding the right solution, but they are also more likely to have conflicts and longer discussions (Wills, 2023). In healthcare settings, diversity among the nursing staff as well as among other healthcare professionals increases the quality of care and improves overall patient satisfaction (Le, 2021). Healthcare providers who understand this connection, have the advantage of offering familiar services to diverse patients. The principal findings in our thesis were related to the inevitable diverse and multicultural future of nursing in healthcare organisations where cultural competencies, communication, educational interventions, and attitudes toward diversity play a crucial part. This suggests that improving skills and knowledge, as well as changing attitudes and behaviours towards diversity, are important factors in meeting the current and future needs in healthcare (Corbie et al., 2022). The reviewed articles highlighted the role and importance of all healthcare professional, and especially the healthcare leaders, in supporting the various features of promoting diversity, equity, and inclusion (Debesay et al., 2022).  Although the specific focus of each included article differed, all the articles had quite similar findings, and mentioned the positive effects and impacts that cultural diversity brings, and that challenges are possible to overcome. As healthcare is becoming more diverse, leaders are in a key role to implement strategies on diversity, equity, and inclusion. According to the findings, also humility and sensitiveness are important issues. Success in collaboration and co-operation in work environments were seen when the experiences of working in a culturally diverse team grew and team members got familiar with the different backgrounds of the members. The reviewed articles also showed that when leaders showed example and genuinely fostered an inclusive culture, this made an important difference that effected not only migrant nurses, but native nurses as well (Chua et al., 2023; Koesnell, et a.,2019).

The reviewed articles also mentioned the most common stumbling blocks in leading a multicultural team in healthcare organisations. These were insufficient knowledge, communication including lack of common understanding, change leadership education, intolerance and difficulties adapting to new ways of thinking (Uman et al., 2023; Koesnell et al., 2019; Debesay et al., 2022). Healthcare leaders are in a key role showing appreciations and cultural sensitiveness with humility in achieving successful inclusion and functioning multicultural diversity. Culturally diverse societies need care givers with various backgrounds. In improving the integration of a multicultural team in healthcare the management can learn from the past and from different work fields. Communication is an issue that arises on several occasions. Communication refers to language as well as interaction among teams. Language barriers and misunderstandings should be discussed and models and methods that support everyone’s way to speak and to be understood should be developed (Safdar et al., 2023).

As can be seen, successful implementation of diversity, equity, and inclusion has its demands. Online learning, in this case through a MOOC, on the topic of multicultural leadership in healthcare has the possibility to make this implementation more efficient. It can also support long-lasting and future-oriented ways to gain personal and professional goals in the form of providing leaders with solutions that respond to the rapidly changing multicultural needs in the healthcare sector. As the nursing shortage and workforce crisis is unlikely to be solved in the near future, all measures to bring alleviation to the problem are necessary to take. The increase in diversity and multiculture that international recruitment brings poses new challenges and demands on nursing leaders. In fostering diversity and inclusion, education plays a pivotal role, as it not only equips healthcare leaders with the necessary knowledge and skills but also influences their attitudes and perspectives. So, why not accept the challenge and upgrade your knowledge? The Cultural Diversity in Healthcare MOOC (3 ECTS) will be available at Arcada next autumn (2024).

Marjukka Honkanen, Master student in Healthcare Leadership, Arcada UAS

Liisa von Schoultz, Master student in Healthcare Leadership, Arcada UAS

Jonas Tana, Ph.D., Principal lecturer in Healthcare, Degree Program Director, Arcada UAS

References

AlDahdouh, A.A., & Osório, A.J. (2016). Planning to design MOOC? Think first! The Online Journal of Distance Education and e-Learning, 4(2), 47–57.  

Bates, A. W. (2022). Teaching in a digital age: Guidelines for designing teaching and learning (3rd ed.). Tony Bates Associates Ltd. https://pressbooks.bccampus.ca/teachinginadigitalagev3m/ External link

Cheng, H., Luo, W., Si, S., Xin, X., Peng, Z., Zhou, H., Liu, H., & Yu, Y. (2022). Global trends in total fertility rate and its relation to national wealth, life expectancy and female education. BMC Public Health, 22(1346). https://doi.org/10.1186/s12889-022-13656-1 External link

Chua, S.W.Y., Sun, P.,Y., & Sinha, P. (2023). Making sense of cultural diversity’s complexity: Addressing an emerging challenge for leadership. International Journal of Cross Cultural Management, 23(3), 635–659.  https://doi.org/10.1177/14705958231214623 External link

Corbie, G., Brandert, K., Noble, C. C., Henry, E., Dave, G., Berthiume, R., Green, M., & Fernandez, C. S. P. (2022). Advancing Health Equity Through Equity-Centered Leadership Development with Interprofessional Healthcare Teams. Journal of general internal medicine, 37(16), 4120–4129. https://doi.org/10.1007/s11606-022-07529-x External link

Debesay, J., Arora, S., & Fougner, M. (2022). Organisational culture and ethnic diversity in nursing homes: a qualitative study of healthcare workers’ and ward nurses’ experiences. BMC Health Services Research, 22(843). https://doi.org/10.1186/s12913-022-08184-y External link

Kamau, S., Oikarainen, A., Kiviniitty, N., Koskenranta, M., Kuivila, H., Tomietto, M., Kanste, O., & Mikkonen, K. (2023). Nurse leaders' experiences of how culturally and linguistically diverse registered nurses integrate into healthcare settings: An interview study. International Journal of Nursing Studies: 146. https://doi.org/10.1016/j.ijnurstu.2023.104559 External link

Koesnell, A., Bester, P., & Niesing, C. (2019). Conflict pressure cooker: Nurse managers' conflict management experiences in a diverse South African workplace. Health SA = SA Gesondheid, 24, 1128. https://doi.org/10.4102/hsag.v24i0.1128 External link

Le, M. (2021). Health Care Leader Strategies for Cultural Diversity in the Workplace. Walden University. https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=12631&context=dissertations External link

Miller, J. (2023). The Power Of Diversity And Inclusion: Driving Innovation And Success. Forbes business council. Read: 9.1.2024. https://www.forbes.com/sites/forbesbusinesscouncil/2023/08/16/the-power-of-diversity-and-inclusion-driving-innovation-and-success/?sh=1b51fc122505 External link

Narayan, A., Schaefer, P., Daye, D., Alvarez, C., Chonde, D., McLoud, T., Flores, E., & Brink, J. (2021). Practical Tips for Creating a Diversity, Equity, and Inclusion Committee: Experience From a Multicenter, Academic Radiology Department. Journal of the American College of Radiology : JACR, 18(7), 1027–1037.

Racoviță, M., Tate, J., Wait, S., & Adams, E. (2023). Overcoming the nursing workforce crisis in Europe to improve care for people with non-communicable diseases. British Journal of Nursing, 32(14).

Safdar, S., Mahali, S. & Scott, C. (2023). A critical review of multiculturalism and interculturalism as integration frameworks: The case of Canada. International Journal of Intercultural Relations, 93.

Tevameri, T. (2021) Katsaus sote-alan työvoimaan. Toimintaympäristön ajankohtaisten muutosten ja pidemmän aikavälin tarkastelua. TEM toimialaraportit, 2021:2. Työ- ja elinkeinoministeriö. https://julkaisut.valtioneuvosto.fi/bitstream/handle/10024/162852/TEM_2021_02_t.pdf External link

The Ministry of Economic Affairs and Employment of Finland. (2023). Labour Force Barometer. Available from: http://www.tyovoimabarometri.fi External link [Accessed: 16.5.2024]

Uman, T., Edfors, E., Padoan, S.,& Edberg A-K. (2023). Contribution of an inclusive climate to the work of culturally diverse healthcare teams: A qualitative descriptive design. Nordic Journal of Nursing Research, 43(1). https://doi.org/10.1177/20571585211070381 External link  

World Health Organization. 2022. Ticking timebomb: Without immediate action, health and care workforce gaps in the European Region could spell disaster. Available from: https://www.who.int/europe/news/item/14-09-2022-ticking-timebomb--withoutimmediate-action--health-and-care-workforce-gaps-in-the-europeanregion-could-spell-disaster External link  [Accessed: 16.5.2024]

Wills, J. (2023). How to Lead and Manage Diverse and International Teams. Stratx-Exl, Experiental Learning. Read: 10.1.2024. https://www.stratx-exl.com/industry-insights/how-to-lead-and-manage-diverse-and-international-teams External link  

Cultural diversity in healthcare – the role of leadership and education

The shortage of nurses is a global issue that already threatens the ability to deliver safe and effective care. According to the World Health Organization (WHO), this gap in the healthcare workforce, especially in Europe, could be characterised as a ‘ticking time bomb’ that could worsen health outcomes and, in extreme cases, lead to system collapse (WHO, 2022).

Category: Publication

Can Machine Learning aid in finding key factors to improve the Finnish healthcare system?

Finland is in the process of change in our health care system. The Nordic well-fare system is challenged in Finland, for instance, due to difficulties in attracting nurses, changing demographics in Finland, and a general pressure to reduce costs in the whole public sector. This poses severe challenges for the entire healthcare sector. Can Machine Learning (i.e., the subfield of Artificial Intelligence, which focuses on having a machine imitate intelligent human behavior) be used to understand relationships between different critical properties of our healthcare system? Yes, it can! An excellent example of how this can be done is found in a scientific paper by Hu et al. (2020), where the authors investigated nurses' willingness to report errors in a specific geographical area of the US.

Category: Publication