20.10.2020 | Kommentarer

Challenges of working in a multicultural team in healthcare

Abstract

From the global health care perspective, the utilization of a multicultural team is due to the facilitating factors as well as the attached benefits. Korpela (2008), in an investigation of the Finnish healthcare multicultural environment, notes that the demand for healthcare professionals is growing rapidly all over the world, and countries are welcoming more staff from abroad. Notably, the utilization of a multicultural team workforce is utilized in the healthcare sector due to benefits like improved productivity, increased creativity and innovation, and general improved quality care services in the industry. This essay aims at discussing the challenges of working in a multicultural team in healthcare, and possible solutions in Finland and other parts of the world.

Introduction

Culture has been defined in different ways. Hofstede (2004) describes culture as the assemble programming of the mind which discerns members of one group from another. Culture is a pattern of thinking that is transferred from parents to children, friends to friends, teachers to students, as well as leaders to their followers. According to Leininger (1995), culture is learned, shared values through the socialization process from one generation to another. The centre of one’s culture is cultural values, beliefs, norms, and lifestyles that guide the thinking of individuals and groups belonging to that culture, decision-making, action, and behaviour. Halverson and Tirmizi (2008), defines a multicultural team as a collection of individuals with different cultural backgrounds, who are self-reliant in their work, who share liability for outcomes, who see themselves and are seen by others as an intact social entity set in one or more significant social systems, and who maintain their relationships across the boundaries of an institution and beyond.

At the end of 2019, almost 412,700 people were living in Finland whose mother tongue is other than Finnish, Swedish, or Sami. The figure of foreign nationals living in Finland was almost 268,000 in 2019, and by far the largest foreign national group were Estonians followed by Russians. The number of people who received Finnish citizenship was 9,649 in 2019 of which most were of Russia, Estonia, Iraq, and Somalia. In 2019, 44,700 people with foreign backgrounds lived in Finland married to a person with a Finnish background. Moreover, the number rises to 63,300 when the number of persons living in cohabitation is added to marriages. Also, about 56,000 married or cohabiting families lived in Finland, where both spouses had a foreign background (Statistics Finland, 2020).

Cultural differences among team members come from various factors, including geographic origin, language and dialect, migratory status, race, shared traditions, religious, values, and symbols, literature, food preferences, folklore, and music, settlement and employment patterns, institutions serving and maintaining the group, politics, and homeland, and external and internal perceptions of distinctiveness (Glazner, 2008).

Even though multicultural teams serve great significance, the practice is facing significant challenges, thus lowering the realization of its goals within health care organizational settings (Strand, Chen & Pinkston, 2016). Some of the challenges multicultural organizations facing are ineffective communication, culture difference, direct vs indirect communication, power and hierarchy, racial discrimination, and difficulty in undertaking the decision-making process.

Challenges of a multicultural team

As mentioned above, due to globalization, the world is more multicultural than ever, increasing immigration and evolving technology. People are increasingly moving to a new country for work or family, which makes them face various challenges to adapt to new situations. The capability to operate in a multicultural environment and to understand different cultures is a crucial factor in adapting to a new environment (Korpela, 2008).

Ineffective communication

Ineffective communication can cause many challenges in a multicultural workforce. Communication is an essential aspect of a multicultural team. Graham (2005) notes that the language barrier can hinder the utilization of multicultural teams in the healthcare industry. This is captured due to different ways in which team members speak, words used as well as tools utilized to convey ideas, feelings, and hopes. Every member of the team is tied to their respective language (Xiao, Willis, and Jeffers, 2014; Aalto, Elovainio, Heponiemi, Hietapakka, Kuusio, and Lämsä, 2013; Raguz, Filipovic, and Matijevic, 2014). In the work of Xiao, Willis, and Jeffers (2014), it was clear that nurses working in a multicultural team experienced a communication challenge. In the study, one of the immigrant nurse participants indicated that sometimes she had difficulties understanding the drug request by the host nurse from another ward; even after requesting her to spell it. She just had to go there and get the name of the drug. The team members who do not belong to the ethnic group may face linguistic difficulties when the common language is not so fluent. Whereby they can lose a lot of useful knowledge or problem-solving skills. This can cause frustration in the team (Brett, Behfar, and Kern, 2006). Even though the language is an essential component, it is not the only one involved in effective communication; various non-verbal cues are also crucial to communication among the multicultural team. For instance, Americans are taught to keep eye contact when communicating in contrary to other cultures like Arabic origin can consider it as impolite and aggressive. An Indian might stare at the ground as a sign that they are listening (Maier-Lorentz, 2008).

Cultural difference

Cultural difference is another characteristic of a multicultural team. Usually, people from western cultures are quite different from persons from eastern cultures. With varying cultural norms, different persons within the multicultural team have a different interpretation of culture and norms (Lisak and Erez, 2015; Raguz, Filipovic, and Matijevic, 2014). Aalto et al. (2013), shows the differences in the operating cultures of nursing and differences in the nurse’s job description in different countries. For instance, in Finnish nursing units the nurse implements nursing and primary care to the patient while in many other countries, the duties of a nurse are more clearly limited to nursing tasks such as administration of intravenous antibiotics, administration of intravenous or intramuscular analgesics, and suturing of wounds. Foreigners from outside Europe may experience challenges in the Finnish way of life. Workers may have different views about, say, dressing, diet, hygiene, temperament, punctuality, and how to discuss specific topics. Traditions and religious beliefs may as well impose restrictions (Korpela, 2008).

Other challenges

Direct vs indirect communication is another challenge whereby some people are used to direct communication, which means asking something directly. Some again prefer indirect communication, which means just not pointing out the problem. This is due to the communication norms of different cultures when the wrong way of communicating is accidentally understood as an insult, it can have an impact on the team (Brett, Behfar, and Kern, 2006).
The quality decision-making process primarily depends on the ability to define the problem, time frame, skilled personnel, and resources. This causes frustration in those who want to decide faster when there are those on the team who still want to think about the problem further (Brett, Behfar, and Kern, 2006; Raguz, Filipovic, and Matijevic, 2014). Also, different cultural values and beliefs result in the utilization of different styles of decision making. For example, an Australian registered nurse usually feels empowered to voice in her ideas and makes quick decisions compared to an immigrant nurse who takes time to gather information in-depth as well as consult team members before making decisions (Xiao, Willis, and Jeffers, 2014). The diversity in styles of decision making and requirements primarily affects the effectiveness and efficiency of the decision-making process among the team members. Another challenge in a multicultural team can be racial discrimination whereby doctors and nurses of foreign origin, especially the once from African descent get discriminated by co-workers, managers, or patients (Aalto et al., 2013; Xiao, Willis, and Jeffers, 2014). A study by Casey and Smith (1997), indicates that racial discrimination takes place at all levels in the medical profession, from the medical school application, examination process, to job applications. The minority ethnic nurses are racially harassed by workmates as well as face discrimination in training and promotion. Black Africans are more subject to racial harassment than Asian nurses. Discriminated nurses are more prone to job dissatisfaction, which may lead to quitting than those who have never been racially discriminated (Shields, 2000).

Power and hierarchy can be seen differently in different cultures. This creates a challenge for multicultural team leadership. An egalitarian culture poses a challenge to team members who are from the hierarchical culture. If these team members were to defer to a higher status in an organization, they would find it uncomfortable to adapt to a flat structure, and their behaviour would be deemed inappropriate, consequently damaging their stature and credibility (Brett et al. 2006). Nursing practice in some developing countries is undervalued than in developed countries (Xiao, Willis, and Jeffers, 2014).

Possible solutions to multicultural challenges

Attempts should be made to solve problems by creating new procedures, policies, and resources. Therefore, structural changes in organizations are needed, where national levels should be supportive. Although the cultural differences may render the significance useless, it can be averted by offering effective education and training programs on cultural diversity. The programs will enable the members of the multicultural teams to understand different cultural norms, perceive assertiveness, as well as appropriate communication. Also, the language problem should be resolved to ensure easy teamwork and patient safety (Aalto et al., 2013; Xiao, Willis, and Jeffers, 2014). It is suggested that immigrant nurses and host nurses try to learn from each other regarding the different styles, manners, and body language used in communication across cultures. Effective communication cannot be achieved without considering the impact culture has on communication (Xiao, Willis, and Jeffers, 2014). To avoid misinterpretation of information, there is a need to learn to communicate simple and straight forward (Sogancilar and Ors, 2018).

Organization leaders should set a good example for others on how to consider people from a different ethnic background. This includes reducing prejudices and other barriers arising from multiculturalism (Carnevale and Stone, 1994). The management should gather feedback from minority groups in the sense that by asking information on employee's opinions as well as participation. Then management can see how the multicultural workforce looks like and how much support they give to them. This helps to see if a multicultural workforce is valuable or not (Carnevale and Stone, 1994). It is useful to be careful about applying meaning to nonverbal behaviour because nonverbal communication is assertive and can contradict verbal input.
By implementing equal opportunities policy, which implies regular training and monitoring of racial discrimination issues, automatically decreases the frequency of racial harassment by workmates. By applying recent legislation which eliminates the upper limit for compensation in cases of proved discrimination, meaning the employers could be fined if found guilty. This will enhance the employers to ensure that they have systems set, that minimizes the discrimination possibility (Casey and Smith, 1997; Shields, 2000).

Conclusion

The utilization of a multicultural team in the healthcare industry is common due to the attached benefits such as improved productivity, increased creativity and innovation, and improved healthcare services. Notably, multicultural teams face significant challenges like ineffective communication, cultural differences, difficulty in the decision-making process, direct vs indirect communication, racial discrimination, and power and hierarchy. However, challenges facing multicultural teams can be mitigated through appropriate education and training, thus effective learning in cultural diversity, due diligence as well as diplomacy to attain improved quality health care services.

References

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• Xiao, L. D., Willis, E. & Jeffers L. 2014. Factors affecting the integration of immigrant nurses into the nursing workforce: A double hermeneutic study. International Journal of Nursing Studies 51(4), 640-653.

 

Author: Delvin Suopelto Nursing student, Novia UAS 

Supervisor:Anita Wikberg, RN, RM, PhD och Senior Lecturer, Health Care, Novia UAS