Competences in Ethnicity & Health: Using the Organisational Level to spread Cultural Competences, a Social Network Analysis

Background: In most European metropolitan areas, health services are required to provide culturally competent health care to ethnic minority patients. So far this goal has remained elusive because the cultural competences have been mostly considered as an individual competence. We aimed at investigating the role of inter-professionals relationships on the diffusion of cultural competences within health care organisations. We tested the hypothesis that an individual is more likely to be culturally competent if his leaders are culturally competent themselves. Methods: We carried out a social network analysis in 24 inpatient and outpatient health services, selected according to their geographic localisation and their patient-centeredness. All healthcare professionals were requested to fill in a questionnaire tapping their level of cultural competences and their inter-professional relationships. We identified the most central actors within each health service according to the in-degree centrality. We regressed the cultural competences of the individuals on the cultural competences of the service leaders. Results: Bivariate regression indicated that the cultural competences of the individuals increased with the cultural competences of the leaders (beta=0.24, p<0.01). The cultural competences of the individuals increased with the cultural competences of the leaders (beta=0.20, p<0.01), after controlling for contextual and sociodemographic variables. Overall interaction analysis suggest that the leadership effect depends on the own skills of the leaders rather than on their professional experience. Conclusions: Cultural competences are partly acquired among health professionals through role-modelling. Implementation of the cultural competences requires an appraisal of inter-professional relationships and to rely on leadership role-modelling within the health care services.