Influence of the leaders on cultural competences of health professionals: a social network analysis of the COMETH project in Belgium

Dauvrin, Marie [UCL] Lorant, Vincent [UCL]

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 ties on the diffusion of cultural competence within health care organisations. We tested the following hypothesis: An individual is more likely to be culturally competent if his leader is culturally competent himself. Methods: We carried out a social network analysis of 24 inpatient and outpatient health services, selected according to their geographic localisation and their degree of patient-centeredness. All healthcare professionals were requested to fill in a questionnaire tapping their level of cultural competences and their inter-professionals ties. We identified the most central actors within each health service according to the in-degree centrality. We regressed the individual cultural competences on the leader cultural competences. 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). After controlling for contextual and individual variables, individual cultural competences increased with the cultural competences of the leaders (beta=0.20, p<0.01). We found that the leadership effect was higher for older leaders than for younger leaders. Conclusions: Cultural competences are spread among health professionals through role-modelling. Implementation of the cultural competences requires an appraisal of social ties and leadership within the health services.