Cultural diversity is an important competency for all health care professionals to develop regardless of their expertise and years of experience. A real challenge for leaders and managers whose backgrounds differ from staff is “fitting in” and being included. Unfortunately these differences in cultural backgrounds can have a negative impact on effective care expectations. The purpose of this paper is to explore the implications of cultural diversity in patient care delivery, where one can expect that staff and the patient community have different backgrounds, expectations, priorities and values.
Why culture matters
Patient care delivery operates in a cultural context that includes the beliefs of the health care professionals as well as the patients. This greatly influences interactions between health care professionals.

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The congruency of patient care delivery and health beliefs
The staff is representative of the community at large. Essentially learning to lead a mostly Hispanic team will assist in serving a mostly Hispanic population. Communication techniques and practices alone cannot therefore bridge the gap- there is a need to understand the experience of a culture as well as to be bilingual in the body language, practices and underlying frameworks used in communication (Conn et al., 2015). A specific example of the impact of patient care delivery and health care beliefs are found in the fact that as an outsider I am not being included in many discussions and decisions, despite my authority. This is preventing me from guiding and leading my staff in decisions, and it impacts patient care.

Cultural misconceptions and different communication styles
Cultural misconceptions due to differing communication styles can occur for a number of reasons, such as timing, the level of intensity, body language used and the extent to which personal information is revealed. This can result in misunderstandings or misunderstood responses which can compound, or it may result in withdrawal as it did in this case study, with staff choosing to leave out myself, given the lack of cultural understanding.

Next steps for leaders and organizations
There are steps that I must take as the leader and manager of the staff in order to create an environment that recognizes and values difference. The need to do so is clear; the multicultural context in which health care operates is real and increasing (Hsieh, 2013). Language and cultural barriers tend to result in increased diagnostic testing by health care provider, reduced preventative care and follow up and reduced patient satisfaction (Hsieh, 2013). One can assume that studies would find similar impacts with regard to staff interaction.

Helping staff to understand cultural and communication factors
There are two aspects to helping my staff to better understand my cultural and communication factors, and that is that I must learn more about the dominant Hispanic culture while at the same time increasing the understanding of and expectations with regard to my framework and communication style. This requires changes in my own attitude, as I can increase my openness and curiosity about the culture. I might also be helpful to learn Spanish. I can also clarify communication expectations with staff so that I am not left out of important discussions regarding care.

How the organization incorporates cultural beliefs into patient care
The various organizations involved in healthcare incorporate cultural beliefs into patient care on a number of levels and in multiple ways including how patients and their status or condition might be viewed, as well as aspects of practice and coordination between staff that can impact patient care. There are diverse possible paths to incorporating a cultural context that values diversity (Shield et al., 2015). With such a large global movement of nurses and other health professionals, it is clear that cultural competencies in the work context are an important aspect of the continuous improvement objectives in health care (Sherwood & Shaffer, 2014).

The development of cultural competency in diverse settings takes learning and time, but professionals such as nurses in the health care sector face this imperative as the cultural diversity of backgrounds of staff, patients and the local community is increasing, and a lack of cultural competence has an impact on patient care and the work environment. When cultures communicate different, and this is not highlighted or explored in the work context, then it can easily become entrenched in practice. This is not necessary, as with a two-step approach it is possible to become more aware of cultural factors through better understanding the culture but also by highlighting the reality of the issue with staff.

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