Improving ethnocultural competence of hospital staff by training: experiences from the European 'Migrant-friendly Hospitals' project

Cultural competence training for staff in healthcare seems one of the most widespread measures to deal with ethnocultural diversity, especially in North America. Most of the studies and experiences of this training originate from the United States; European contributions, especially from continental Europe, are rare. This paper contributes to the cultural competence discourse by presenting experiences from hospitals in eight states in the EuropeanUnion. These experiences were collected as part of the ‘Migrantfriendly Hospitals’ project, which aimed to improve the impact of hospitals on the health and health literacy of migrants and ethnic minorities in 12member states. In the part of the project reported here, cultural competence training was provided for all types of hospital staff, primarily with the intention of providing support for staff. The evaluation criteria were feasibility/acceptability, quality, effectiveness, cost-effectiveness and sustainability. Data were collected through a staff questionnaire in a ‘before and after’ design, documentation sheets, telephone interviews with project co-ordinators and group discussions at project meetings. Key findings showed that seven of the eight pilot hospitals managed to implement cultural competence training. Acceptance of the training among staff, measured in terms of participation, variedconsiderably.Variationswerealso identified in the quality of the training as measured by concordance with an agreed implementation pathway. The training had a positive impact on staff perceptions of their knowledge, skills and comfort levels in transcultural situations. The training was also considered to be cost-effective with regard to external costs, and sustainable in that it was accepted as part of continuous professional development in hospitals. Themost critical factors for implementing cultural competence training were: (1) support by management is crucial; (2) time and energy are needed to convince staff of the relevance of the training; (3) training oriented at solving the real specific problems of everyday practice is more likely to be accepted; (4) a skills-oriented design including experiential learning is useful but difficult to integrate with long working hours and changing shifts; (5) recruiting competent trainers is crucial but the profile required for an integrated, skills-oriented training is difficult to match; (6) thus, splitting the integrated trainingmodel into a short generic introduction combined with the inclusion of cultural diversity issues into the normal quality improvement routines of departments should be tested.