UCLA Medical Center Cultural Liaisons Program: Managing Cultural Conflicts in the Clinical Setting

May 27, 2002

Program History

In 2000, UCLA Medical Center created a new volunteer opportunity for staff and managers within the medical center. With a highly diverse clientele and an active recruitment of patients from other countries throughout the world, UCLA was faced with the need to address conflicts in the clinical setting that have a cultural component. An innovative program was developed with collaboration between the Department of International Relations and the Department of Nursing. Volunteers were solicited from all Medical Center departments. These volunteers were appointed by their supervisors to serve as ‘ambassadors’ for enhancing cultural understanding within their department. They also provide feedback to the institution about cultural competency needs and, in turn, are trained to meet these needs and fulfill the requirements of their role. Their role was officially dubbed “Cultural Liaisons.” The goal of the program is to improve communication and cooperation between employees and patients with a focus on managing differences between the patient’s culturally-based behaviors and the requests or preferences of the UCLA Medical Center staff.

Based on the input of the Cultural Liaisons, one of their greatest needs is in facilitating episodic culturally-influenced conflicts. The Cultural Liaisons requested more information about particular cultures. UCLA Medical Center’s multi-cultural patient population and world-wide referral status made it difficult to predict which cultures would present at any given time. The response by the medical center was two-fold: provide basic educational tools for facilitating conflict that are useful with any conflict situation including culturally-influenced situations, and, provide on-the-spot “cultural consultations.” To accommodate the need for cultural consultations, the role of the “Cultural Advisor” was born.

Cultural Advisors

UCLA’s own multi-cultural employee base made it easy to solicit a new group of volunteer Cultural Advisors who could assist the Cultural Liaisons with obtaining advice about particular cultures when needed. However, before expecting the Cultural Advisors to ‘jump in’ to unfamiliar settings and situations, their role was carefully crafted and they were trained with the Liaisons on the division of their respective responsibilities. A total of fourty-four Cultural Advisors were selected to participate representing 20 different cultures.

The process of how Cultural Liaisons and Advisors interface is carefully defined. Liaisons seek advice and work with their unit-based colleagues on the conflict and utilize Advisors only for advice on the particular culture without involving them directly in the conflict. In this manner, Liaisons hope to better understand the sources of the conflict in order to improve communication and enhance the probability of a successful outcome.

The Cultural Liaison’s Role

The Cultural Liaison’s role includes attending seminars and educational events, assessing the unit’s cultural competency needs, pro-actively identifying issues in the unit, conducting training programs for unit staff, using a multi-disciplinary and team-building approach to identify solutions to culturally-based issues, make proper referrals, and network with other liaisons and advisors. The skills of the liaisons are described as:

Value and respect cultural differences
Demonstrate leadership potential via teaching, role-modeling and facilitation
Demonstrate interest in diversity issues, international relations, and intercultural issues
Express an interest in volunteering, show motivation to assist with the unit’s culturally-related patient needs
Serve as a facilitator between the unit and other employees, the employees and the patients
Demonstrate knowledge of medical center policies and procedures
Demonstrate an ability to teach cross-cultural communication and conflict/mediation skills

There are currently 115 volunteers serving in the role of Cultural Liaison. They represent a variety of departments, all of which have face-to-face contact with patients. Contact by the Liaisons with the patients includes everything from the first encounter with the admissions staff to final encounters with patient billing staff. Nursing units are well-represented with a goal of a Cultural Liaison on every unit. The support of the Director of Nursing, Heidi Crooks, has been essential to the success of the program and the level of participation within the nursing units.

Training Programs

Thus far, two full-day training programs have been held. The first dealt largely with an orientation to cultural competency. Attitudes of healthcare employees regarding conflict and aversion to conflict situations were covered. Actual conflicts from the clinical setting were incorporated to develop the liaisons’ skills in managing real life situations. Mind expanding examples and exercises are used to demonstrate occasions when ‘our’ rules conflict with the patient’s/family’s view and how the rules can violate a patient’s interests or values in various situations. A particular example is the dilemma with the legal requirements related to informed consent vs. the cultural need for family to keep information from the patient. In some cultures it is believed that health information could be harmful to the patient’s ability to heal. Additionally, within some cultures it is common for someone within the family to make the decisions regarding care and a request is made for all information to be channeled through the patient’s family representative rather than the patient. Legal constructs dictate that patients be fully informed of risks and benefits of treatment decisions in order to consent to treatment. These types of dilemmas are quite common.

One of the goals of the training sessions is to develop a certain camaraderie between Cultural Liaisons and a sense of authority for developing their own unit-based cultural competence programs. To encourage this, information can be exchanged between Liaisons via email, supervisors are contacted separately to help develop the role, feedback is solicited, and training materials are developed for use by the liaisons in staff meetings on their units.

Future of the Program

Since the organizational system for this program is now complete, the future direction for the program revolves around promoting its availability to all hospital staff, not just for use by the Liaisons. Staff will be encouraged to discuss issues with their Liaison and to solicit a ‘cultural consultation’ whenever necessary.

The future of the training program has taken an interesting turn since the program was started. The original thought was to provide basic mediation training to the liaions. The concept of developing fully trained mediators became impractical, based on time and resource constraints for both training and time commitments on the job. At the same time, there is a desire to reduce tension when some of the most inflammatory types of conflict occur, posing tremendous burdens for an organization if they are not curtailed at the outset. This type of prevention does not require extensive training, but it does require conflict facilitation skills that can be used and applied in an extremely fast-paced environment. An additional training day is now in the planning stages to provide the liaisons with hands-on practice with facilitating actual conflicts.

All signs point to a successful outcome of the training efforts with an emphasis on ensuring staff are fully trained and promotion of the program across the organization. Assessments by the ‘trainees of the training are extremely high. They obviously feel better equipped to deal with situations for which they have had some training in the past. The next training session will provide more of a workshop setting for staff to learn how to quickly apply skills in real-life situations.