Cultural Assessment Tool Research Articles

The development of a safety and quality culture assessment tool from a longitudinal, mixed-method research journey

PurposeThe purpose of this paper is to describe the 16-year research and development journey of the Culture Excellence assessment tool, which is used widely to assess safety and quality culture in the food industry. It is the third article in a theme issue of Worldwide Hospitality and Tourism Themes, discussing the importance of measuring food safety and quality culture.Design/methodology/approachAn iterative process of in-depth interviews and mixed-method case studies led to the development of a conceptual model and an online assessment tool, which are used to gain insight into safety and quality culture.FindingsThe research process resulted in a conceptual model of four categories and 20 dimensions of safety and quality culture, alongside a practical online assessment tool to enable their measurement; these categories and dimensions are demonstrated using qualitative quotations.Originality/valueThis paper introduces qualitative data on safety and quality culture direct from the food industry with academic analysis to highlight new dimensions and issues. It will be of value to food safety and quality practitioners, trainers, auditors and other stakeholders involved in the food industry.

Quality and Cultural Sensitivity of Linguistically Appropriate Cardiovascular Disease Information for Chinese Immigrants

Chinese immigrants are at an increased risk for cardiovascular diseases (CVDs) compared with Chinese nationals partly because of lifestyle changes and knowledge deficits. Translated patient resources are available on the Internet and are often provided by health professionals; however, the quality and cultural sensitivity of these resources have not been reported. The aim of this study was to assess the availability, quality, and cultural sensitivity of Chinese-language information available from national "Heart Foundations" (cardiac research bodies, nongovernmental organisations) of the 5 most popular destinations of Chinese immigration. This study is a descriptive research in which national "Heart Foundation" websites were systematically searched for Chinese-language CVD patient education resources. Quality (content, identification, structure) was assessed using the Ensuring Quality Information for Patients instrument. Cultural sensitivity was evaluated using the Cultural Sensitivity Assessment Tool. From 107 identified resources, 33 were CVD specific: coronary heart disease (n = 20), arrhythmias (n = 7), and heart failure (n = 6). Quality of resources was adequate (mean Ensuring Quality Information for Patients score, 69%), but scores varied significantly (min, 60%; max, 85%). Although all resources were classified as culturally sensitive (Cultural Sensitivity Assessment Tool score ≥ 2.5), 2 resources scored low (≤2.5) for visual impact, and across all resources, written and visual domains were assessed as least culturally sensitive. Most resources lacked culturally specific references. Chinese-language CVD resources were inconsistent in the supply of key information. Quality and level of cultural sensitivity were adequate, but most resources lacked culturally specific references. Comprehensive, high-quality CVD resources powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation tailored for Chinese immigrants are urgently needed for healthcare providers to support CVD education and care of patients belonging to this population.

How much do Organizations Plan for a Positive Safety Culture? Introducing the Aviation Academy Safety Culture Prerequisites (AVAC-SCP) Tool

Safety culture has been a topic of discussion in safety literature in the past three decades. Since its first mentioning after the Chernobyl accident much have been written about what fosters a positive safety culture within organizations. The Aviation Academy of the Amsterdam University of Applied Sciences conducted a literature review into safety culture development guidelines and identified a list of 37 prerequisites for safety culture development. Existing safety culture assessment tools target to measure the subjective perceptions of the workforce without examining the parameters affecting safety culture. Thus, they cannot be used to provide the organisations with guidance on the action points for improving their safety culture. To accommodate the need for practical guidance to companies, and as part of four-year research into Aviation Safety Metrics, the Aviation Academy has developed the AVAC-SCP tool, which aims to shed light on the planning and implementation for developing a safety culture. Knowledge experts and companies have reviewed the tool as a means to meet various criteria referred to literature with regards to safety metrics. The tool will enable organisations to derive actionable points from the results. A scoring method is included in the AVAC-SCP in order provide organizations with the ability to monitor their performance over time, compare between departments, and prioritize changes. The concept, academic background, reviews and other characteristics of the AVAC-SCP are discussed.

Prostate Cancer Information Available in Health-Care Provider Offices: An Analysis of Content, Readability, and Cultural Sensitivity.

Prostate cancer (PrCA) is the most common cancer affecting men in the United States, and African American men have the highest incidence among men in the United States. Little is known about the PrCA-related educational materials being provided to patients in health-care settings. Content, readability, and cultural sensitivity of materials available in providers’ practices in South Carolina were examined. A total of 44 educational materials about PrCA and associated sexual dysfunction was collected from 16 general and specialty practices. The content of the materials was coded, and cultural sensitivity was assessed using the Cultural Sensitivity Assessment Tool. Flesch Reading Ease, Flesch-Kincaid Grade Level, and the Simple Measure of Gobbledygook were used to assess readability. Communication with health-care providers (52.3%), side effects of PrCA treatment (40.9%), sexual dysfunction and its treatment (38.6%), and treatment options (34.1%) were frequently presented. All materials had acceptable cultural sensitivity scores; however, 2.3% and 15.9% of materials demonstrated unacceptable cultural sensitivity regarding format and visual messages, respectively. Readability of the materials varied. More than half of the materials were written above a high-school reading level. PrCA-related materials available in health-care practices may not meet patients’ needs regarding content, cultural sensitivity, and readability. A wide range of educational materials that address various aspects of PrCA, including treatment options and side effects, should be presented in plain language and be culturally sensitive.

Quality and Cultural Sensitivity of Linguistically Appropriate Cardiovascular Disease Information for Chinese Immigrants: A Review of Online Resources from Heart Foundations

Background Chinese immigrants are at an increased risk for cardiovascular diseases (CVDs) compared with Chinese nationals partly because of lifestyle changes and knowledge deficits. Translated patient resources are available on the Internet and are often provided by health professionals; however, the quality and cultural sensitivity of these resources have not been reported. Objective The aim of this study was to assess the availability, quality, and cultural sensitivity of Chinese-language information available from national Heart Foundations (cardiac research bodies, nongovernmental organisations) of the 5 most popular destinations of Chinese immigration. Methods This study is a descriptive research in which national Heart Foundation websites were systematically searched for Chinese-language CVD patient education resources. Quality (content, identification, structure) was assessed using the Ensuring Quality Information for Patients instrument. Cultural sensitivity was evaluated using the Cultural Sensitivity Assessment Tool. Results From 107 identified resources, 33 were CVD specific: coronary heart disease (n = 20), arrhythmias (n = 7), and heart failure (n = 6). Quality of resources was adequate (mean Ensuring Quality Information for Patients score, 69%), but scores varied significantly (min, 60%; max, 85%). Although all resources were classified as culturally sensitive (Cultural Sensitivity Assessment Tool score ≥ 2.5), 2 resources scored low (≤2.5) for visual impact, and across all resources, written and visual domains were assessed as least culturally sensitive. Most resources lacked culturally specific references. Conclusions Chinese-language CVD resources were inconsistent in the supply of key information. Quality and level of cultural sensitivity were adequate, but most resources lacked culturally specific references. Comprehensive, high-quality CVD resources powered by Editorial Manager and ProduXion Manager from Aries Systems Corporation tailored for Chinese immigrants are urgently needed for healthcare providers to support CVD education and care of patients belonging to this population.

The safety attitudes questionnaire in Chinese: psychometric properties and benchmarking data of the safety culture in Beijing hospitals

BackgroundIn China, increasing attention has been devoted to the patient safety culture within health administrative departments and healthcare organizations. However, no official version of a patient safety culture assessment tool has been published or is widely used, and little is known about the status of the safety culture in Chinese hospitals. The aims of this study were to examine the reliability and validity of the Safety Attitudes Questionnaire in Chinese and to establish benchmark data on the safety culture in Beijing.MethodsAcross-sectional survey on patient safety culture was conducted from August to October 2014 using the Safety Attitudes Questionnaire in Chinese. Using a stratified random sampling method, we investigated departments from five integrative teaching hospitals in Beijing; frontline healthcare workers in each unit participated in the survey on a voluntary basis. The internal consistency and reliability were tested via Cronbach’s alpha, and the structural validity of the questionnaire was tested using a correlation analysis and confirmatory factor analysis. The patient safety culture in the five hospitals was assessed and analyzed.ResultsA total of 1663 valid questionnaires were returned, for a response rate of 87.9%. Cronbach’s alpha of the total scale was 0.945, and Cronbach’s alpha for the six dimensions ranged from 0.785 to 0.899. The goodness-of-fit indices in the confirmatory factor analysis showed an acceptable but not ideal model fit. The safety attitude score of healthcare workers in the five hospitals was 69.72, and the positive response rate was 38.57% overall. The positive response rates of the six dimensions were between 20.80% and 59.31%.ConclusionsThe Safety Attitudes Questionnaire in Chinese has good internal consistency, and the structural validity and reliability are acceptable. This questionnaire can be used to assess the safety culture in Beijing hospitals, but some items require further refinement. The patient safety culture in Beijing hospitals must be improved in certain key areas.

Te Waka Kuaka, Rasch analysis of a cultural assessment tool in traumatic brain injury in Māori

Background: The aim was to examine the validity of a new measure, Te Waka Kuaka, in assessing the cultural needs of Māori with traumatic brain injury (TBI). Methods: Māori from around Aotearoa, New Zealand were recruited. 319 people with a history of TBI, their whānau (extended family members), friends, work associates, and interested community members participated. All completed the 46-item measure. Rasch analysis of the data was undertaken. Results: All four subscales; Wā (time), Wāhi (place), Tangata (people) and Wairua practices (activities that strengthen spiritual connection) were unidimensional. Ten items were deleted because they did not fit the model, due to statistically significant disordered thresholds, non-uniform differential item functioning (DIF) and local dependence. Five items were re-scored in the fourth subscale resulting in ordered thresholds. Conclusions: Rasch analysis facilitated a robust validation process of Te Waka Kuaka.

Evolution of patient safety culture in a medium-stay hospital: monitoring indicators

Patient safety is a challenge for health care. The aim of this study is to identify the dimensions with the greatest impact on patient safety culture of healthcare staff in a medium-stay hospital; to asses its evolution over time and to check the sensitivity of monitoring indicators. Two cross-sectional studies (2013 to 2015) were conducted. The safety culture assessment tool used was the Spanish version of the "Hospital Survey on Patient Safety" (AHRQ). Outcome variable is high perception of safety (score = 75th percentile). socio-demographic characteristics and perceptions of the evaluated dimensions. The association between variables was quantified by Odds Ratio. The mean of perceived safety was similar in both studies: (7.81 and 7.48, N2013= 66; N2015=92). The best aspects evaluated were: "Supervisor actions" and "Teamwork within unit"; the worst evaluated were: "Staffing", "Management support" and "Teamwork across units". Socio-demographic variables had little significance, while a positive perception in some of the considered dimensions was associated with high perceived safety. The most strongly associated aspects were: "Supervisor actions", "Communication openness" and "Problems in transitions". In the comparative study, indicators based on individual dimensions detected changes better than the assessment of the degree of perceived safety. The regular assessment of Patient Safety Culture makes it possible to know the status and evolution of professionals' perceptions. The choice of appropriate indicators optimises the information obtained through these surveys.

Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: Mixed-methods results from the DSM-5 international field trial

BackgroundThere is a need for clinical tools to identify cultural issues in diagnostic assessment.AimsTo assess the feasibility, acceptability and clinical utility of the DSM-5 Cultural Formulation Interview (CFI) in routine clinical practice.MethodMixed-methods evaluation of field trial data from six countries. The CFI was administered to diagnostically diverse psychiatric out-patients during a diagnostic interview. In post-evaluation sessions, patients and clinicians completed debriefing qualitative interviews and Likert-scale questionnaires. The duration of CFI administration and the full diagnostic session were monitored.ResultsMixed-methods data from 318 patients and 75 clinicians found the CFI feasible, acceptable and useful. Clinician feasibility ratings were significantly lower than patient ratings and other clinician-assessed outcomes. After administering one CFI, however, clinician feasibility ratings improved significantly and subsequent interviews required less time.ConclusionsThe CFI was included in DSM-5 as a feasible, acceptable and useful cultural assessment tool.

Training on the DSM-5 Cultural Formulation Interview improves cultural competence in general psychiatry residents: A pilot study.

The objective of this study was to assess whether a 1-hour didactic session on the DSM-5 Cultural Formulation Interview (CFI) improves the cultural competence of general psychiatry residents. The main hypothesis was that teaching adult psychiatry residents a 1-hour session on the CFI would improve cultural competence. The exploratory hypothesis was that trainees with more experience in cultural diversity would have a greater increase in cultural competency scores. Psychiatry residents at a metropolitan, county hospital completed demographics and preintervention questionnaires, were exposed to a 1-hour session on the CFI, and were given a postintervention questionnaire. The questionnaire was an adapted version of the validated Cultural Competence Assessment Tool . Paired samples t tests compared pre- to posttest change. Hierarchical linear regression assessed whether pretraining characteristics predicted posttest scores. The mean change of total pre- and posttest scores was significant ( p = .002), as was the mean change in subscales Nonverbal Communications ( p < .001) and Cultural Knowledge ( p = .002). Demographic characteristics did not predict higher posttest scores (when covarying for pretest scores). Psychiatry residents' cultural competence scores improved irrespective of previous experience in cultural diversity. More research is needed to further explore the implications of the improved scores in clinical practice.

A Cultural Competence Organizational Review for Community Health Services: Insights From a Participatory Approach.

Cultural competence is an important aspect of health service access and delivery in health promotion and community health. Although a number of frameworks and tools are available to assist health service organizations improve their services to diverse communities, there are few published studies describing organizational cultural competence assessments and the extent to which these tools facilitate cultural competence. This article addresses this gap by describing the development of a cultural competence assessment, intervention, and evaluation tool called the Cultural Competence Organizational Review (CORe) and its implementation in three community sector organizations. Baseline and follow-up staff surveys and document audits were conducted at each participating organization. Process data and organizational documentation were used to evaluate and monitor the experience of CORe within the organizations. Results at follow-up indicated an overall positive trend in organizational cultural competence at each organization in terms of both policy and practice. Organizations that are able to embed actions to improve organizational cultural competence within broader organizational plans increase the likelihood of sustainable changes to policies, procedures, and practice within the organization. The benefits and lessons learned from the implementation of CORe are discussed.

How Effective is Cultural Competence Training of Healthcare Providers on Improving Patient Satisfaction of Minority Groups? A Systematic Review of Literature.

With the rapid growth of minority populations in the United States, the need to train healthcare providers to give culturally competent care has never been greater. Extensive research on cultural competence of healthcare providers has been conducted, but no systematic review specifically focused on the effect of cultural competence training on patient satisfaction of clients from minority groups. To search and critically appraise published research articles that evaluated the effectiveness of cultural competence training of healthcare providers on improving patient satisfaction of clients from minority groups. Using MeSH entry terms: Competency, Cultural; Cultural Competencies; Cultural Competence; Competence, Cultural; Satisfaction, Patient; and non-MeSh text words: Cultural Awareness, Cultural Sensitivity, Cultural Competence Training, Cultural Sensitivity Training, and Cultural Awareness Training, a comprehensive literature search of peer-reviewed articles from 2002 to 2014 in CINAHL, Cochrane, PsycINFO, PubMed, and Web of Science databases was conducted. Original studies that reported cultural competence training and measured its impact on patient satisfaction were included. Quality of the reviewed studies was assessed on the basis of methodological limitations related to experimental design, sample size and sampling approaches, and ethnic spread of the participants. Seven studies met the inclusion criteria. Six studies revealed that cultural competence training intervention significantly increased the cultural competence level of healthcare providers. Five studies demonstrated that cultural competence training of healthcare providers was significantly associated with increased patient satisfaction. Cultural competence training is an effective intervention that enables healthcare providers to give culturally competent care that increases satisfaction of patients from minority groups. However, more research with better research designs, large sample sizes, and validated standardized cultural competence and patient satisfaction assessment tools is needed to unequivocally attribute cultural competence training to patient satisfaction.

Elements of cultural competence in an Australian Aboriginal maternity program.

Pregnancy, labour and neonatal health outcomes for Australian Aboriginal women and their infants are frequently worse than those of the general population. Provision of culturally competent services may reduce these differences by improving access to timely and regular antenatal care. In an effort to address these issues, the Aboriginal Maternity Group Practice Program commenced in south metropolitan Perth, Western Australia, in 2011. The program employed Aboriginal Grandmothers, Aboriginal Health Officers and midwives working in a partnership model with pre-existing maternity services in the area. To identify elements of the Aboriginal Maternity Group Practice Program that contributed to the provision of a culturally competent service. The Organisational Cultural Competence Assessment Tool was used to analyse qualitative data obtained from surveys of 16 program clients and 22 individuals from partner organisations, and interviews with 15 staff. The study found that the partnership model positively impacted on the level of culturally appropriate care provided by other health service staff, particularly in hospitals. Two-way learning was a feature. Providing transport, team home visits and employing Aboriginal staff improved access to care. Grandmothers successfully brought young pregnant women into the program through their community networks, and were able to positively influence healthy lifestyle behaviours for clients. Many elements of the Aboriginal Maternity Group Practice Program contributed to the provision of a culturally competent service. These features could be considered for inclusion in antenatal care models under development in other regions with culturally diverse populations.

Effectiveness of culturally focused interventions in increasing the satisfaction of hospitalized Asian patients: a systematic review.

Patient satisfaction is a driving force for healthcare organizations to enhance patient services. As the Asian population in the United States is increasing at a significant rate, it is important to understand the needs of this population to implement culturally focused services that will lead to increased Asian in-patient satisfaction. The objective of the systematic review was to identify the best available evidence on the effectiveness of culturally focused interventions in increasing satisfaction of hospitalized adult Asian patients. This review considered studies that included Asian adults, 18 years of age and older, who were admitted to acute-care hospitals in countries where Asians are a minority culture. This review considered studies that included any intervention or sets of interventions implemented by hospitals for the purpose of making the hospital experience consistent with the cultural preferences of adult Asian in-patients. Satisfaction of adult Asian hospitalized patients as measured by self-report satisfaction scales or tools considered by accrediting and/or governing bodies to be acceptable sources of evidence of patients' perceptions of their care. This review first considered randomized controlled trials (RCTs), non-RCTs and quasi-experimental studies. As no RCTs or quasi-experimental studies were found, the reviewers also considered before and after studies, cohort studies and case-control studies for inclusion. This review also considered for inclusion descriptive study designs including case series, individual case reports and descriptive cross-sectional studies related to the adult Asian population in acute-care hospital settings. Three descriptive studies were selected in the review. The search strategy aimed to find both published and unpublished studies in English and Chinese (Mandarin and Cantonese) languages. A search of MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Educational Research Information Clearinghouse (ERIC), the Cochrane Library, the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, Scopus, Excerpta Medical Databases (Embase) and Academic Search Premier was conducted, followed by a reference search of relevant studies and a gray literature search of the Virginia Henderson Library, Google Scholar, Mednar, conference proceedings and websites. The initial key words searched were patient satisfaction, culturally focused, hospitals, Asian-American and adult. Data were extracted using a standardized critical appraisal checklist and data extraction instrument from the Joanna Briggs Institute. Due to the statistical and methodological heterogeneity between included studies, statistical meta-analysis was not possible. Results are presented in a narrative summary. Three descriptive studies were reviewed with sample sizes ranging from 107 to 19,583 and a total of 386 Asian participants. Two of the studies reported on nine measures of patient satisfaction, whereas the third provided data on four measures. The interventions identified were: communication between physician/registered nurse and patient, cultural services, Asian social workers, interpreters, and cultural food. The first study included intervention groups that were exposed to inpatient information on hospitalized Chinese cultural services compared to the "usual care" control. The percentage of patients' satisfaction in the group who knew about the services (95%) was significantly higher (p < 0.01). In the same study, patients' satisfaction with nurses was higher (95%) in patients with nurses who were aware of Chinese cultural services, compared to patients with nurses who were unaware (83%) (p < 0.01). The second study developed a survey measuring 'Level of Top Box' satisfaction of Chinese patients in Chinese unit ('Informed of Chinese Culture Service') and non-Chinese unit ('Usual Care') with the outcome measure for patient satisfaction without p value. The two studies showed an increase in Asian inpatient satisfaction with communication between the physician/registered nurse and patient, as well as with pain control and quietness of the room. Also, two studies used the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) questions as patient satisfaction surveys. The third study was a descriptive/comparative secondary analysis of HCAHPS and Cultural Competency Assessment Tool for Hospitals (CCATH) surveys. There was also no p value for patient satisfaction measurement. The design and analysis of this study was more complex, using hospital wide-cultural competency and addressing factors such as race and language ability (English and non-English speakers). The surveys completed in Chinese were less than 0.1% of the sample size and the Asian data were eliminated. This study also showed that a greater degree of cultural competence in hospitals was positively associated with patient satisfaction with doctors' communication (P < 0.05). Evidence was insufficient to demonstrate cause and effect. Results suggest that culturally competent communication with patients by physicians and registered nurses, quietness of the room, information about treatments and procedures, and cultural foods are associated with increased satisfaction among hospitalized adult Asian patients.

The Cultural Competence of Graduating Nursing Students.

Cultural competence is an essential component in nursing. The purpose of this study was to evaluate the level of cultural competence of graduating nursing students, to identify associated background factors to cultural competence, and furthermore to establish whether teaching multicultural nursing was implemented in nursing education. A structured Cultural Competence Assessment Tool was used in a correlational design with a sample of 295 nursing students in southern Finland. The level of cultural competence was moderate, and the majority of students had studied multicultural nursing. Minority background (p = .001), frequency of interacting with different cultures (p = .002), linguistic skills (p = .002), and exchange studies (p = .024) were positively associated to higher cultural competence. To improve cultural competence in students, nursing education should provide continuous opportunities for students to interact with different cultures, develop linguistic skills, and provide possibilities for internationalization both at home and abroad.

The advance of cultural competency assessment tool in nurses

Multicultural nursing starts late in our country. At present, the domestic scholars' research is focusing on the influencing factors of multi-cultural nursing ability and cultivating mode. There are few studies pay attention to the cultural competency assessment tool which is limited to nursing students in school. I believe that establishing evaluation tools that suit our national condition, efficient and comprehensive will help reflecting the multicultural nursing ability and the training effect objectively and also promoting the development of multi-cultural care in China. Key words: Multicultural care; Assessment tools; Progress

Cultural Competence Among Italian Nurses: A Multicentric Survey

To assess Italian nurses' cultural competence, as they are increasingly called upon to care for people of foreign origins. A cross-sectional, multicentric study. From September 2013 to May 2014, a survey was carried out among Italian nurses. Cultural competence was assessed by the Cultural Competence Assessment tool, translated and adapted to the Italian context. Nurses who completed the survey numbered 1,432; 70.6% were female; 42.6% ranged in age from 41 to 50 years; and 50.0% were bachelor's prepared. More than 50% had participated in some kind of cultural diversity training. Overall, cultural competence was moderate, showing a moderately high level of cultural awareness and sensitivity (mean = 5.41; SD = 0.66) and a moderate level of culturally competent behaviors (mean = 4.33; SD = 1.10). Although Italian nurses' cultural competence was acceptable, given the growing diversity of the patient population, nurses should be better prepared to face the changing health requests. Providing culturally competent care has been associated with improved provider-client communication, higher satisfaction with care, and health status improvement, as full comprehension of health status, adherence to medications and lifestyle recommendations, and appropriate utilization of the health system. Healthcare providers need to be adequately trained to provide culturally competent care. This research provides, for the first time, a report on Italian nurses' levels of cultural competence, and strengthens the current literature underlining the need for continuous education to enhance cultural competence among nurses.

An Extended Validity Argument for Assessing Feedback Culture

NEGEA 2015 CONFERENCE ABSTRACT (EDITED)Measuring an Organization's Culture of Feedback: Can It Be Done?Steven Rougas and Brian ClyneConstruct: This study sought to develop a construct for measuring formative feedback culture in an academic emergency medicine department. Four archetypes (Market, Adhocracy, Clan, Hierarchy) reflecting an organization's values with respect to focus (internal vs. external) and process (flexibility vs. stability and control) were used to characterize one department's receptiveness to formative feedback. The prevalence of residents' identification with certain archetypes served as an indicator of the department's organizational feedback culture. Background: New regulations have forced academic institutions to implement wide-ranging changes to accommodate competency-based milestones and their assessment. These changes challenge residencies that use formative feedback from faculty as a major source of data for determining training advancement. Though various approaches have been taken to improve formative feedback to residents, there currently exists no tool to objectively measure the organizational culture that surrounds this process. Assessing organizational culture, commonly used in the business sector to represent organizational health, may help residency directors gauge their program's success in fostering formative feedback. The Organizational Culture Assessment Instrument (OCAI) is widely used, extensively validated, applicable to survey research, and theoretically based and may be modifiable to assess formative feedback culture in the emergency department. Approach: Using a modified Delphi technique and several iterations of focus groups amongst educators at one institution, four of the original six OCAI domains (which each contain 4 possible responses) were modified to create a 16-item Formative Feedback Culture Tool (FFCT) that was administered to 26 residents (response rate = 55%) at a single academic emergency medicine department. The mean score of each item on the FFCT (range = 0–100) was analyzed. Convergent and divergent properties of the four archetypes were assessed using a multitrait–multimethod matrix of Pearson's coefficients. Expecting that items in one archetype would diverge from the others, whereas items within an archetype should have strong convergent properties, convergent validity was assessed by comparing items across domains that all related to the same archetype. Similarly, divergent validity was assessed by comparing the correlation of items within an archetype to the correlations of those items within a hetero-domain block (i.e., to other items within the same domain). Results: Three of the four domains of the FFCT (Overall Departmental Characteristics 35.4 ± 15.4, Departmental Foundation of Feedback 46.1 ± 16.7, and Departmental Emphasis of Feedback 30.3 ± 17.7) had the highest mean in the Market archetype (results/achievement oriented), whereas the final domain (Departmental Definition of Successful Feedback 34.8 ± 22.1) had the highest mean in the Clan archetype (personal growth/team achievement). Item responses in the Clan and Hierarchy archetypes had the strongest convergent and divergent validity, respectively. Item responses in the Adhocracy archetype had the weakest convergent and divergent validity. Conclusions: Although the sample size was small, this initial study demonstrates that a modified organizational culture assessment tool can feasibly be utilized to identify the primary formative feedback archetype of a cohort of residents. This may have future implications for measuring changes in culture after the implementation of strategic programs to address formative feedback. Future studies should examine the generalizability of the FFCT to other institutions, as well as address the weak validity evidence of the Adhocracy archetype in the FFCT.

Abstract A55: Racial differences in cultural values for cancer prevention and control: Fact or fiction

Abstract Background: Attention to cultural beliefs and values is a critical component of culturally competent cancer care for prevention, treatment, and control among all individuals. Yet, culturally tailored interventions have only been developed for racial and ethnic minorities. This is because cultural beliefs and values for cancer behavioral outcomes have only been ascribed to and evaluated in racial and ethnic groups. Objective: The purpose of this study was to evaluate racial and ethnic differences in cultural beliefs and values related to religiosity, collectivism, individualism, and past and present temporal orientation for cancer prevention and control (CPC) in a national random sample of African Americans, whites, and Hispanic adults (n=1699). Respondents completed the Multi-Dimensional Cultural Values Assessment Tool (MCVAT) to assess cultural beliefs and values for CPC. Results: There were significant racial/ethnic differences only in religious beliefs and values for CPC. Compared to whites, African Americans (Coefficient=3.75, p=0.001) and Hispanic (Coefficient=2.42, p=0.001) reported significantly greater religiosity. In addition, religious values were higher among respondents who were female (Coefficient=1.10, p=0.01), those who were high school graduates or had less education (Coefficient=-1.87, p=0.001), and respondents who had incomes less than $50,000 (Coefficient=-2.23, p=0.001). Education had a similar association with collectivist values (Coefficient=-1.01, p=0.01), but only the comparison of Hispanics versus whites had a significant association with these values (oefficient=0.76, p=0.04), individualistic values for CPC (Coefficient=1.04, p=0.001), and past (OR=1.85, 95% CI=1.28, 2.68, p=0.001) and present temporal orientation (OR=1.72, 95% CI=1.21, 2.44, p=0.003). Conclusions: With the exception of religiosity, there are few differences in cultural beliefs and values for CPC between African Americans, whites, and Hispanics. Endorsement of cultural beliefs and values should not be assumed based on racial and ethnic group membership. Rather, cultural beliefs and values for CPC should be evaluated individually among patients and at-risk groups to provide culturally competent cancer care. Citation Format: Melanie Jefferson, Jodie Riley, Lashanta Rice, Chanita Hughes-Halbert. Racial differences in cultural values for cancer prevention and control: Fact or fiction. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr A55.

Measurement tools and process indicators of patient safety culture in primary care. A mixed methods study by the LINNEAUS collaboration on patient safety in primary care

ABSTRACTBackground: There is little guidance available to healthcare practitioners about what tools they might use to assess the patient safety culture.Objective: To identify useful tools for assessing patient safety culture in primary care organizations in Europe; to identify those aspects of performance that should be assessed when investigating the relationship between safety culture and performance in primary care.Methods: Two consensus-based studies were carried out, in which subject matter experts and primary healthcare professionals from several EU states rated (a) the applicability to their healthcare system of several existing safety culture assessment tools and (b) the appropriateness and usefulness of a range of potential indicators of a positive patient safety culture to primary care settings. The safety culture tools were field-tested in four countries to ascertain any challenges and issues arising when used in primary care.Results: The two existing tools that received the most favourable ratings were the Manchester patient safety framework (MaPsAF primary care version) and the Agency for healthcare research and quality survey (medical office version). Several potential safety culture process indicators were identified. The one that emerged as offering the best combination of appropriateness and usefulness related to the collection of data on adverse patient events.Conclusion: Two tools, one quantitative and one qualitative, were identified as applicable and useful in assessing patient safety culture in primary care settings in Europe. Safety culture indicators in primary care should focus on the processes rather than the outcomes of care.