Cultural Competency and its Effect on Job Satisfaction in the Imaging Department By Alyssa Cohen Ben Gardner Kendra Olson Libby Parr Maurisa Pulsipher Annabelle Seamons Jessica Stephens Amy Warnick A thesis submitted to the School of Radiologic Sciences in collaboration with a research agenda team In partial fulfillment of the requirements for the degree of MASTER OF SCIENCE IN RADIOLOGIC SCIENCES (MSRS) WEBER STATE UNIVERSITY Ogden, Utah December 15, 2023 2 THE WEBER STATE UNIVERSITY GRADUATE SCHOOL SUPERVISORY COMMITTEE APPROVAL of a thesis submitted by Alyssa Cohen Ben Gardner Kendra Olson Libby Parr Maurisa Pulsipher Annabelle Seamons Jessica Stephens Amy Warnick This thesis has been read by each member of the following supervisory committee and by majority vote found to be satisfactory. ______________________________ Dr. Tanya Nolan, EdD Chair, School of Radiologic Sciences ______________________________ Dr. Robert Walker, PhD Director of MSRS Innovation & Improvement 3 THE WEBER STATE UNIVERSITY GRADUATE SCHOOL RESEARCH AGENDA STUDENT APPROVAL of a thesis submitted by Alyssa Cohen Ben Gardner Kendra Olson Libby Parr Maurisa Pulsipher Annabelle Seamons Jessica Stephens Amy Warnick This thesis has been read by each member of the student research agenda committee and by majority vote found to be satisfactory. Dec 14, 2023 ______________________ Dec 17, 2023 ______________________ ______________________ Jan 7, 2024 ______________________ ______________________ Jan 8, 2024 ______________________ Alyssa Cohen Alyssa Cohen (Dec 14, 2023 18:57 EST) ____________________________________ Alyssa Cohen Benjamin J. Gardner ____________________________________ Ben Gardner Benjamin J. Gardner (Dec 17, 2023 17:32 MST) ____________________________________ Kendra Olson Libby Parr ____________________________________ Libby Parr Libby Parr (Jan 7, 2024 11:49 MST) ____________________________________ Maurisa Pulsipher Annabelle Seamons ____________________________________ Annabelle Seamons Annabelle Seamons (Jan 8, 2024 10:06 MST) Jessica Stephens Jan 5, 2024 ______________________ Jessica Stephens (Jan 5, 2024 17:21 MST) ____________________________________ Jessica Stephens Jan 5, 2024 ______________________ Amy Warnick (Jan 5, 2024 17:48 MST) ____________________________________ Amy Warnick 4 Abstract Cultural competency is a topic of increasing importance in healthcare due to the ever growing number of minority groups in the United States. In the imaging department, staff often feel the need for greater institutional support for patients of differing cultures by providing more resources like cultural competency training for staff and access to translators. This research hopes to distinguish that there is a direct correlation between cultural competency training in the imaging department and employee job satisfaction. In this quantitative study, 130 certified imaging personnel of varying modalities were surveyed on cultural competency and its effect on job satisfaction. The subjects were composed of varying ages ranging from 18-70 years old, all of whom live within the United States, and are currently practicing within a medical imaging department or facility. The results of the survey showed only a small correlation indicating that cultural competency is important to staff, with most imaging employees feeling they are already culturally competent. However, there was a high correlation between imaging personnel’s desire for respectful recognition and organizational support contributing to job satisfaction. The latter two aspects are thus incredibly important to imaging employees, while cultural competency is valued, but not as significant to their job satisfaction. There was a notable difference in the importance of cultural competency at a higher age range than a younger age range, however this result may be skewed because there was a significantly larger number of older personnel taking the survey. No significance was 5 perceived between cultural competency and years worked in the field or weekly hours worked by imaging staff. Based on the results of this survey, it can be concluded that imaging employees do not currently feel a correlation between their job satisfaction and cultural competency. However, the participants of this survey were 88.5% of white ethnicity and felt they were already culturally competent. Given the vital importance of cultural competency in today’s society, perhaps future research should evaluate how culturally competent these imaging employees actually are and what education they are in need of. To accurately measure cultural competency and job satisfaction, a more broad ethnicity background is likely needed among future surveyors. 6 Acknowledgements We would like to express our deepest appreciation to Dr. Tanya Nolan for her guidance. This endeavor would not have been possible without her help and her influence. We are grateful to Dr. Laurie Coburn and Dr. Ambree Penrod for their individual contributions to this project. We would also like to acknowledge all the participants who took our survey. Without which we would not have been able to conduct this research. And lastly, we would like to thank all of our friends and family for the love, support, and encouragement along the way. 7 Table of Contents Chapter 1: Introduction Statement of the Problem Purpose of the Study Research Questions Nature of the Study Significance of the Study/Definition of Key Terms Chapter 2: Literature Review Cultural Competency Cultural Competency Education and Training Barriers of Cultural Competency Training Culturally Competent Staff Improves Team Dynamics Job Satisfaction/Culturally Competent Management Summary Chapter 3: Research Method Introduction Research Methods and Design/Population Sample/Materials/Instruments Operational Definition of Variables Data Collection, Processing, and Analysis/Assumptions Limitations/Delimitations/Ethical Assurances Summary Chapter 4: Findings Introduction Results Evaluation of Findings Summary Chapter 5: Implications, Recommendations, and Conclusions Implications Recommendations 3 3 4 5 6 8 8 11 15 19 22 24 25 25 26 27 28 30 31 33 34 34 44 45 48 48 50 References Appendices 66 Appendix A: Survey Instrument 66 Appendix B: IRB Approval 70 8 List of Figures Figure 1. Ethnicity…………….……………………………………………………………35 Figure 2. Age.………………………………………………………………………………35 Figure 3. Cultural Knowledge………………………………………………………...37 Figure 4. Cultural Skills…………………………………..…………………………..38 Figure 5. Cultural attitudes……………………………………………………………39 Figure 6. Cultural competence………………………………………………………..39 Figure 7. Employee Satisfaction……………………………………………………...41 Figure 8. Respectful Recognition…………………………………………………….41 Figure 9. Organizational Support.……………………………………………..……..42 Figure 10. Cultural competence vs. Job Satisfaction………………………………...43 Figure 11. Age and Cultural Competence……………………………………………43 Figure 12. Employee Satisfaction and Facility Size…………………………………44 Figure 13. Respectful Recognition and Facility Size.……………………………….44 Figure 14. Organizational Support and Facility Size.…………………………………...45 1 Chapter 1: Introduction Cultural competency developed, integrated, and practiced among healthcare professionals has significant impacts on employee and patient satisfaction. Little effort is required to identify examples of failure on the part of the organization, the employee, and/or the patient which have led to an inappropriate or disappointing outcome. Most recently, a technologist shared an experience with a Hispanic patient who was diagnosed with COVID-19. An echocardiogram was ordered, and upon entering the patient’s room, the technologist was informed the patient only spoke Spanish. The technologist did not speak Spanish, and the nurse could not either. As a result, the technologist attempted to locate a hospital issued Ipad with language translation software. After several minutes, an Ipad could not be located. Therefore, on-site interpretive services were called by phone. Unfortunately, because the patient had COVID-19, the interpreter could not be arranged because the company policy prohibited the interpreter from entering the room. In the end, the only option the technologist had was to complete the exam as best they could using hand signals and simplified English. In reflecting on this technologist’s experience, one could easily observe a disconnect between training for cultural competency, interpretation of cultural competency, and having enough resources to implement cultural competency whereby all parties were served and satisfied. Healthcare professionals are under extreme pressure and high workloads. The practice of cultural competency, which may feel unnatural and arduous, will require intentional effort and supportive resources from healthcare teams, management, and organizations. Having correct and adequate supplies and tools is important to both healthcare professionals and patients. 2 The United States is a melting pot of cultural diversity. Healthcare workers serve diverse patient populations with a variety of backgrounds, languages, cultures, traditions, religions, socioeconomic status, orientations, and ideologies. Healthcare professionals altruistically want to and strive to provide the same standard of care for each patient, but a lack of education, resources, and supporting policies often thwart the professional’s ability to comfortably and proficiently maintain the highest level of care across diverse populations. Patients place their lives in the hands of healthcare professionals on a daily basis. Cultural competency is a window through which healthcare professionals can build patients’ trust and understanding to serve the whole patient and not just the pathology or injury. This study is designed to describe and correlate healthcare workers’ cultural competence with healthcare employees’ satisfaction. Cultural competency has a significant impact on how diverse staff feel going to work and whether they feel accepted. In being satisfied with the job, a professional often has an increased capacity and desire to do well at their job. However, successful implementation of any program or behavior requires a clear definition of cultural competency, what it entails, and how it may be adequately implemented. A lack of cultural competence among healthcare employees directly affects the quality of care given. In a study performed at BMC Health Services, researchers sought to determine how comfortable employees were in providing care for patients from other cultures. Participants were asked to describe how satisfied they were with their own perceived level of cross-cultural knowledge, and it was found that under 15% of participants reported being ‘extremely satisfied’ with their level of knowledge. 3 Researchers at BMC warned that as diversity within patient populations grows, a lack of training in implementing principles and behaviors of cultural competence may result in healthcare employees feeling continuously inadequate. This sense of isolation and lack of esteem or self-efficacy may interact with employees’ sense of satisfaction and resilience because support and community are key factors for both variables (Shepherd, 2019). The question to be weighed and considered is how can training be implemented and cultural competence be evaluated? Statement of the Problem By 2044, it is projected that minorities will become the majority population in the United States for the first time (Colby, 2015). Cultural competence is the ability to understand an individual or group's values, beliefs, norms and way of life (Cai, 2016). This is an essential skill for an employee in the healthcare industry to develop. Healthcare providers seek to create culturally safe environments wherein patients feel able to participate in their health journey and have trust in their imaging providers. However, inadequate cultural competency training and resources hinder the best and standardized care for each and every patient. This may be a two-tiered problem because cultural competency training and resources are required for both imaging staff and managers who are at the forefront of developing and implementing policy that may or may not support culturally sensitive practices. As a result, many imaging technologists feel they lack the necessary training, skills and confidence to effectively provide culturally sensitive care for their increasingly diverse patient populations which is an inadequacy directly related to diminutive selfefficacy and employee satisfaction. 4 Purpose of the Study The purpose of this quantitative study is to measure and correlate the current level of cultural competency acquired by professionals within the imaging profession to their level of employee satisfaction. In this study, we will develop an electronic survey for a minimum of 100 imaging professionals in different modalities to gather data about individual and collective levels of cultural competency as determined by independent sub-variables including knowledge, skills, and attitudes. All subjects will be between the ages of 18-70 years, who are currently employed at medical facilities. It is postulated that higher levels of cultural competency will be directly related to higher levels of employee satisfaction. If proven, this relationship supports the development of additional training and resources to assist in individual and organizational competency. Research Questions We seek to explore through descriptive analysis the demographics of our sample as related to the independent and aggregate variable, cultural competency. We also seek to understand the relationships between our predictor variable cultural competency and criterion variables employee satisfaction. Each variable will be measured according to several statements expressed along a Likert Scale with enough data points necessary to ensure a scalar relationship. Q1. What level of cultural competence, as measured by participant’s knowledge, attitudes, and skills, is present among Medical Imaging Professionals? H10. Medical imaging professionals have no measurable level of cultural competence. 5 H1a. Medical imaging professionals have a low level of measurable cultural competence. Q2. How are cultural competence knowledge, skills, and attitudes independently related among Medical Imaging Professionals? H10. Cultural competence variables of knowledge, skills, and attitudes have no relationship. H1a. All variables of cultural competence have a positive relationship. Q3. How does cultural competence relate to employee satisfaction among Medical Imaging Professionals ? H10. Cultural competence does not relate to employee satisfaction. H1a. Cultural competence and employee satisfaction have a positive relationship. Nature of the Study The nature of our study is to understand whether those currently employed in the imaging profession have acquired a level of cultural competence and how this competency may be related to their employee satisfaction. The theoretical foundations of this study were determined through examination of scholarly articles, health journals, and current imaging professional surveys published within the last 10 years. Similar to several researchers, a survey will be designed and used to measure variables related to cultural competence and employee satisfaction. Sub-variables are defined and aggregate values will be used to measure diffuse aspects of both independent and dependent variables. The surveys will include nominal and scalar data, generally measured on a Likert Scale. Although cultural competence and employee satisfaction 6 have been measured in previous literature, our study is unique in both its sample and in determining the relationship between each complex and defined variable. Significance of the Study This study is a key to understanding the importance of cultural competency within an imaging department as it relates to employee satisfaction. If related, results of the study provide support for an intentional focus on the development and practice of skills, knowledge, and attitudes related to cultural competency within an imaging department. It is possible that some data may reveal challenges and/or deficits regarding the development of cultural competency. However, if such challenges may be resolved, improved cultural competency within imaging departments may support better patient care, understanding, and self-efficacy resulting in improved employee satisfaction. Definition of Key Terms Cultural competency. Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations (Betancourt et al., 2002). Cultural Knowledge: Cultural knowledge is an understanding of cultural characteristics, history, values, beliefs, and behaviors of another ethnic or cultural group or community (Brownlee, n.d.). Cultural Skills: Cultural skills, including language and interpersonal skills, are skills necessary to be fully proficient as a health care professional competent in serving persons with diverse cultural backgrounds. 7 Cultural Attitudes: A health care professional’s unconscious and underlying attitudes and assumptions that affect interpersonal relationships and responses to a patient’s health journey. Employee Satisfaction: a feeling of fulfillment or enjoyment that a person derives from their job supported through variables of respectful recognition and organizational support. (Oxford University, n.d.). Respectful Recognition: Respectful recognition is the means whereby employees are compensated, rewarded, and listened to in a personal, meaningful, and genuine manner. Organizational Support: Organizational support is demonstrated through appropriate resources, teamwork, collaboration, communication, policy, and procedures that uphold and maintain the role and values of the health professionals and patient care. 8 Chapter 2: Literature Review Minority racial and ethnic groups that make up the minority population, will compromise an estimated 56.4% of the US population in the year 2044 (Colby & Ortman, 2015). Therefore, diversity training within higher education and other working institutions have been incorporated as means to develop and increase confidence of individuals working with a more diverse population. Brown et al. submits that “the healthcare workforce must be prepared to provide culturally relevant, patient-centered services” (Brown et al., 2021, p.78). As healthcare professionals gain confidence in cultural competence, these skills will increase their self-efficacy and satisfaction both individually, among their peers and patients, and within their organizations. Cultural Competency Cultural competency is a subject that has been gaining more attention throughout the years in the healthcare industry. With patient care as a number one priority, professionals have been asked to look at the quality of the care that is received by all patients within a community, especially those who may not closely relate to the dominant culture. Our study will look at how cultural competency can be developed, integrated, and practiced and how this practice of knowledge can impact employee and patient satisfaction. In order to do this, cultural competence must clearly be defined because it is multifaceted and has been the subject of continuous modification and adaptation throughout the decades. In a concept analysis, Henderson, Hills, and Horne (2018) suggest that effective healthcare management and decreased health inequalities could be achieved if clarity on the subject were improved. 9 Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations (Betancourt et al., 2002). Expanding on this idea, Georgetown University (2004, p. 1), compiled and reviewed several definitions of cultural competency. First, they defined culture as "the integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values and institutions of a racial, ethnic, religious or social group”. Next, competence was defined as "the capacity to function effectively" (Georgetown University, 2004, p.1). Based on these definitions, healthcare professionals may ask themselves how they might or might not effectively think, communicate, and act in regards to the customs, beliefs and values of their patients. In truth, much of what is required for cultural competence must be done at a personal level. In a study completed nearly 20 years ago, Denboba in 1993 advocated that individuals must examine their own “attitude and values, and the acquisition of the values, knowledge, skills and attributes that will allow [them] to work appropriately in cross cultural situations” (Georgetown University, 2004, p.3). Denboba then shared four traits of culturally competent individuals including the ability to value persons’ similarities and differences, engage in individual and organizational cultural self-assessment, flexibly adapt services to individual needs, and institutionalize a level of cultural knowledge and competence. (Georgetown University 2004, p.3). In short, cultural competency in healthcare is how an individual professional understands their patient, the needs of their patient, and is able to effectively provide those needs in a manner that is acceptable to the organization and the patient. As imaging 10 professionals, self-assessment requires a hard look at whether each patient’s needs are understood, whether resources are available for flexible and effective treatment, and whether each interaction between patient and professional is deemed satisfactory by all involved. Changing the system and creating a systemically institutionalized culturally competent organization will require several adaptations and training throughout a professional’s career. These include, but are not limited to, exposing students to principles of cultural competency early in their education, improving workplace communications, providing culturally immersive activities including humanitarian service, thoughtfully acquiring and using of organizational resources, measuring accountability and satisfaction, and thoughtfully employing diverse hiring practices. Within the next two decades, the minority populations within the United States will surpass the current majority (Colby & Ortman, 2015). Waiting to address cultural competence within healthcare risks widening the gap of trust that connects each imaging professional to their patients. Delayed action is likely to cause disastrous outcomes in regards to patient and employee satisfaction. "The lack of cultural capacity in health professionals, constant social changes, and the intense development of multiculturalism leads to the growing and intense inequality and marginalization of minorities or vulnerable groups receiving quality and effective health care services" (Argyriadis et. al, 2022, p.2). The earlier that healthcare professionals are exposed to cultural competency in their education, the more clearly they can understand the demands of competence and become proficient. In a study done by the Agency for Healthcare Research and Quality 11 (2014, p.1) they stated, "A lack of conceptual clarity around cultural competence persists in the field and the research community. There is confusion about what cultural competence means, and different ways in which it is conceptualized and operationalized. This confusion leads to disagreement regarding the topic areas and practices in which a provider should train to attain cultural competence.” Though definitions differ from one organization to the next, the fact that cultural competency is an issue which warrants our attention is unanimous. "We all win when we endeavor to understand the social and cultural constructs within which we practice our given professions" (Lytle, 2023, p.4). Hence, it is time to “walk in another person’s shoes” and seek out opportunities to understand the community at large. "Cultural humility is best defined not by a discrete endpoint but as a commitment and active engagement in a lifelong process that individuals enter into on an ongoing basis with patients, communities, colleagues, and with themselves" (Georgetown University, 2004, p.3). Cultural Competency Education and Training Building imaging professional’s confidence in cultural competency begins early within their educational programs. Schools provide a safe environment for simulation and discussion whereby imaging professionals learn best practice in handling situations that require knowledge of cultural sensitivities and preferences. Didactic curriculum for imaging professionals should include topics of inclusion, diversity, antiracism, and equity (Alli et al., 2023). According to Brown et al. (2021, p. 78), “diversity in higher education and the workforce means being open to differences in races, ethnicity, cultural norms, language, communication style, gender, sexual orientation, physical appearances or 12 abilities, and age”. Beyond knowledge, a culturally competent professional will be able to utilize their knowledge to access resources and effectively serve and communicate with diverse patients. Nontraditional means of providing culturally competent education is through study abroad, service, and humanitarian cultural experiences. Humanitarian missions offer opportunities whereby a learner is immersed within a different culture in which they develop an understanding of others and build trust among different persons. These experiences are often life changing and serve to teach several life lessons, including adaptation. Often, participants face challenges that include working within unfamiliar areas, having reduced resources, communication issues, and culture shock. In the end, these challenges work to instill a level of cultural competency and the overall benefits that far outweigh any negative impacts. During humanitarian missions, healthcare professionals witness first-hand the challenges that communities and patients face from day to day within varying countries and circumstances. To be successful, a healthcare volunteer must put aside personal biases and remove preconceived notions that keep them from fully embracing a new culture. Cultural humility, as mentioned earlier, includes acknowledging diversity and having an awareness of the beliefs and needs of the people being served. It is extremely important to treat patients with respect and learn about the culture before arriving at the location. Often, healthcare volunteers have opportunities to observe ceremonies, learn new languages, and build rapport with the people they serve. Most volunteers return to their own community having formed bonds of respect and love for the people they 13 served, making it easier for them to incorporate similar skills and attitudes needed to adjust to and effectively serve diverse patients in their normal work environments. There are many opportunities for healthcare workers to do humanitarian work. Although many professionals focus on service abroad, there are numerous opportunities to serve closer to home. During the Covid 19 pandemic, nurses from local hospitals were asked to travel to New York City to help healthcare workers with their surge of Covid 19 patients. These hospitals were severely understaffed and overwhelmed, and although targeted hospitals were located within the same country, volunteers were forced to adjust to varying hospital cultures. Indeed, the policy, practices, and attitude of patients differs across the country and throughout the world. Another example of outreach efforts during the Covid-19 pandemic includes the incredible response of healthcare workers to meet the needs of the Navajo nation within Arizona, Colorado, New Mexico, and Utah. On reservations, water, medicine, vaccinations, and other essential resources were in high demand. Multiple organizations and individuals responded and served these persons with respect to them and their cultural beliefs and traditions. One member of this research team served a humanitarian mission in 2012. In reference to this experience, the researcher found the mission provided her means to learn, grow, and develop compassion for others. While abroad, she served in the radiology department on the USNS Mercy. While serving on this Navy ship, she was responsible for taking all of the chest radiographs for the patients who came aboard. Tuberculosis was predominant in this part of the world, and all patients had to be screened before coming aboard. Members of the humanitarian team learned basic language skills to help them communicate with patients. When patients felt a sense of 14 familiarity with healthcare volunteers, communication and trusting relationships were easier to develop. Through this immersive process, members of the humanitarian team found joy in serving people who were dependent on the skills and help that they provided. As detailed above, communication is key to professional, safe, and satisfactory experiences for patients and healthcare professionals. Resources are provided within healthcare institutions to assist better communication between patients and professionals who experience language barriers. Some of these resources include iPad translation apps and professional medical translators. Panayiotou et al. (2019) suggested that technology improves daily communication between staff and patients. Although technology is a useful tool, there are also some disadvantages to solely using electronic options for translation. For example, some iPad translation resources do not include all the languages or may incorrectly translate some communications. Abdulai et al. (2019) states that iPad translation apps should not be used in lieu of professional translators and recommends these tools as aids. Some imaging professionals use unconventional ways of communicating when faced with communication barriers. Unfortunately, these creative means of communication may lead to false or misleading directions or interpretations. Some of these unconventional ways include using family members as translators, trying to communicate nonverbally with hand gestures, and using other nonprofessional translators. When family members act as translators between health provider and patient, there is a possibility of miscommunication (Abdulai et al., 2019). Other health professionals are using a “getting by” approach which also leads to inadequate care 15 (Panayiotou et al., 2019). This approach includes facial expressions, gestures, and knowledge of minimal key words in the language instead of using actual professional translators. Unfortunately, the use of professional translators is limited by finance and time. (Panayiotou et al., 2019). Barriers of Cultural Competency Training Cultural competency in healthcare is often linked to ideologies of inclusion and making people of different races, religions, genders, ages, and socio-economic backgrounds feel comfortable. Regardless of most professionals’ best efforts, not every person feels included. Can et.al (2022) studied cultural diversity among nurses and midwives in Turkey. Subjects in the study suggested a best practice on how to curb communication barriers for patients. The participants suggested that full-time interpreters should be employed and/or immigrants should be returned to their home country for education and to learn the language. These researchers’ solutions fail to be inclusive, safe, or feasible for patients refugees fleeing a country. Unfortunately, an influx of refugees places a tremendous burden on the receiving country and its professionals. Several healthcare employees feel torn between what is best, what is right, and what is possible in these crisis situations. Overall, it is a daunting challenge to successfully change attitudes and long held beliefs and biases persons have against another's race, religion, and sex (Can et.al, 2022). Several religions, which help inform persons’ moral beliefs, uphold service of others as a way to develop love and compassion. However, morality and ethics may be defined from several origins. Administrative services may capitalize on innate altruistic human tendencies, common among healthcare providers, to support community engagement and 16 service to disaffected and estranged communities (Pratt-Chapman et al., 2022). Training persons by listing appropriate dos and don’ts may be ineffective at procuring understanding and compassion for others. Rather, best practice requires integration into the community served. All cultures can cross pollinate and bridge the gap between language, religion, and tradition and meet at the most basic levels of humanity. This is a foundation fertile for learning and respecting different cultures, languages, and values. In this utopian state, all people are seen as a community with diverse friends and family who are personally tied to and supported by an altruistic health care system. Often, financial resources are a primary barrier to cultural competency. It is expensive to provide adequate technology for interpretive services. Thus, these services are in short supply. For example, one floor of 25-40 patients may be served by a single Ipad for language interpretation. In this case, if two patients were in need of interpretive services at the same time, only one patient could be serviced adequately. If an in-person interpreter is available, it is nearly impossible for any one interpreter to be skilled in every language needed. Thus, additional expenses may be incurred to increase the skill and volume of staff. Another resource that is always scarce is time. Does a healthcare facility have time to pull healthcare professionals from their practice to receive their training? If an employee cannot complete training during regular business hours, that employee must complete the task when they are off duty. Healthcare facility budgets are tight, and time for education may increase overtime paid to employees further exacerbating an already strained budget. 17 Thus, training must be relevant to be beneficial. Ideally, education for language, culture, religion, and customs should be taught from a person with first-hand experience. However, most individuals of diverse backgrounds feel uncomfortable and unprepared to provide education to healthcare professionals. Also, cultural competency may be difficult to assess. How does one measure if a training or presentation was effective? A test or interview may be administered to establish a healthcare professional’s level of understanding. Conversely, a healthcare facility could survey or interview patients regarding their care and satisfaction. Unfortunately, none of these methods accurately define the level of cultural competency a health professional has internalized and used as a result of their training. Furthermore, patient satisfaction can be altered and misunderstood based on the patient’s diagnosis, trauma, and or confounding variables. Overall, developing, implementing, teaching, and measuring a program that encompasses the true nature and spirit of what it means to be culturally competent is one of the most important and daunting tasks that the healthcare profession will face for the foreseeable future. A study performed by Waite and Calamaro (2010) addresses these issues and provides a list of questions for an employee evaluation. The following list of considerations was created for the study regarding cultural competence in nurses. ● Have I been able to separate what is important to me and what is important to this particular client? ● What do I know or not know about this client’s cultural heritage? ● What is this client’s relationship with his or her culture from his or her perspective? 18 ● To what degree is the client acculturated to the dominant culture? ● What are my stereotypes, beliefs, and biases about this culture, and how might these influence my understanding and ability to listen? ● What culturally appropriate strategies/techniques should be incorporated in the assessment process? ● What is my philosophy of how illness is operationalized in individuals from this cultural group? ● Have I appropriately consulted with other mental health professionals, members from this particular culture, and/or members of this client’s family or extended family? ● Has this client aided in the construction of my understanding of this problem? This self-reported evaluation is an internal assessment of how each individual perceived whether they are culturally competent. With this recommended evaluation being self-reported, the data may be skewed and make difficult a healthcare organizations’ ability to hold each employee accountable (Kress et al., 2005). Brunett and Shingles (2017) completed a study to investigate how cultural competency of healthcare employees affects their patients’ satisfaction. Patient surveys post-procedures are common learning tools used by departments to improve process and procedures. This study concluded that high levels of cultural competence among employees was directly related to higher reported patient satisfaction scores. Within the study, patients reported having more trust, openness, and security with culturally competent staff. Because of these feelings, patients were more likely to follow medical advice received from a culturally competent caregiver. 19 One way to hold healthcare providers accountable for their cultural competence is to tie merit pay to patient surveys. In this case, the survey is meant to be evidence of a high standard of care. Waite and Calamaro (2010) expressed that students and practicing healthcare providers must prepare to serve a diverse community wherein individual perceptions of healthcare and their responses to it may vary widely. Compliance to treatments and instructions were significantly tied to whether or not patients’ expectations were met during the patient and professional interaction. An example of a patient satisfaction survey included the following questions. ● Do you feel satisfied with your healthcare experience? ● Do you feel that your healthcare provider is culturally competent? ● Did your healthcare provider treat you with respect? ● Do you feel your healthcare provider showed they have been adequately trained on cultural competence? Culturally Competent Staff Improves Team Dynamics Cultural competency does not solely characterize how professionals treat their patients, but it also characterizes how professionals treat and understand each other. Within organizations, there is a growing emphasis on the importance of hiring and maintaining a culturally diverse staff. Aysola et al. (2018) found a diverse workforce was essential to culturally effective and equitable care. Advantageously, a diverse workforce has more resources to lean on when serving a diverse population. Furthermore, diverse staff learn from each other and implement newfound understandings and compassion toward patients of varied backgrounds. Diversity informs better practice and generates new medical knowledge. Institutional biases shut down communication, integration, and 20 respect. By creating an institution of diversity and understanding, it is possible to explore new ideas and endless possibilities for treatment and care. A limited organizational diversity reduces recruitment and retention (Aysola et al., 2018). Flores and Combes (2013) suggest that some healthcare organizations use diversity as a numbers game or scheme. In essence, organizations with this philosophy seek diversity as a means of appearing compliant and socially responsible to their stakeholders. It is difficult to hide organizational bias, and those with diverse backgrounds may not choose to apply and engage in a work environment that is neither tolerant or accepting. Organizational bias may be altered and changed through supportive and diverse organizational leadership. The presence of diverse leaders creates a sense of acceptance and tolerance among diverse employees for whom they are responsible. Sergeant et al. (2022) found that diverse leaders support open discussions about discriminatory policies, condemn racism, and promote inclusivity. For example, Sergeant et al. (2022) noted positive progress in the promotion of women. Over the years, many women have struggled to move their way up the professional ladder. Thus, it is satisfying to see more women as CEOs and corporate leaders. There have also been concerns about the treatment and inclusivity of the LGBTQ+ community. Katz-Wise et al. (2022) suggests that support and adherence to policies and practices for LGBTQ+ members can be a challenge. Many LGBTQ+ employees are fearful to acknowledge who they are because they feel they will be discriminated against, physically harmed, or harassed. However, Katz-Wise et al. (2022) 21 emphases that most members of the LGBTQ+ community who feared discrimination have recently experienced more positive attitudes and interactions toward them. Lingras et al. (2021) acknowledged that diversity, equity, and inclusion are not a part of every institution. The challenge is that DEI-focused change requires a shift in leadership, a climate of inclusivity, and a feeling of urgency (Lingras et al., 2021). If leaders are not promoters of inclusion and diversity, especially within their departments, few of their coworkers and staff will be willing to change and/or adhere to policy. One method of developing a DEI-focused change is to create and sustain an inclusion committee at the department level. This committee would discuss current challenges, successes, and new ideas on how to increase and support diversity within their departments. (Lingras et al., 2021). Inclusion committees are important in helping leadership identify problems and change department environments and cultures wherein each employee is represented and acknowledged. Although diversity and inclusion practices within this section have focused mainly on local organizations, a broader perspective is valuable as many healthcare workers are choosing to work globally due to staffing shortages. Balante et al. (2021) found many healthcare workers struggled with diverse countries’ policies and procedures and felt they were treated poorly by staff because of their unique perspectives. For example, healthcare workers from the Philippines struggled in Britain while helping cancer patients with end of life care. Because of their religion and culture, Filipino and British health providers had a difference of opinion regarding the patients’ rights and care. These extreme differences caused a lot of contention within the department. Healthcare workers from Britain did not feel that the Filipino workers were doing their 22 best for the patient. In contrast, Filipino healthcare workers felt that the British workers treated their patients with cruelty. Conflict is expected, especially when comparing different cultures, ideas, and religion. However, being able to understand colleagues from their unique perspectives is a key to working together. Employees, as well as patients, are always more comfortable and more trusting of organizations wherein they can see themselves. Job Satisfaction Job satisfaction indicates that an imaging professional feels secure within the workplace. Satisfied professionals trust both coworkers and leadership within their department. Additionally, satisfied professionals feel fulfilled with their job, are desirous to diligently and effectively perform their duties, and are more likely to demonstrate characteristics of resilience. Resilience refers to an individual’s ability to deal with and overcome stressful challenges and problems effectively and efficiently. Individual resilience is strengthened in environments wherein support is freely given from multiple sources and communicated on a regular basis. Good communication requires “open door policies” between coworkers and leadership. Clear and consistent two-way communication supports real and perceived safety among and between professionals and patients. Promoting good working relationships between management, co-workers, and patients enhances the professional's sense of accomplishment. These relationships inform the professionals’ overall sense of purpose and help them feel that they are making a difference with what they do. Culturally Competent Management The cultural competence of an imaging department’s management team has influence on job satisfaction, retention, occupational growth, recognition, and team 23 dynamics. When management takes into account the experiences and backgrounds of their employees, their leadership impacts attitudes, behaviors, and expectations of their team. In a study on nursing assistants in long-term care facilities, Kumra et al. (2020, p.1) stated, “Organizational cultural competence may increase job satisfaction and retention by creating more effective teams. Perception of organizational cultural competency was one of the strongest predictors of job satisfaction”. Recognizing and valuing the unique skills and perspectives that employees from diverse cultural backgrounds bring to the imaging department is one of the ways in which management can promote job satisfaction, reduce employee burnout, and slow turnover rates. Often employees of different cultures feel that they don’t have the same opportunities for advancement as employees who share a common culture. For example, in a study of mental health nurses in Venezuela, Andrade (2022, p.1) stated, “White mental health nurses report statistically significant higher levels of satisfaction with external rewards and professional opportunities”. When employees are valued for their unique differences, they are more productive, feel a sense of devotion to their department, and seek out growth and opportunity. In opposition, management teams that demonstrate cultural discrimination diminish organizational commitment, job performance, and creative risk-taking (Andrade, 2022). Although many organizations perceive an improved sensitivity to healthcare disparities, it has been documented that many minority persons still perceive a significant gap in equality. It is possible that the best solutions may be presented with newer and younger generations of healthcare workers. Kumra et al. stated, “Because the younger generation is more diverse, they may place more value on diversity than older generations 24 and may also perceive organizational cultural competence to be a greater influence on their teamwork climate. Health [organizations] can create programs to recruit and retain staff members who reflect the cultural diversity of the community served…and develop culturally specific healthcare settings.” (Kumra et al., 2020, p.1) Cultivating unique perspectives fosters approachability and flexibility. Employees can feel a sense of community and belonging when they feel culturally represented within their own department. Summary Training in cultural competency is essential in creating an imaging department that is equipped with proper skills, knowledge and attitudes of inclusion. This will result in an imaging department that functions successfully as a team, has high job satisfaction, and an equal opportunity for advancement within the department. Also, patient satisfaction will improve as culturally competent imaging staff gain the confidence of their patients through understanding and compassion. Immersive cultural opportunities may assist in the development and understanding of healthcare professionals. Often, practices that increase the diversity of department staff results in better patient resources, cooperative learning, and respect for self and others. Overall, these learned attitudes, behaviors, and skills enhance the patient experience and their overall care. 25 Chapter 3: Research Method Introduction Many imaging technologists lack the necessary training, skills and confidence to effectively provide culturally sensitive care for their increasingly diverse patient populations which inadequacy is directly related to diminutive self-efficacy and employee satisfaction. The purpose of this quantitative study is to measure and correlate the current level of cultural competency acquired by professionals within the imaging profession to their level of employee satisfaction. In this research, we will seek to understand the relationships between our predictor variable cultural competency and criterion variables employee satisfaction. Each variable will be measured according to several statements expressed along a Likert Scale with enough data points necessary to ensure a scalar relationship. Restate the research question(s)/hypotheses verbatim. Q1. What level of cultural competence, as measured by participant’s knowledge, attitudes, and skills, is present among Medical Imaging Professionals? H10. Medical imaging professionals have no measurable level of cultural competence. H1a. Medical imaging professionals have a low level of measurable cultural competence. Q2. How are cultural competence knowledge, skills, and attitudes independently related among Medical Imaging Professionals? H10. Cultural competence variables of knowledge, skills, and attitudes have no relationship. 26 H1a. All variables of cultural competence have a positive relationship. Q3. How does cultural competence relate to employee satisfaction among Medical Imaging Professionals ? H10. Cultural competence does not relate to employee satisfaction. H1a. Cultural competence and employee satisfaction have a positive relationship. Research Methods and Design(s) This study is a descriptive and correlational design with use of a quantitative survey. Correlation research is a way to help find a relationship between two or more variables. The main purpose is to measure the strength and direction of the relationship between cultural competence and employee satisfaction. The survey was designed for credentialed professionals working within the imaging department and included our variables measured on likert scale and demographic information. We sought at least 100 professionals to complete the survey. Population The population included certified healthcare workers employed and practicing within a medical imaging department or facility. This population included subjects of varying backgrounds ranging in age from 18-70 years old who lived within the United States. Demographics included varying gender, ethnicity, geographic region, work experience, and educational background. Surveys were distributed via text and email messaging to qualified professionals. 27 Sample The sample was a convenient sample. Due to constraints in time and resources, a convenience sample was determined most feasible among researchers. Our sample included healthcare workers across the United States of America, and over 100 surveys were completed and analyzed meeting the demand of statistical power. The sample was selected because of their current knowledge and experience working within the healthcare system. It was hopeful that there would be a wide range of work experience as means of perspective between pre- and post- pandemic policies and operations. It was also a goal of the researchers to target all modalities in effort to demonstrate a wide range of imaging professional working cultures and environments. All data collected from our sample informed us of the current work conditions, levels of cultural competence, and employees’ job satisfaction. Materials/Instruments The variables in this study were measured using a quantitative survey. The survey was conducted to gather data in regards to cultural competency and its effect on job satisfaction. The survey quantified cultural competency by asking questions on a Likert scale to inform researchers of a participant’s cultural knowledge, skills, and attitudes. Similarly, overall statements of employee satisfaction and its sub-variables respectful recognition, and organizational support were utilized. A demographics section began the survey, where the questions included gender, age, job title, total years worked, age participant started in imaging, facility employed at, modality worked in, employment status, hours worked, shift worked, ethnicity, geographic location of work, and geographic location of home. Participants were 28 provided an informed consent and were permitted to complete all, part, or none of the survey based on their free will. The participants took the survey through a link and QR code. The participants were given a description of the variable prior to looking at the statements given about the variable. The participants were then asked to rate the statement on a 6 point Likert Scale from Strongly Disagree to Strongly Agree. The survey consisted of 48 questions that were developed by a research team of Imaging professionals. On the basis of our experience in the imaging profession, we carefully selected and discussed ideas that would correctly measure each variable. There were two sections of the survey. The first section measured sub variables of cultural competency such as cultural knowledge, skills, and attitudes, eight statements were provided for each variable. At least one negative statement was given for each variable and re-coded for statistical analysis. In total, 24 statements were given in this section. The second section of the survey measured employee satisfaction. These variables encompassed employee satisfaction, respectful recognition, and organizational support. Eight statements were provided under each variable. Again, at least one negative statement was given for each variable and re-coded for statistical analysis. This totaled 24 statements for the second section of the survey. Operational Definition of Variables The primary constructs associated with our research are cultural competency, cultural knowledge, cultural skills, cultural attitudes, employee satisfaction, respectful recognition, and organizational support. We will use a quantitative survey to measure these constructs using statements expressed along a Likert scale ranging from 1-6 29 (Strongly Disagree to Strongly Agree). These surveys will be electronically distributed to different imaging departments and then measured using regression analysis to predict a scalar relationship. Construct/Variable 1. Cultural Competency. Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations. (Betancourt et al., 2002) Construct/Variable 2. Cultural Knowledge: Knowledge and understanding of cultural characteristics, history, values, beliefs, and behaviors of another ethnic or cultural group or community. (Brownlee, n.d.) Construct/Variable 3. Cultural Skills: Skills including language and interpersonal skills, are necessary to be fully proficient as a health care professional competent in serving persons with diverse cultural backgrounds. Construct/Variable 4. Cultural Attitudes: A health care professional’s unconscious and underlying attitudes and assumptions that affect interpersonal relationships and responses to a patient’s health journey. Construct/Variable 5. Employee Satisfaction: A feeling of fulfillment or enjoyment that a person derives from their job including variables of respectful recognition and organizational support. (Oxford University n.d.) Construct/Variable 6. Respectful Recognition: The means whereby employees are compensated, rewarded, and listened to in a personal, meaningful, and genuine manner. 30 Construct/Variable 7. Organizational Support: Factors that aid in an employee feeling supported at work, including appropriate resources, teamwork, collaboration, communication, policy, and procedures that uphold and maintain the role and values of the health professionals and patient care. Data Collection, Processing, and Analysis We collected the results of the surveys completed by 138 imaging professionals. Eight surveys were removed due to incomplete results. Of the 130 surveys, any questions that were missed and unaccounted for were assigned the value of zero. Due to insufficient data, several of our statistical groups were condensed. Ethnicity was condensed to white and nonwhite, a categorization of age was changed from 58+ to 48+, and facility size was condensed to small, medium, or large hospital, or clinic/outpatient/office/other. Work address was changed to west, midwest, and other. Title was changed to staff technologists, travel technologists, clinical coordinator/instructor, supervisor/ chief technologist, department/corporate manager, and other. Hours were changed to business hours/daytime and overnight/ evening/ other. Age working was changed to 18-27 and 28+. Lastly, the locations perceived as home were changed to west, midwest, and other. There were several questions that were considered a negative statement that had to be recoded due to incorrect data input by SPSS. The numbers that were used were 1-6, 1 being that the individual strongly disagreed and 6 being that the individual strongly agreed. With negative statements the scale needed to be reversed so 1 was strongly agreed and 6 was strongly disagreed. There were 20 negative questions, whose responses had to be recorded for this reason. 31 Assumptions We assume only healthcare professionals working within the medical imaging as a technologist or sonographer completed the survey. We also assume all participants selfreported their answers honestly. It is expected that participants will respond as having cultural competence because most strive to be altruistic in serving others and attending to patient needs. We also assume most healthcare workers will have poor employee satisfaction due to rising levels of burnout. Limitations A limitation of the study would be generalizability due to the small number of responses gathered from varied geographic regions of the United States and across the globe. This is especially true as the sample is a convenience sample and does not have the same rigor to ensure unintentional bias. Potential threats to validity also include whether healthcare workers did or did not answer the study honestly. It is difficult to give a full spectrum of the issues regarding cultural competency and employee satisfaction as this is only a quantitative versus a mixed-method design. Delimitations The study was narrowed to imaging technologists within the United States among those ranging in age from 18 to 70 years. We did not include data from incomplete surveys nor did we include any protected populations. Ethical Assurances Because our research will be implementing the use of human subjects (those working in the healthcare profession) to gather data through means of a survey, it is imperative that we exercise compliance within our study. By conforming to the rules and regulations necessary to protect the ethical values of our subjects, we promise to protect 32 the privacy and rights of those who will be participating in our survey by maintaining anonymity both in name and place of employment. If at any time one of our participants wishes to withdraw, they will have the ability to do so without fear of repercussions or punishment. Institutional Review Board (IRB) approval was secured to protect the well-being of all of our participants used in this research prior to collecting our data through survey distribution. This study’s objectives and methods were submitted to and reviewed by the Weber State University IRB and accepted as low risk and exempt. As required by compliance standards, our informed consent included the following: ● Full detailed description of our research study and its significance. ● Clear depiction on what information would be collected from the participant in the study (survey), and a disclosure about our data analysis. Confidentiality of those who participated in our survey will remain of utmost importance. The surveys and data collected will remain anonymous, secure, and password protected from any persons not part of the research team. Care will be taken to ensure that those who participate cannot be linked to identifying information based on their responses in our survey (ie. specific place of employment). Summary The main purpose of this study was to understand the relationship between our predictor variable cultural competency and criterion variable employee/job satisfaction. The survey consisted of 48 carefully selected questions that were developed by a research 33 team of Imaging professionals. The survey was then distributed digitally and included an informed consent before proceeding into the survey. The population that participated in the quantitative survey were between the ages of 18-70 and located within the United States. The participants were employed in an imaging department with varying demographics, experience, and educational backgrounds. Over 100 surveys were collected and the surveys that showed as being incomplete were not included. It is assumed that only imaging professionals completed the survey and reported honest answers. It’s anticipated that the participants of the survey will display cultural competence since healthcare workers strive to serve others and it is further anticipated that healthcare workers will have poor employee satisfaction due to the rise of burnout. The research involves human subjects to gather data through the quantitative survey. The privacy and human rights of the participants are protected and remain entirely anonymous and confidential in all aspects. Any participant can withdraw from the survey at any time without consequence. IRB approval was given to protect all our participants in this research. The study is considered low risk and exempt. 34 Chapter 4: Findings Introduction Cultural competence, knowledge, skills, and attitudes may be underdeveloped, and affect direct care patients are receiving from Medical Imaging Professionals. The purpose of our study was to investigate the correlation of cultural competency and job satisfaction in the workplace. The population of the study participants was a convenient sample of Medical Imaging Professionals, not exclusive to one modality. The research questions included: 1) What level of cultural competence, as measured by participant’s knowledge, attitudes, and skills, is present among Medical Imaging Professionals? 2) How are cultural competence, knowledge, skills, and attitudes independently related among Medical Imaging Professionals? 3) How does cultural competence relate to employee satisfaction among Medical Imaging Professionals? A quantitative survey was conducted with questions regarding cultural competence measured using a Likert scale. This chapter will review Results, Findings, Summary, Implication, Recommendations, and a Conclusion regarding our data collected. Results A total of 138 participants took part in this survey. Of the 138 participants, 8 were excluded. The reason for exclusion was failure to respond to a significant number of questions. Following the exclusion criteria, 130 participant answers remained. 35 Figure 1. Ethnicity Of these 130 participants, the majority of the ethnicity was white at 88.5%, while the rest of the participants were non-white at 11.5%. The age of participants was 18 to 27 at 23.8% and 76.2% between the ages of 28 to 37+. Figure 2. Age 36 The gender identity of participants were 46.2% cisgender (identity corresponds with birth, female, feminine, woman), 30% identified as female (feminine, woman, but preferred not to disclose cisgender or transgender), 13.1% identified as cisgender (identity corresponds with birth male, masculine, man), 7.7% identified as male (masculine, man, but preferred not to disclose cisgender or transgender). 3.1% of participants chose not to disclose what their identity was thus this information was considered missing because of the lack of participants that answered this way. The geographic region for participants were 72.3% from the west, 19.2% from the midwest, and 8.5% from other areas of the United States. The age that participants started working in the field of radiology was 73.1% between the ages of 18 and 27 and 26.9% between the ages of 28 and above. Shifts that participants work in radiology were 74.6% during business hours or day time and 25.4% work nights, swings, or other non business hour shifts. The titles that participants had at work were 74.6% staff or senior technologist, 6.9% were travel technologists, 6.9% were supervisors or chief technologists, 3.8% were clinical coordinators or instructors, 3.8% were department or corporate managers and 3.8% were considered a different title in their work environment. Where participants are currently working was 76.2% in the west, 16.9% in the midwest, and 6.9% in other parts of the United States. The facility that participants worked at was 20.8% in a clinic, outpatient, physicians office, and other, 13.8% work in small hospitals. 36.9% work in medium hospitals, and 28.5% work in large hospitals. The amount of years that participants have been working is 32.3% between the years of 0 and 4, 20.8% between 5 and 10 years, 15.4% between 11 and 15 years, 15.4% 37 between 16 and 20 years, 9.2% between 21 and 25 years, and 6.9% have been working more than 25 years in the field of radiology. The weekly work hours for participants was 7.7% work less than 20 hours, 40% work between 20 and 40 hours, and 52.3% work more than 40 hours a week. The modality that participants worked in are Cardiac interventional at 8%, Computed tomography at 11.5%, Magnetic resonance at 12.3%, Mammography at 6.2%, Medical dosimetry at 8%, Nuclear medicine and Radiation therapy at 1.5% each, Radiography at 33.1%, Sonography at 21.5%, Vascular intervention at 9.2% and other radiology modalities at 1.5%. Following demographics, Each participant was asked to answer questions related to cultural competency. These questions were grouped into three different categories; cultural knowledge, cultural attitudes, and cultural skills. In the category of cultural knowledge, the findings were extremely positive. The highest number that participants could answer in this section was 48 and the lowest being zero. Figure 3. Cultural knowledge sum 38 After calculations were performed, it was discovered that the answers found at 24 or higher were seen as positive, while those lower than 24 were considered more negative towards cultural knowledge. The numbers showed that no one answered anywhere below 24 and therefore gave a more positive correlation with cultural knowledge. In the category of cultural skills, the findings were also positive. The highest number the participants could answer was 48 and the lowest being zero. Figure 4. Cultural Skills Sum After calculations, it was found that anything over 24 was considered positive. The majority of participants answered positively, with a small number answering negatively. While this category still has a positive rating, it is not as positive as cultural knowledge. In the category of cultural attitudes, the findings were positive. The highest number participants could answer was 48, the lowest being zero. 39 Figure 5. Cultural attitudes sum After calculations, it was found that anything over 24 created a positive finding. Participants in this category answered 30 or higher. This section has the highest positive findings in the cultural competency categories. Figure 6. Cultural competence sum 40 Based on the findings listed above, it has been confirmed that there is a positive correlation between how cultural competence, knowledge, skills, and attitudes independently relates to medical imaging professionals jobs. Cultural competence skills do have some negative correlations that were discovered, however the majority of participants still answered positively. Looking at the independent areas of cultural competence was an important part in understanding how culturally competent imaging professionals feel they are. However, looking at the overall combination of cultural competence areas was also an important analysis. The findings from this survey show a slightly skewed positive correlation. The highest number participants could answer was 144 and the lowest being zero. The mean score was 72 and participants answered 88 or higher creating a slightly positive correlation. One research question addressed how cultural competence compared with job satisfaction. Three sub-variables were considered for job satisfaction; employee satisfaction, respectful recognition, and organizational support. When looking at employee satisfaction, there was a somewhat positive outcome. However, there was a small amount of negativity when it comes to employee satisfaction. The participants could answer from zero to 48, with the mean being 24. There were some numbers that were under the 24 mean marker. 41 Figure 7: Employee satisfaction sum Respectful recognition had a primarily positive outcome. The mean outcome for respectful recognition was also 24, and participants could answer anywhere from zero to 48. Interestingly, there were more answers that fell below the 24 mean outcome in this section when compared to the summed employee satisfaction. Figure 8: Respectful Recognition sum 42 Looking at organizational support, there was another primarily positive outcome. Participants could answer between zero to 48, with the mean being 24. Organizational support does have several answers that fall below the mean of summed employee satisfaction. Figure 9: Organizational support sum Overall, cultural competence and job satisfaction individually have positive outcomes. However, the question that has not been addressed is whether cultural competence has a relationship on job satisfaction. Looking at the findings, there is not a strong correlation between job satisfaction and cultural competence. Cultural competence only appears to affect a small portion of job satisfaction. However, when comparing employee satisfaction, respectful recognition, and organizational support, there is a very strong positive correlation between the three. 43 Figure 10. Cultural competence and Job Satisfaction Linear Regression While cultural competence does not have a strong correlation with job satisfaction, age may have more of an effect. When comparing cultural competence and age, participants in the older age bucket of 28-37 responded with more cultural competence than that of the younger group. Figure 11. Age and cultural competence While age and cultural competence have significant findings, so does that of job satisfaction and facilities that participants work at. Looking at employee satisfaction and 44 the different facilities in which participants work, medium hospitals and large hospitals have more employee satisfaction than those in small hospitals and clinics/outpatient/office/other. Figure 12. Employee satisfaction and Facility size When analyzing respectful recognition, participants at medium and large hospitals felt more recognized than those in small hospitals, and clinic/outpatient/office/ other. Figure 13. Respectful recognition and facility size 45 However, in looking at the findings for organizational support, it appears that clinics/outpatient/office/other and medium sized hospitals feel more organizational support. Large and small hospitals did not report as having as much organizational support. Overall when looking at facilities that see the most job satisfaction, it appears as though medium sized hospitals have the most job satisfaction. Figure 14. Organizational support and facility size Evaluation of Findings When evaluating the findings, it was determined that cultural knowledge, attitudes and skills had a strong positive correlation. This means that imaging employees feel it is important to be culturally competent within all three variables. However, there was not a significant correlation between job satisfaction and cultural competence in the imaging profession as was expected by our research team. It would appear that even though imaging professionals feel cultural competence is important, it does not determine how happy they are in their field of work. And the results show that most imaging 46 professionals who took the survey already felt they were sufficiently culturally competent. There was a significant correlation between the age of the survey participants and cultural competence. Surveyors in the older age bucket scored cultural competence as more important than the surveyors in the younger age bucket. This was an unexpected finding. Another unexpected finding from the survey was the significant correlation between employee satisfaction, organizational support, and respectful recognition. This shows that imaging professionals feel most satisfied in their work when they are supported and recognized. Although respectful recognition had a positive correlation, it also had a lot of negative responses showing that imaging employees do not feel they are recognized enough. Organizational support also had a positive correlation with a lot of negative responses showing that imaging employees also feel they do not have enough support from their facility. Despite their desire for more recognition and support, employee satisfaction had the most positive correlation with few scores below the mean. Which leads us to conclude that overall, imaging employees are satisfied with their jobs. Lastly, there was a significant correlation between the facility that participants work in and their employee satisfaction, respectful recognition, and organizational support. Overall, imaging employees working at medium sized hospitals felt the strongest satisfaction, recognition, and support. While employees at larger hospitals and small clinics or offices did not feel as satisfied, recognized and supported. 47 Summary In conclusion, we found that the majority of our participants were white, from the western United States, were between the ages of 28-37 years old, and had started working in the medical imaging profession between the ages of 18-27. Based on age, many of the participants in this age bracket claimed to have more cultural competency than those in the other age groups. We also found that the majority of participants worked during the day as a staff or senior technologist, worked 40+ hours a week, worked in a hospital setting, and had been working for 11+ years. Those who were in a hospital setting, whether large or small, were found to be more satisfied in their work in regards to cultural competency, compared to those working in small hospitals or clinics. This group of participants also claimed to be more satisfied with employee recognition and organizational support. As a research team, we set out to answer these three questions. 1) What is the level of cultural competency in the field? 2) How are competence, knowledge, attitudes, and skills related? 3) How does cultural competence relate to employee satisfaction? The data we gathered was able to answer these questions in the following ways. We found that our survey came back with most imaging professionals having a positive correlation with the concept of cultural knowledge and cultural skills. The highest positive correlation came in the area of cultural attitudes. Between the three areas, cultural skills were slightly lower, allowing us to conclude that many imaging professionals know the importance of cultural competency and have the desire to be competent, but may be lacking in resources to fully have the skill set to do so. Still, the 48 level of “lacking” by imaging professionals was low, as most participants felt they “knew enough”. In regards to job satisfaction and its relationship with cultural competency, the three things measured were employee satisfaction, respectful recognition, and organizational support. All three of these areas were fairly positive in their relation with job satisfaction, but there was still room for improvement in all three areas. We were surprised to find that there is not a strong correlation between job satisfaction and cultural competence. Competency in this area does not determine the level of happiness in the imaging field. Chapter 5: Implications, Recommendations, and Conclusions Medical imaging professionals may lack the necessary training, skills and confidence to effectively provide culturally sensitive care for their increasingly diverse patient populations which may then negatively impact the professionals’ employee/job satisfaction. The purpose of this quantitative study was to measure and correlate the current level of cultural competency acquired by imaging professionals to their level of employee/job satisfaction. The quantitative survey was distributed digitally and included an informed consent before proceeding into the survey. Some limitations were due to the 49 number of answered surveys, that only a small geographic area was covered. It is assumed that the participants that responded to the survey were working within the medical imaging department as a technologist or sonographer. Another limitation would be that we have to assume that all participants self-reported their answers honestly. The research involved human subjects and the gathering of data through the quantitative survey. Due to this, the privacy and human rights of the participants are protected and remain entirely anonymous, confidential. The participants are able to withdraw at any time. IRB approval was given to protect all our participants in this research. The study is considered low risk and exempt. Implications: One goal of this research was to determine what level of cultural competence, as measured by participant’s knowledge, attitudes, and skills, is present among medical imaging professionals? The results of this study shows that the majority of participants feel they are already culturally competent. When looking at the results of the three independent variables, participants scored themselves highest in attitude, next in knowledge and last in skills. A potential limitation of these results is that 88.5% of the survey participants were of white ethnicity. Although they scored themselves high on cultural attitude, knowledge, and skills, it is unclear how culturally competent these individuals actually are. It can thus be implied that there is no true measure of cultural competence in medical imaging professionals, only their perception of their own cultural competence. Another goal of this research was to determine how cultural competence relates to employee satisfaction among medical imaging professionals. The results of this study 50 shows that there was no correlation between job satisfaction and cultural competence. Once again this result may be limited in nature because of the large sample size of white survey participants. It is recommended that in future studies, a larger ethnic background be surveyed to compare results. However, based on the results of this survey, we can imply that cultural competence does not affect job satisfaction when imaging employees feel they are already culturally competent. If we place these results back in context with our study problem, that in ten short years, it is projected that minorities will become the majority population in the United States, is it concerning that the majority of white imaging employees feel they are already culturally competent? Or is this a result of adequate training taking place in the medical profession? Our research indicated that medical imaging professionals may lack the necessary training, skills and confidence to effectively provide culturally sensitive care for their increasingly diverse patient populations which may then negatively impact the professionals’ job satisfaction. However this survey indicates that imaging employees only feel they may need additional skills, and that they’re attitudes and knowledge are already sufficient. And that their job satisfaction is not negatively impacted by cultural competence. Instead what they desire is more recognition and organizational support. Recommendations Several recommendations can be made for this study and future studies. If this study were to be repeated, the team might consider the order of the survey questions. Several researchers were in the vicinity of participants when they were taking the survey and heard them questioning what kind of survey they were being asked to take. The first question of the survey asks what sex the participant identifies as. This line of questioning 51 can be sensitive for some survey participants. In order to generate the most participation, a less intrusive question may be considered. Another recommendation would be to send the survey to hospitals in major cities and across greater geographic regions with dense populations in an effort to generate as much ethnic and cultural diversity as possible. This study was limited due to the time frame with which the survey could be conducted. Finding participants was also a challenge because healthcare facilities have a limited number of imaging staff. More participants would provide stronger data points with stronger correlations. Furthermore, an evaluation of the survey would identify weaknesses in its reliability. Conclusions In choosing our study, we felt the need to explore the correlation between cultural competency and employee/job satisfaction, seeing as how we serve a diverse population in our field of work. We questioned whether employees have the necessary training, skills, and confidence to be proficient in cultural knowledge, skills, and attitudes. We received IRB approval to distribute our survey to those working in the imaging profession, and although only a small geographic area was able to participate, we were able to measure these things in question. Our study showed that most imaging professionals feel that they are culturally competent, but perhaps need more resources and training in cultural skills. Due to factors of ethnicity, honesty, and perceptions, it is still unclear whether or not these findings are accurate in assuming employees in this field are indeed competent. Based on the data gathered in our survey we did not find a relationship between cultural competency and job satisfaction. Again, this may be due to the fact that most of our participants were 52 white and from a small sample in regards to geographic location. However, with our population projected to become more diverse in the future, cultural competency may become an issue. Employees may need more knowledge and skills, and if their places of employment lack resources in cultural competency, job satisfaction could be impacted. In the future if this study is conducted again, we recommend making adjustments to the order of questions that were asked in our survey and sampling a larger group with diverse ethnicity and geographic location. 53 References Abdulai, M., Alhassan, A.R., & Sanus, M. (2019). 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Perspectives in Psychiatric Care, 46(1), 74–80. https://doiorg.hal.weber.edu/10.1111/j.1744-6163.2009.00240.x 57 Appendix A Cultural Competency and its Effect on Job Satisfaction in the Imaging Department Survey Age What is your age? o 18-27 (1) o 28-37 (2) o 38-47 (3) o 48-57 (4) o 58 years and older (5) o Prefer not to say (6) Gender With what gender do you identify? o Cisgender (identity corresponds with birth sex): woman/female/feminine (1) o Transgender: woman/female/feminine (2) o Woman/female/feminine (prefer not to disclose cisgender or transgender) (3) o Cisgender (identity corresponds with birth sex): man/male/masculine (4) o Transgender: man/male/masculine (5) o Man/male/masculine (prefer not to disclose cisgender or transgender) (6) o Nonbinary/genderfluid/genderqueer (7) o Two Spirit (8) o Agender (9) o Another gender not listed (10) o Choose not to disclose (11) Ethnicity What is your ethnic background? o White / Caucasian (1) o Asian - Eastern (2) o Asian - Indian (3) o Hispanic (4) o African-American (5) o Native-American (6) o Mixed race (7) o Other (8) 58 o I prefer not to say (9) Home Address In which geographic region of the United States have you spent most of your life and consider home? o Northeast (1) o Midwest (2) o South (3) o West (4) o Other (5) Career Start At what age did you enter the field of Medical Imaging? o 18-27 (1) o 28-37 (2) o 38-47 (3) o 48-57 (4) o 58 years and older (5) o Prefer not to say (6) Work Exp How many total years have you worked within the field of Medical Imaging? o 0-4 (1) o 5-10 (2) o 11-15 (3) o 16-20 (4) o 21-25 (5) o 25+ (6) Weekly Hours How many hours per week do you work? o Less than 20 (1) o 20-40 hours (2) o 40+ hours (3) Shift What type of shift do you primarily work? o Business Hours/Daytime (1) o Evening Shifts (2) o Swing Shifts (Inbetween Hours) (3) o Graveyard/Overnight (4) o Locum Tenens/PRN (5) o Other (6) Page Break Modality In which modality do you primarily work? o Bone Densitometry (1) o Cardiac Interventional (2) o Cardiovascular Interventional (3) o Computed Tomography (4) 59 o Magnetic Resonance (5) o Mammography (6) o Medical Dosimetry (7) o Nuclear Medicine (8) o Radiation Therapy (9) o Radiography (10) o Sonography (11) o Vascular Interventional (12) o Other (13) Position/Title What position or title do you hold? o Staff Technologist/Senior Technologist (1) o Traveling or Temporary Technologist (2) o Program Director (3) o Clinical Coordinator (4) o Clinical Instructor/Didactic Instructor (5) o Advanced Practice Clinicians (RPA, PA) (6) o Supervisor/ Chief or Lead Technologist (7) o Administrator/Department Manager (8) o Corporate Manager/Corporate Representative (9) o Other (10) Work Address In which geographic region of the United States are you currently employed? o Northeast (1) o Midwest (2) o South (3) o West (4) o Other (5) Facility In which type of facility are you primarily employed? o Armed forces (1) o Clinic/Outpatient Facility (2) o Rural Hospital 1-25 beds (3) o Small Hospital 25-100 beds (4) o Medium Hospital 100-499 beds (5) o Large Hospital >500 beds (6) o Imaging Center (7) o Locum Tenens/PRN (8) o Per Diem (9) o Mobile Unit (10) 60 o Physician Office (11) o Temporary Service (12) o Home Health (13) o Other (14) Cultural Know Cultural Competency Survey Cultural competency is defined as a set of behaviors, attitudes, and policies that enable professionals and organizations to work effectively in cross-cultural situations (Betancourt, J., Green, A. & Carrillo E., 2002). All of the following statements illustrate characteristics of cultural knowledge or how a person understands cultural history, values, and beliefs of varied cultural communities. Please respond to each statement on how you would rate your cultural knowledge on a Likert scale from Strongly Disagree (1) to Strongly Agree (6) Strongly Disagree Slightly Slightly Agree Strongly Disagree (2) Disagree Agree (5) Agree (6) (1) (3) (4) I know about and understand the cultural characteristics of my community. (1) o o o o o o I am not interested in other cultures. (2) o o o o o o I effectively use my cultural knowledge to understand my patients’ needs. (3) o o o o o o 61 I have received education or training to help me better understand cultural differences. (4) o o o o o o I respect others’ beliefs and values. (5) o o o o o o I am uncomfortable around different cultures. (6) o o o o o o My organization celebrates cultural differences and promotes a diverse community. (7) o o o o o o I don’t understand why cultural beliefs and values are important. (8) o o o o o o Page Break 62 Cultural Skills All of the following statements illustrate cultural skills including language and interpersonal skills needed to help patients with diverse cultural backgrounds. Please respond to each statement on how you would rate your cultural skill level on a Likert scale from Strongly Disagree (1) to Strongly Agree (6) Strongly Disagree Slightly Slightly Agree Strongly Disagree (2) Disagree Agree (5) Agree (6) (1) (3) (4) I effectively listen to and communicate with diverse patients. (1) o o o o o o My organization has provided me with opportunities to learn and practice cultural skills. (2) o o o o o o I cannot effectively solve the problems that occur with patients of different cultures. (3) o o o o o o I can speak two or more languages. (4) o o o o o o I travel and spend quality time within different cultures. (5) o o o o o o 63 I never use a professional medical translator to help me communicate with my diverse patients. (6) o o o o o o I feel confident working with a culturally diverse professional team. (7) o o o o o o I cannot interpret how people of different cultures feel in times of stress, pain, or discomfort. (8) o o o o o o Cultural Attitude All of the following statements illustrate cultural attitudes that are unconscious assumptions about different cultures.. Please respond to each statement on how you would rate your cultural skill level on a Likert scale from Strongly Disagree (1) to Strongly Agree (6) Strongly Disagree Slightly Slightly Agree Strongly Disagree (2) Disagree Agree (4) (5) Agree (6) (1) (3) 64 I provide the same level of care and compassion for every patient. (1) o o o o o o I show respect and support for co-workers who have different cultural values and beliefs. (2) o o o o o o I was taught to be wary of people who were different from me. (3) o o o o o o I make quick judgments about patients. (4) o o o o o o I am annoyed when a patient doesn’t speak the same language as me. (5) o o o o o o 65 I am motivated to use tools that help my patients understand their exams. (6) o o o o o o I have negative thoughts when helping patients from different cultures. (7) o o o o o o I prefer being with people who look like me and act like me. (8) o o o o o o Emp Sat Employee Satisfaction Survey Employee satisfaction is a feeling of fulfillment or enjoyment that a person derives from their job (Oxford Language, 2023). All of the following statements illustrate characteristics of employee satisfaction. Please respond to each statement on how you would rate your employee satisfaction on a Likert scale from Strongly Disagree (1) to Strongly Agree (10) Strongly Disagree Slightly Slightly Agree Strongly Disagree (2) Disagree Agree (5) Agree (6) (1) (3) (4) I feel satisfied and accomplished at the end of my work day. (1) o o o o o o 66 I am unhappy at my job. (2) o o o o o o I am able to reach my potential and am competent at my job. (3) o o o o o o I find myself frustrated or annoyed at work. (4) o o o o o o I am thankful for my work. (5) o o o o o o I look for other jobs or careers on a regular basis. (6) o o o o o o The job I do makes a difference in this world and gives my life meaning. (7) o o o o o o I feel loved and appreciated at work. (8) o o o o o o Recognition All of the following statements illustrate aspects of respectful recognition whereby employees are compensated, rewarded, and listened to in a personal, meaningful, and genuine manner. Please respond to each statement on how you would rate your experience as an employee with respectful recognition on a Likert scale from Strongly Disagree (1) to Strongly Agree (6) 67 Strongly Disagree (1) Disagree (2) Slightly Disagree (3) Slightly Agree (4) Agree (5) Strongly Agree (6) My employer shows me that I am valued. (1) o o o o o o I do not feel that I am heard by my organization. (2) o o o o o o I am not compensated fairly for the work I do. (3) o o o o o o My organizational leadership knows my name and appreciates my feedback. (4) o o o o o o My organization has rewards, bonuses, or benefits for doing a good job. (5) o o o o o o I am replaceable. (6) o o o o o o 68 I would recommend my workplace to a friend who is seeking a good job. (7) o o o o o o People at my workplace know what I do and that I do it well. (8) o o o o o o Org Support All of the following statements illustrate aspects of organizational support including appropriate resources, teamwork, collaboration, communication, policy, and procedures that uphold and maintain the role and values of the health professionals and patient care. Please respond to each statement on how you would rate your organizational support on a Likert scale from Strongly Disagree (1) to Strongly Agree (6) Strongly Disagree Slightly Slightly Agree Strongly disagree (2) Disagree Agree (5) Agree (6) (1) (3) (4) I experience higher than normal levels of stress because of my workload. (1) o o o o o o I have the resources I need to do my job effectively and efficiently. (2) o o o o o o 69 My organization’s policies support the employee and the patient. (3) o o o o o o My organization openly communicates with its team members. (4) o o o o o o I feel disconnected from my employer. (5) o o o o o o I receive appropriate training. (6) o o o o o o I do not believe that I can accomplish the job expectations set by my organization. (7) o o o o o o I am able to provide input to my organization and be heard. (8) o o o o o o 70 Appendix B: IRB Approval Innovation and Improvement group thesis Fall 2023 Interim Agreement Report Created: 2023-12-14 By: Cathy Wells (cathywells@weber.edu) Status: Out for Signature Transaction ID: CBJCHBCAABAApTEqqRGKz8bK3BLFmX5FFgbxwKzSIOOO 2024-01-05 Agreement History Agreement history is the list of the events that have impacted the status of the agreement prior to the final signature. A final audit report will be generated when the agreement is complete. 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Gardner 2023-12-18 - 0:32:44 AM GMT- IP address: 104.243.62.175 Document e-signed by Benjamin J. Gardner (benjamingardner1@mail.weber.edu) Signature Date: 2023-12-18 - 0:32:46 AM GMT - Time Source: server- IP address: 104.243.62.175 Document emailed to Kendra Olson (kendraolson@mail.weber.edu) for signature 2023-12-18 - 0:32:49 AM GMT