Adapting Health Care to Israel’s Cultural Diversity

Undergoing a medical procedure can be a stressful experience, and can be made even more so when the care is being given in a language you cannot speak or read.

Many non-Hebrew speakers face this very challenge when trying to navigate Israel’s health care system, which has been insufficiently mindful of patients and families who do not understand Hebrew.

This is beginning to change, thanks to recent government efforts to improve the cultural competence of the health system.

In 2013, the Ministry of Health issued new cultural and linguistic standards based on international practices, to promote cultural competence. This was defined as enabling the health care system to provide care to patients with different values, beliefs, and behaviors, and to adapt care to their social, cultural, and linguistic needs.

According to Smokler Center researcher Irit Elroy, cultural competence is part of a larger Ministry effort to reduce gaps in health care outcomes.  “Research has shown that patients are more likely to comply with their treatment plan when they receive explanations in their native language, and if they feel that the physician is sensitive to their culture.  Sticking to the plan means improvements in health and less need for additional care.”

MJB recently concluded an innovative study of cultural competency in Israel’s 35 general hospitals.  Researchers built a survey instrument that looked at a broad range of activities and policies within hospitals—including accommodations for different religions, translation services, adaptions of the physical environment, and staffing dedicated to cultural adaptation.  According to Elroy, the 75-question survey was the first time such a comprehensive tool was developed in Israel to rigorously measure cultural competence.

The study found that, on average, hospitals scored “relatively low to moderate” in terms of overall cultural competence (an average of 2.2 out of 4).  There was, however, variation across all hospitals, with some having a strong foundation in place and others scoring very low.

Given Israel’s multicultural population, the Ministry’s directives include a requirement that hospital signs should be posted in the languages most common to the local patient population.  This typically would include Hebrew, Arabic, and English, although in some communities Russian is also mandated.

In practice, the researchers found that almost 60% of the signs were only in Hebrew.  About 20% also had English or Arabic, and only a small percentage had Russian in addition.  Emergency rooms were generally more linguistically accessible than other parts of the hospital.  Directional and warning signs were more linguistically accessible than signs that provided emergency instructions.

Elroy emphasized that “it’s about person-centered care: can a patient get services that take into account their culture, their language, their religion?”  For health care professionals, the challenge is to be aware of potential cultural sensitivities.  “No one is expecting them to know every specific cultural accommodation that might be appropriate, but they need to know that an accommodation might be needed.”

Since the publication of MJB’s study, the Ministry of Health has adopted the cultural competence tool and is implementing it to measure on an ongoing basis how well hospitals are meeting the new standards.  Hospitals will be given an official “cultural competence” score, which will be publicized just as various measures of clinical quality are now made public.