Cultural Competence of General Hospitals in Israel

Cultural competence (CC) in the health system refers to the ability of the system to provide care to patients with different values, beliefs and behaviors, and to match the care to their social, cultural and linguistic needs.

This study – the first of its kind in Israel – mapped the state of CC in 35 of the 39 general hospitals in the country. The research team developed the mapping and observation tool for purposes of the study, on the basis of the international literature in this area. At 35 hospitals, interviews were conducted with the help of the mapping; at 18 large hospitals (more than 300 beds), there were also semi-structured, in-depth interviews, and at 10 of them, there were observations to examine the languages used in signs and other written materials posted in the public space.

The goals of the study were to evaluate hospital activities promoting CC, to identify factors advancing or inhibiting it, and to learn about the hospitals’ plans for furthering it. The study was conducted shortly after a Director-General’s Circular addressing the issue went into effect (2013). The timing of the study was set for an early stage in the roll-out process so that the data collected could serve as a basis for repeat examination in the future.


  • The average score of all the hospitals on the CC measure was low to moderate (2.24 on a scale of 0 to 4), and the range of scores was large, from 0.7 to 3.2.
  • The analysis of the scores on the CC measure showed that the hospital levels of CC were not uniform. Thus, for example, Government hospitals had the highest level, followed by public, and lastly, private hospitals; hospitals that had completed the process of accreditation from the US Joint Commission International (which  sets standards for patient care) had a higher level than others.
  • Interviewees cited the important role of the guidelines of the Circular in promoting CC and of the involvement of hospital directors.
  • Factors inhibiting CC as reported by the interviewees were the difficulty of understanding how to implement the guidelines of the Circular, the absence of a staff position for an officer in charge, and adequate resources to make the necessary changes.

The findings show that several programmatic directions may advance the level of CC, including: the publication of appendices to the Circular with clear definitions and guidelines for the implementation of standards of quality, staffing levels, and performance monitoring; the allocation by the Ministry of Health of earmarked resources for CC; the pooling of resources to create a cooperative framework for sharing knowledge and tools across hospitals; the preparation of an annual hospital work program; the allocation of a staff position for a CC officer, and the appointment of an in-house steering committee.

It is important that a repeat mapping be performed in two-three years time to examine the progress made by hospitals on CC.

The findings have been presented to decision-makers at the Ministry of Health, to the hospital personnel in charge of CC, and to other researchers in the field, and they have already raised awareness of the topic to help advance it.

The study was conducted with the assistance of the Israel National Institute for Health Policy Research.

Citing suggestion: Elroy, I., Schuster, M., & Elmakias, I. (2016). Cultural Competence of General Hospitals in Israel. RR-706-16. Myers-JDC-Brookdale Institute. (Hebrew)