ITIC MENA: Cultural differences in assistance and healthcare
Experts in cultural behaviour in the healthcare and assistance sectors shared their experiences and advice for companies operating in the sector, highlighting the importance of understanding and communication across cultural barriers
Ece Acar Demirkok, Manager, Medical Sales, marm assistance
Ece’s presentation looked at the cultural norms of which international assistance, funeral repatriation and air ambulance providers should be aware, as well as looking at the limitations that local regulations can place on international assistance companies.
It’s important, said Ece, to distinguish between cultural norms and regulations. The term ‘culture’ refers to attitudes and patterns of behaviour in a given group. The knowledge of different cultures –in everything from legal regulations to food and drink habits relating to religion – can be crucial in medical assistance. ‘Norm’ refers to attitudes and behaviours that are considered normal, typical or average within that group. All societies have cultural norms, said Ece, and norms are good to know, but taboos and laws are essential when providing services in different environment.
In the assistance sphere, the nationality of the claimant is important for the call centre agents to understand, but it is also vital that the agent understands the culture of the country the client is visiting. Selecting the correct mix of service providers in a network is also important for assistance companies, as they need to be classified according to client requirements, such as an alcohol-free hotel, or hospital with a prayer room.
When it comes to case management and cost containment services, it is essential to clearly understand the local healthcare regulations to successfully establish a medical assistance network: “Contractual cooperation, as well as discount agreements, are always done under the terms of the healthcare regulations and legal requirements of the country,” pointed out Ece. Adherence to local and international regulations is also vital when it comes to providing telemedicine services, which is something that all providers should be more aware of nowadays, with the increasing use of such services following the pandemic.
“Funeral repatriation is one of the most sensitive missions done by assistance companies,” said Ece. “The culture and religion of the deceased should be known and understood. Staff should be trained to communicate with the families, cooperate with local funeral companies, and meanwhile, the home country norms should be considered.” Network selection decisions when it comes to funeral providers, she said, is made on quality, fast response, and good communication, she added. Medical escort and air ambulance arrangements is another area where understanding of cultural differences is vital; firstly when thinking about the patient’s own country, but assistance companies should also be mindful of the cultural background of the medical team providing the transportation services.
If an assistance company wishes to start operating in another a country, they can either establish a branch office, or work with a local assistance company. Working directly from abroad can also be an option, but it is not cost effective and sustainable, believes Ece. For example, after marm decided to launch an office in Dubai, it started to cooperate with a local consultant to help with the establishment of operations because regulations in service areas like medical regulation, travel requirements, and other legal issues, are different than Turkey. Local staff who know the culture, norms, traditions, and laws are also a necessity for the successful established of a medical assistance network, with proper operation by proper communication.
Marco Ambrogio, Founder, Creator of Successful Business Stories
The value of knowledge and good communication was underscored by Marco’s own experience as a member of an emergency medical team in the Italian Alps, which, he said, showed him how a patient’s understanding of what is going to happen to them is key to a satisfied and safe patient.
The case for ensuring staff working internationally undergo cultural training, said Marco, lies in the fact that companies are obliged to develop an awareness between people where a common cultural framework does not exist. Working in a stressful situation can make cultural differences worse, so in assistance and healthcare provision, it is more essential than in many other industries that staff are ready to deal with a stressful situation that involves communication with people from multiple different backgrounds. Furthermore, such training supports individuals and teams by empowering them to develop the self-confidence that is necessary to deal with difficult challenges both in the workplace, and outside it. Marco told attendees: “Mutual understanding leads to enhanced trust among people, and this can be an enabler for better collaboration and for improving productivity in the workplace. When people feel safe and trust each other, they become motivated to improve and achieve more.”
Marco then offered attendees an insight into what he called ‘the equation of excellence’, which, he said is: Q x S x C – quality x service x communication. “An organisation cannot survive and thrive without an obsessive focus on quality,” Marco informed the audience, and as for service, excellence can’t come from a one-off review where a patient had a great experience, it has to be sustainable: “Whatever status you achieved in the market is far from permanent, you need to reconfirm your status in the market every single day through stellar service.” Moving on to the importance of communication, Marco pointed out that this is central to the two previous points of the equation: “Understanding cultural differences and developing your intercultural soft skills through relevant training will enable you to communicate with confidence, thus bringing quality and service together to support your customers wherever they are in the world and make a difference when it is most needed.”
Dr Fatih Mehmet Gul, MD, Vice President – UAE and Growth Office Chief Executive Officer – Fakeeh Care Group
Cultural richness within an organisation is powerful and challenging, as trying to manage all these differences can be a difficult thing to do, said Dr Fatih. Fakeeh Care Group, for instance, has 47 nationalities among its staff members. Human resources are tasked with ensuring there is a diverse workforce in each department. Cultural differences are a strength that has to be carefully balanced.
“Culture difference is the mosaic of people who bring a variety of backgrounds, styles, perspectives, values and beliefs as assets to the groups and organizations with which they interact,” said Dr Fatih. “And patients have to trust the physician and nurse that are treating them. The issue is engagement, and staff have to be engaged with their patients and with each other.”
There are both visible and invisible aspects of cultural differences, both of which are equally important. While race, gender, age and language are the obvious aspects, less obvious ones can be religion, skills, education, background, personality, beliefs and values.
Dr Fatih then explained the social, health, and business benefits of becoming a culturally competent healthcare organisation. With the current lack of healthcare staff in certain counties – the UK, for instance, increasing cultural understanding is essential to a successful recruitment strategy. Socially, enhancement of cultural understanding among staff increases mutual respect and understanding between patients and the organisation; from a health benefits perspective, it improves data collection and reduces disparities in the patient population; while from a business point of view, it incorporates different perspectives, ideas and strategies into the decision making process, decreases barriers that slow progress, and moves companies further towards the goal of meeting legal and regulatory guidelines.
In order to become more culturally aware, healthcare organisations should perform community surveys, and engage more with their community, which will serve to educate their staff, said Dr Faith, who is speaking from experience when it comes to opening a new hospital in a different country. To tap into the talent market, and then the international patient market, organisations need to be inclusive for all religions – celebrate Diwali, Eid and Christmas, for instance, he suggested.
“If you create the organisational structure from the beginning that brings fair and equitable treatment to all staff, with respect from all sides for the staff, the staff members are empowered to treat patients with the same equity and respect,” pointed out Dr Fatih. Organisations that create loyalty will have a higher staff retention rate.
It is important that organisations respect the opinion of other team members, acknowledge cultural and generational differences, and historical injustices, without becoming defensive. “You must be open to learning about other cultures and ideas,” said Dr Fatih. “Give others the benefit of the doubt in a dispute, and seek first to understand other peoples’ points of view, then to be understood yourself.” Effective communication, he continued, comes when we don’t stereotype other people and don’t judge them by our own cultural standards. Dr Fatih concluded: “When we feel a sense of belonging it is not because we are the same as everyone else, but because we have been accepted as we are.”