HLTH 5003 Module 2 Organizational Culture and Cultural Competency Analysis Example

Speed, Relationship and Privacy Under One Roof: An Organizational Culture and Cultural Competency Analysis for a Merging County Family Health Clinic

Student Name

American College of Education

HLTH5003: Leadership and Management in Public Health Organizations

Module 2 Assignment

Instructor Name

October 12, 2026

Why Culture Comes First

The first module applied adaptive leadership to a composite county health department's plan to merge its WIC, immunization and family planning clinics into one family health clinic. It concluded that the hardest parts of the merger were not the floor plan or the scheduling system but what each program's staff believed their work was for. This paper examines those beliefs directly as organizational culture, and then asks a related question the merger raises: whether the combined clinic will serve the county's increasingly diverse families better or worse than the three clinics did.

The department serves a county where about 14% of residents speak Spanish at home, and smaller but growing numbers speak Vietnamese or Haitian Creole. Merging front desks and waiting rooms changes who greets families, in what language, and how private their conversations are, so culture inside the organization and cultural competency toward the community must be analyzed together.

Three Levels of Culture

Schein and Schein (2017) describe organizational culture at three levels. Artifacts are what an outsider can see and hear, such as layouts, dress, routines and stories. Espoused values are the organization's own account of itself, in mission statements, policies and speeches. Beneath both lie basic assumptions, beliefs so settled that people act on them without noticing and rarely think to question them. Change efforts that address only artifacts and stated values tend to fail when they collide with assumptions nobody has named.

Applied to the three clinics, the model shows why the merger has unsettled staff. The programs share a mission statement and a single organizational chart, but their artifacts and assumptions differ sharply.

The Three Program Cultures

The WIC clinic's artifacts include appointment blocks of 30 minutes, children's drawings on the walls and staff who know families by name across several pregnancies. Its stated value is nutrition support, but its underlying assumption is that trust built over time is what keeps families coming back. The immunization clinic's artifacts are a fast queue, a whiteboard counting doses given each day and a nurse-to-nurse handoff that takes seconds. Its assumption is that efficiency is a form of care, because every missed dose is a child left unprotected. The family planning clinic's artifacts are a separate side entrance, a policy of calling patients by number and a rule that staff never confirm a patient's visit to anyone. Its assumption is that privacy is the condition of care; without it, many patients would not come at all.

Each assumption is reasonable, and each conflicts with the others in a shared space. A single front desk asks WIC to be faster, immunizations to be slower and family planning to be more visible, and each group hears that as being asked to care less. The merger design should therefore protect each assumption explicitly, for example with private check-in booths for family planning, a fast lane for vaccine-only visits and a named WIC counselor for returning families, rather than asking staff to adopt a new blended culture on the first day.

Cultural Competency and the National CLAS Standards

Cultural competency in an organization is less about individual attitudes than about practices that make services effective for everyone. The federal CLAS Standards, kept by the Office of Minority Health, give a usable framework: a principal standard calling for effective, understandable and respectful care that responds to cultural health beliefs, languages, health literacy and other communication needs, backed by 15 more specific standards in three groups, one on governance and staffing, one on language help and communication, and one on community engagement and accountability (Office of Minority Health, n.d.). The language assistance standards call for free language assistance, informing people that it is available, using competent interpreters rather than untrained staff or minors, and providing materials and signage in the languages common in the service area.

Measured against those standards, the three clinics differ. WIC has two bilingual Spanish-speaking counselors and materials in Spanish. The immunization clinic relies on whichever staff member speaks Spanish that day and, for other languages, on family members, sometimes children, to interpret. Family planning uses a telephone interpreter service but does not tell patients in writing that it exists. No clinic has materials or signs in Vietnamese or Haitian Creole.

What the Evidence Suggests About Competency Efforts

Cultural competency training is the most common response to such gaps, but the evidence suggests it is not enough by itself. Truong et al. (2014), in a systematic review of 19 reviews, found moderate evidence that cultural competency interventions improved provider outcomes and access to and use of services, and weaker evidence of improvement in patient outcomes. For the department, that argues for concentrating on structural changes that affect access directly, such as interpreter systems, translated materials and hiring, and treating training as support for those changes rather than as the solution.

Listening to Families

The analysis so far rests on staff views and program records, and a culture analysis that never asks the people served is incomplete. Over two weeks, the design team held three short listening sessions in the waiting areas, one in Spanish with a staff interpreter, one in English and one arranged through a Vietnamese community church, and asked families what made a visit feel respectful and what made it hard. Three themes came through. Families valued being greeted by name and not having to repeat their story at every counter, which supports WIC's relationship-based approach. Many were uneasy about discussing family planning within earshot of neighbors, which confirms the privacy concern in terms staff had not heard directly. And Vietnamese-speaking parents said they often brought an older child to interpret because no one had told them an interpreter was free. Those comments turn the CLAS gaps from abstract shortcomings into specific moments in a family's visit, and they give the design team a reason to act that comes from families rather than from managers.

Recommendations

The merger is an opportunity to raise every program to the standard of the best one. The department should adopt the CLAS language standards clinic-wide from the first day: telephone and video interpreters available at every station, a written notice in the county's four main languages that interpretation is free, and a firm rule against using children as interpreters. It should translate core forms and signs into Vietnamese and Haitian Creole and test them with community members. It should recruit for language skills when filling the positions the merger opens. Internally, it should hold facilitated sessions where each program's staff describe what they most want to protect, and build the design team's charter around those three assumptions. Progress should be measured by the share of limited English proficient visits with a qualified interpreter, family ratings of respect and privacy by language, and staff reports of whether their program's values survived the merger.

References

Office of Minority Health. (n.d.). National CLAS Standards. Think Cultural Health, U.S. Department of Health and Human Services. https://thinkculturalhealth.hhs.gov/clas/standards

Schein, E. H., & Schein, P. A. (2017). Organizational culture and leadership (5th ed.). Wiley.

Truong, M., Paradies, Y., & Priest, N. (2014). Interventions to improve cultural competency in healthcare: A systematic review of reviews. BMC Health Services Research, 14, Article 99. https://doi.org/10.1186/1472-6963-14-99