Think Salad, Not Stew: Managing Cultural Differences in Your HIM Department

The Opportunity and Challenge of Diversity

You're representing coders at a hospital-wide task force charged with recommending improvements to the hospital's information systems. You arrive promptly at the first meeting, ready to jump in and tackle your assignment. The team members, many of whom you've never met, have three short weeks to get the report done. So why are some sitting around the table looking impatient to get started while others use up time detailing their dog's last trip to the vet?

Welcome to what is likely a culture clash in action. Get used to it. Our society is more vibrantly diverse than ever, thanks to changing birth rates, immigration, mobility, openness, and consciousness of equal opportunity for all. We are increasingly likely to find our workplaces enriched and challenged by differences in gender, race, language, customs, religion, abilities, sexual orientation, and geographic origins.

Recognizing the Impact of Cultural Differences

According to Marcelle E. DuPraw of the National Institute for Dispute Resolution and Marya Axner, diversity awareness consultant, six fundamental patterns of cultural differences may influence how your staff works together.

• Communication styles. What meanings do employees with different backgrounds assign to common words (e.g. "yes" or "maybe") and non-verbal cues (e.g. loud voices; physical space between speaker and listener)?
• Attitudes toward conflict. How directly and openly do different employees handle disagreements with colleagues?
• Approaches to completing tasks. Are there differences in work styles on your staff? Are some people focused on relationships and teamwork while others dismiss meetings as time wasters?
• Decision-making styles. Do some staff expect to delegate decision-making while others favor a top-down executive style? When your group makes a decision together, do some expect consensus and others a majority vote?
• Attitudes toward disclosure. Are some staff willing to share personal information and emotional reactions while others believe that feelings have no place at work?
• Approaches to knowing. Do some staff favor concrete facts and data while others recognize instinct and logical speculation as valid forms of information?

Setting the Tone

The old notion of a cultural melting pot--a stew of differences made palatable by blending them into a non-threatening sameness has been replaced with a new approach that challenges managers to think salad instead. The objective is not to make differences disappear, but toss them into a problem-solving and productivity mix that maintains the unique character and contribution of each employee.

Managers set the tone. What each employee brings to the table--skill set, work and communication style, etc.--is to be valued and respected. All employees are expected to work creatively with differences rather than avoiding or negatively stereotyping them.

Tips for Working Together

Managers will never be able to anticipate all the issues that will emerge in a culturally diverse HIM department. However, these tips can help work through the interpersonal problems that will inevitably arise.

• Sensitize your staff to cultural communication differences. Avoid creating a paradigm where some communication styles are thought to be better than others. Help staff understand specific habits that may be culturally linked, for example: speaking volume and the tendency to interrupt or talk at the same time as another.
• Help staff establish norms. Model helpful, respectful, nonjudgmental language for solving culturally related issues. "Lalitha, you have a special talent for talking and listening at the same time, but I'm not able to follow two conversations at once. Can we agree to limit the floor to one speaker at a time?"
• Consider diversity training. Check with your human resources department about seminars or workshops for your staff to increase skills for interpreting culturally based behaviors.

Now back to that meeting where we started. Remember the talk about the trip to the vet? You may be seeing the preference of some cultures to establish relationships before starting a project--and focusing on task completion as it crescendos toward the end--while your own background may make you eager to start work on the task and build relationships as needed.

Either style will get the job done. The trick is for everyone to work together--if not always comfortably, at least effectively.