Open Access Research article

Cultural competency of health-care providers in a Swiss University Hospital: self-assessed cross-cultural skillfulness in a cross-sectional study

Alejandra Casillas14*, Sophie Paroz2, Alexander R Green3, Hans Wolff4, Orest Weber5, Florence Faucherre5, Françoise Ninane1 and Patrick Bodenmann1

Author Affiliations

1 Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland

2 Department of Community Medicine and Public Health, Lausanne University Hospital, Lausanne, Switzerland

3 Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School, Cambridge, USA

4 Department of Primary Care, Community Medicine, and Emergencies, Geneva University Hospitals, Geneva, Switzerland

5 Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland

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BMC Medical Education 2014, 14:19  doi:10.1186/1472-6920-14-19

Published: 30 January 2014



As the diversity of the European population evolves, measuring providers’ skillfulness in cross-cultural care and understanding what contextual factors may influence this is increasingly necessary. Given limited information about differences in cultural competency by provider role, we compared cross-cultural skillfulness between physicians and nurses working at a Swiss university hospital.


A survey on cross-cultural care was mailed in November 2010 to front-line providers in Lausanne, Switzerland. This questionnaire included some questions from the previously validated Cross-Cultural Care Survey. We compared physicians’ and nurses’ mean composite scores and proportion of “3-good/4-very good” responses, for nine perceived skillfulness items (4-point Likert-scale) using the validated tool. We used linear regression to examine how provider role (physician vs. nurse) was associated with composite skillfulness scores, adjusting for demographics (gender, non-French dominant language), workplace (time at institution, work-unit “sensitized” to cultural-care), reported cultural-competence training, and cross-cultural care problem-awareness.


Of 885 questionnaires, 368 (41.2%) returned the survey: 124 (33.6%) physicians and 244 (66.4%) nurses, reflecting institutional distribution of providers. Physicians had better mean composite scores for perceived skillfulness than nurses (2.7 vs. 2.5, p < 0.005), and significantly higher proportion of “good/very good” responses for 4/9 items. After adjusting for explanatory variables, physicians remained more likely to have higher skillfulness (β = 0.13, p = 0.05). Among all, higher skillfulness was associated with perception/awareness of problems in the following areas: inadequate cross-cultural training (β = 0.14, p = 0.01) and lack of practical experience caring for diverse populations (β = 0.11, p = 0.04). In stratified analyses among physicians alone, having French as a dominant language (β = −0.34, p < 0.005) was negatively correlated with skillfulness.


Overall, there is much room for cultural competency improvement among providers. These results support the need for cross-cultural skills training with an inter-professional focus on nurses, education that attunes provider awareness to the local issues in cross-cultural care, and increased diversity efforts in the work force, particularly among physicians.

Cultural competency; Cross-cultural care; Medical education; Health disparities; Vulnerable populations; Immigrant populations