Get Prepared: It's Time for a Culture Audit!
Karen Beverly-Ducker, MA, CCC-A, CAE
many different types of audit, some more familiar than others. An income tax
audit involves an Internal Revenue Service review of reported income and the
determination that all credits, deductions, and exemptions taken were
appropriate. A financial audit involves a review of accounting records, internal
controls, policies, cash holdings, and the other financial areas of a company or
business. A Medicare recovery audit is conducted to uncover and prevent Medicare
fraud, waste, and abuse. A patient care audit is often used as part of a quality
improvement initiative and includes a review of medical records to measure the
quality of patient care. The ASHA certification maintenance audit is a random
evaluation of an individual's records and is used to verify compliance with the
standards for certification maintenance.
Independent of the type of audit
being conducted, there is often a certain level of anxiety associated with the
activity. However, performing your own audit in advance can help to identify
areas in need of focus and to prepare for any reviews that may be conducted by
The cultural values and preferences of all
individuals involved as well as those of the setting or environment can impact
all aspects of a "business." For example, a consumer information initiative,
marketing strategy, training program, advertising campaign, or personnel policy
that is highly successful in one culture may be wholly ineffective in a
different culture and have wide-reaching impact on outcome, compliance, and
A culture audit involves the review of the cultural
values and preferences of the overall setting, organization, or business. In the
professional service delivery setting, this includes both how the professional
service provider and the client/patient respond to, for example, clinical
services, strategies, products, practices, policies, communications, and
recommendations in light of cultural influences. The culture audit is designed
to define work behaviors and approaches to service delivery, identify problems
with the system, and remove barriers to professional service delivery.
culture audit also involves the overall review of the cultural values and
preferences of the professional service provider as well as the client/patient.
This includes an examination of the wide array of differences as well as
similarities across cultural variables from the two perspectives.
professional service provider, this process is also referred to as cultural
competence. "Developing cultural competence is a dynamic and complex
process requiring ongoing self-assessment and continuous expansion of one's
cultural knowledge. It evolves over time, beginning with an understanding of
one's own culture, continuing through interactions with individuals from various
cultures, and extending through one's own expansion of knowledge. Professional
competence requires that audiologists and speech-language pathologists practice
in a manner that considers each client's/patient's/caregiver's cultural and
linguistic characteristics and unique values so that the most effective
assessment and intervention services can be provided." (ASHA, n.d.)
Performing a Culture Audit
A formal, customized culture audit
typically consists of five phases—needs awareness, diagnosis, planning, action,
and evaluation—and provides action plans based on results. The audit may be
conducted by an external, independent consultant or completed internally by an
advisory team consisting of staff members and patients/clients. During the
diagnosis phase, the advisory team identifies how the data will be gathered;
collects, reviews, and analyzes the data; and then outlines the desired culture.
During the planning phase, the advisory team develops the plans for intervention
and change. During the action phase, the culture begins to move toward its
desired or envisioned future. This phase often requires change in the
organization's systems—technology, structure, decision making, budgeting, and
managing. During the evaluation phase, the organization assesses the impact of
its culture on its performance.
In preparation for (or in the absence of)
a formal customized culture audit, valuable information can be gathered and
considered. In general, focus may be directed to three major areas—policies,
procedures, and processes; service providers; and clients/patients served—to
assess the current cultural state. Each area should be reviewed with
consideration given to how the area may be impacted by cultural variables, such
as race, ethnicity, culture, language, dialect, national origin, gender, gender
identity or expression, sexual orientation, age, religion, socioeconomic status,
Questions for guidance include:
Procedures, and Processes
- Does the professional setting have a
vision statement, a mission statement, and strategic goals that reflect
inclusiveness and a commitment to culturally competent care?
- Do current
policies, procedures, and processes hinder or support the vision, mission, and
- Do current policies, procedures, and processes support
efforts to accomplish work or do they impede progress?
- Is written
information provided in languages in addition to English?
- Is the
facility accessible by individuals with different needs and levels of
- Are the professional services accessible in terms of
language(s) used? Does this extend to the first point of contact-for example,
- Are there scheduling options, such as evening and
- Are materials and resources available that are
appropriate for working and communicating with individuals who do not use spoken
- Are financial resources available to support the acquisition
of materials, assessment tools, etc. that meet diverse cultural and linguistic
- Is a teamwork approach used to deliver services, and does that
approach include and acknowledge the valuable role of different team members
(e.g., the audiologist, audiology assistants, interpreters, etc.)?
human resources dedicated to meeting the needs of diverse populations?
- Are professional service providers
prepared to provide services to diverse populations?
- How do individual
service providers describe the culture of the professional setting?
do individual service providers display and share their cultural
- Are there opportunities for individual service providers to
assess, understand, share, and celebrate their respective cultures?
there specific strategies for recruiting and retaining diverse staff
- Do the knowledge and skill sets of staff members mirror the
needs of the patient/client population?
- Is there funding specifically
dedicated for professional education in the area of cultural and linguistic
- Are professional service providers aware of the regulatory
requirements, mandates, and national standards regarding the provision of
- Do staff members know how to access needed resources
(i.e., interpreter services, telephone or video language services) for
individuals who do not use spoken English?
- Do service providers have
the needed skills to explore client/patient perspectives and cultural and
religious beliefs related to health, illness, and treatment?
- Does the
staff "photo" reflect diversity? Is this diversity reflected across all
- What is the typical
profile of the patients/clients seen?
- Does the typical patient/client
profile reflect that of the community?
- How often is community-level
demographic data collected?
- How is information gathered about the
- Do clients/patients have the opportunity to
share their individual cultural influences, practices, and preferences?
- Is consumer satisfaction data gathered related to cultural and linguistic
- What are the physical signs of the culture in the
- Do photos, artwork, brochures, etc. reflect a
variety of people and family groupings so that clients/patients "see
- Does signage convey information in a variety of
The Value of a Culture Audit
The objective of the
culture audit is to help gain an understanding of the current culture. As with
all audits, a culture audit represents that moment in time. Culture is dynamic
and should be periodically reviewed. The results from the culture audit will
either confirm the efficacy of the current culture or help to identify areas in
need of change. All information gathered-both the positive aspects and the more
challenging aspects-are needed for the creation and maintenance of the desired
culture and to ensure appropriate service delivery for diverse populations.
About the Author
Karen Beverly-Ducker serves as the director,
Multicultural Resources, at the American Speech-Language-Hearing Association
(ASHA) and as the ex officio to ASHA's Multicultural Issues Board. Her area of
focus is the influence of cultural and linguistic factors on the many aspects of
professional service delivery. Contact her at firstname.lastname@example.org.
American Speech-Language-Hearing Association. (n.d.). Cultural
competence [Practice Portal]. Retrieved February 18, 2014.