Using the framework of corporate culture in “mergers” to support the development of a cultural basis for integrative medicine – guidance for building an integrative medicine department or service

Figures & data

Figure 1 Recommendation areas for general integration management and for dealing with cultural differences.

Table 1 Identified cultural differences that could lead to a clash of cultures when developing and implementing an integrative medicine department or referral service

	Cultural differences	Possible consequences of cultural differences	Recommendations to mitigate cultural differences
The integrative medicine environment (inpatient or outpatient clinic usually as part of a hospital)	A complementary medicine practitioner is most commonly an entrepreneur working in his/her own business, and will have to adapt to a new role in the clinic as an employee who works as part of a team. Most complementary medicine practitioners are unfamiliar with the structures, the type of patients, and working in interdisciplinary teams typical of conventional medicine. Conventional health care providers (eg, medical doctors and nurses) have been trained to work within this environment.	Cultural differences influence the attitudes, communications, and working style within the professional team, as well as patient care (eg, patient–practitioner interaction and communication). Differences can have a negative impact on outcomes, especially on patient satisfaction and provider productivity.	a) In general, team and meeting structures in conventional medicine are already changing to take into account the need for multidisciplinary teams. Complementary medicine could be viewed as one discipline within such a team. It is important to enforce less hierarchical structures, but to have clearly defined roles and responsibilities in the teams. Furthermore, the responsibility for the medical diagnosis – including legal liability – has to be clarified within the team. b) Complementary medicine practitioners have an entrepreneurial background and might have a fresh perspective on the given structures. In terms of continuous improvement, the administration should be open to their innovative ideas (eg, employee idea system). c) Training and education should be provided for complementary medicine practitioners in these areas: 1) team development/exposure training (including materials, group exercises and team building, and conflict resolution pathways), 2) special training in organizational structure (eg, reporting guidelines, record keeping, safety), and 3) education in the medical specialty (eg, breast cancer) and typical safety aspects.
Professional image (part of the personality and includes aspects such as appearance, behavior, habits, and communication style)	The professional image of many complementary medicine practitioners can differ from that of conventional health professionals. The institutions that provide the relevant training, the peers, and the underlying treatment philosophies have an influence on respective professional images.	Cultural difference influences attitudes and communication in the professional team, as well as attitudes toward and communication with the patient. It especially affects corporate philosophy, because complementary medicine practitioners often don’t fit the corporate identity of a conventional medicine organization.	a) For the complementary medicine practitioners, the “social norm” in the integrative medicine institution must be clearly defined. Aspects such as having a clear strategy for complementary medicine providers’ visibility as a marketing tool might be taken into account. b) In the staff selection process, considering both clinical skills and professional image will be useful. As noted earlier, complementary medicine includes practitioners with many different modalities (eg, acupuncture, massage therapy) with a wide variety of cultural variances among them as well. The within-modality differences should be considered as much as the differences between complementary and conventional medicine.
Professional language (a profession is identified in part by its use of a shared – but often specialized – language)	For all conventional health care professionals, a shared basic medical language exists, and it is more detailed in the different specialties. By contrast, the professional language of complementary medicine practitioners is very heterogeneous across the different modalities. Language is also influenced by the different modalities’ respective philosophical groundings.	Different professional languages are problematic for communication with patients and for communication within the professional team. Misunderstandings affect the quality of care and may result in reduced patient safety and patient satisfaction, and can have a negative effect on job satisfaction and productivity.	a) Short-term recommendations include: 1) training of complementary medicine practitioners in the basic medical language, and the provision of details needed for the specialty in which they work, 2) the development of a clear and comprehensive safety triage system, which could also be applied by complementary medicine practitioners (eg, when a cancer patient gets a new headache, imaging would be needed to check for brain tumor), 3) training of conventional health professionals in the basics of the applied complementary medicine methods for a better understanding for appropriate referrals, and 4) increasing respect and mutual understanding in an overall multidisciplinary team structure by avoiding abbreviations and explaining special terms. b) Long-term recommendations include: 1) the inclusion of basic conventional medicine medical terminology
Implementation of EBM (is a conscientious use of current best evidence in making decisions about the care of individual patients or the delivery of health services^Citation22)	Currently, EBM is much more established in conventional medicine than in complementary medicine.	Misunderstandings about EBM have a critical influence on the communication within the professional team, and can reduce productivity and job satisfaction. Because EBM has an influence on strategy, its relevance and the acceptable EBM level should be defined as part of the medical model.	a) Short-term recommendations include: 1) empowering complementary medicine practitioners in research literacy with trainings that focus on their treatment modalities including literature search, critical appraisal, the relevance of EBM, a better understanding for clinically meaningful effects in studies, and the relevance and potential of context effects in overall medicine for patient outcomes, 2) educating both conventional health care professionals and complementary medicine practitioners to understand EBM as evidence that includes three pillars (practitioners’ experience, norms and values of the patient, and evidence from clinical research), that evidence can exist on different levels, and that they should be familiar with the available evidence of both conventional and complementary medicine interventions in their field. b) The long-term recommendations include more research literacy in the complementary medicine training of conventional medicine practitioners.

Abbreviation: EBM, evidence-based medicine.

JoosSMusselmannBMikschARosemannTSzecsenyiJThe role of complementary and alternative medicine (CAM) in Germany – a focus group study of GPsBMC Health Serv Res2008812718549476

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