Case 1:A new Latina graduate of an MHSA program is hired to be in charge of a quality improvement and patient safety initiative at a hospital in Washington,DC.On her first morning at work,she asks her administrative assistant,an older African-American woman, to schedule one-on-one appointments for her key employees involved in the new program.She wants to see them starting on the next day, so she asks her assistant to start making the appointments as soon as possible.The administrative assistantnods, says nothing and returns to her computer work.At the end of the day, the administrative assistant has made no appointments for her new boss.

Case 2:A Vietnamese Death.Dr. Needlemanwas invited to do a presentation on cultural competenceto the hospice staff at a large successful, and very white hospital. As part of his preparation, he visited the inpatient hospice one afternoon.At the end of his visit, he sat with the nurses as they debriefed the shift.One, a leader of some sort, said that she was pleased Dr. Needlemanwouldtalk to them since she needed to know more.She then said why.She had been rushing around for a few hours to solve a problem for a Vietnamese man whose wife had just died in the CCU following palliative surgery for cancer.The CCU needed the bed, but the husband told the nurse that he needed to be with his wife for three days in case her spirit returned.At about this point, Dr. Needlemanwondered out loud what the problem was since the nurse seemed to be listening in a neutral fashion- an important early step in culturally competentcare.She went on. She looked through the hospital for a room where the man could be in private with his wife. In addition, she negotiatedwith some service that needed to have the body for standard hospital procedures after a death.Ultimately, she succeeded in getting the service to back off.In addition she foundthat the hospice conference room might work for the sitting process.However, there was a conference in there; she threw them out.At this point, Dr. Needlemanwas astounded that the nurse felt that she needed more education/practice in cultural competence.She had exhibited the kind of system savvy that he thoughtwas essential in cultural competence and engaged in a negotiationprocess that is the essence of cultural practice.What, he wondered, was the problem? I asked again.She said simply: "But the husband does not believe that his wife is dead."

1. What are the known facts in each scenario?
2. What else may be going on?
3. What cultural differences might explain the misunderstandings in these cases?