Gayle Tang became the first director of multicultural services at a local medical center. Now, as director of linguistic and cultural services, she is responsible for ensuring that patients are able to communicate with the health care system in their language of choice. She ensures that regulations regarding culturally and linguistically appropriate care are met, and is working to establish an infrastructure to provide culturally competent care to all populations.

It is a role Tang essentially created herself when she developed a business plan for a multicultural services center as part of her graduate nursing work. She presented it to the administration and it was approved. Leaving the bedside to take on the position was a difficult decision, she said, but one she does not regret.

Tang's leadership philosophy is to seek to understand before seeking to be understood. That requires being a good listener, which isn't always easy in a busy environment.

Rather than taking a hierarchical approach, where the leader tells the people what to do, Tang tries to help staff understand the importance of what they are doing.

"A good leader needs to lead by influence, to recognize that there is leadership within each and every one of us, and bring that out. It is being a good mentor to people." Leaders learn from everyone and everything, even the mistakes, which she views as opportunities.

As a Chinese immigrant, Tang brings a personal level of understanding to culturally competent care.

"I give it at a level where people can understand and really apply it. Addressing the audience at the level they can embrace is important. The fact that I'm an immigrant must have something to do with how passionate I am about culturally competent care."

She recalls watching her parents practice medicine in Hong Kong, taking care to treat members of a diverse patient base according to their needs. While she originally wanted to be a doctor, Tang became a nurse because she didn't want to "just diagnose."

Tang says her family-husband, children and parents-are incredibly supportive of her because they know her work is improving the health of the community. "My work is my hobby, my passion. If you met me 10 years ago, I was totally different. I went through nursing school without talking unless I had to. I was trying to make changes, but realized if I really wanted to make a difference, then I had to take risks. I had to learn to deal with people in a different way so people would hear me and entrust me to do the task. I'm still incredibly shy. But if I can do it, anybody can do it."

Tang sees culturally competent care as holistic, an approach that designs systems and processes to address the continuum of care. This approach requires looking not only at the health care organization, but also at resources and needs in the community. For example, Tang negotiated a partnership with a community college to create health care interpreter certificate training. As an employer, she recognized that health care interpreters are important, but there are no community standards or training.

"It is a win-win situation. The school gets students and we get trained, quality interpreters. The demand was there, but we had to go outside the system for the supply. It really is not enough to have culturally competent physicians and staff. You have to have culturally competent organizations with the right systems, technology, environment and people to do the job."