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This paper examines the function that cross-cultural competence (3C) has for NATO in a military context while focusing on two member states and their armed forces: the United States and Germany. Three dimensions were established to analyze 3C internally and externally: dimension A, dealing with 3C within the military organization; dimension B, focusing on 3C in a coalition environment/multicultural NATO contingent, for example while on a mission/training exercise abroad; and dimension C, covering 3C and NATO missions abroad with regard to interaction with the local population.
When developing the research design, the cultural studies-based theory of hegemony constructed by Antonio Gramsci was applied to a comprehensive document analysis of 3C coursework and regulations as well as official documents in order to establish a typification for cross-cultural competence.
As the result, 3C could be categorized as Type I – Ethical 3C, Type II – Hegemonic 3C, and Type III – Dominant 3C. Attributes were assigned according to each type. To validate the established typification, qualitative surveys were conducted with NATO (ACT), the U.S. Armed Forces (USCENTCOM), and the German Armed Forces (BMVg). These interviews validated the typification and revealed a varied approach to 3C in the established dimensions. It became evident that dimensions A and B indicated a prevalence of Type III, which greatly impacts the work atmosphere and effectiveness for NATO (ACT). In contrast, dimension C revealed the use of postcolonial mechanisms by NATO forces, such as applying one’s value systems to other cultures and having the appearance of an occupying force when 3C is not applied (Type I-II). In general, the function of each 3C type in the various dimensions could be determined.
In addition, a comparative study of the document analysis and the qualitative surveys resulted in a canon for culture-general skills. Regarding the determined lack of coherence in 3C correlating with a demonstrably negative impact on effectiveness and efficiency as well as interoperability, a NATO standard in the form of a standardization agreement (STANAG) was suggested based on the aforementioned findings, with a focus on: empathy, cross-cultural awareness, communication skills (including active listening), flexibility and adaptability, and interest. Moreover, tolerance of ambiguity and teachability, patience, observation skills, and perspective-taking could be considered significant. Suspending judgment and respect are also relevant skills here.
At the same time, the document analysis also revealed a lack of coherency and consistency in 3C education and interorganizational alignment. In particular, the documents examined for the U.S. Forces indicated divergent approaches. Furthermore, the interview analysis disclosed a large discrepancy in part between doctrine and actual implementation with regard to the NATO Forces.
In the area of cardiac monitoring, the use of digitally driven technologies is on the rise. While the development of medical products is advancing rapidly, allowing for new use-cases in cardiac monitoring and other areas, regulatory and legal requirements that govern market access are often evolving slowly, sometimes creating market barriers. This article gives a brief overview of the existing clinical studies regarding the use of smart wearables in cardiac monitoring and provides insight into the main regulatory and legal aspects that need to be considered when such products are intended to be used in a health care setting. Based on this brief overview, the article elaborates on the specific requirements in the main areas of authorization/certification and reimbursement/compensation, as well as data protection and data security. Three case studies are presented as examples of specific market access procedures: the USA, Germany, and Belgium. This article concludes that, despite the differences in specific requirements, market access pathways in most countries are characterized by a number of similarities, which should be considered early on in product development. The article also elaborates on how regulatory and legal requirements are currently being adapted for digitally driven wearables and proposes an ongoing evolution of these requirements to facilitate market access for beneficial medical technology in the future.