Cultural Empathy: Lip-service or an Opportunity to Transform Therapeutic Engagement?

1. Cultural Empathy: Lip-service or an Opportunity to Transform Therapeutic Engagement? Esthe Davis 18 September 2018

2. Background • A try athlete • A mould breaker • An OTT life optimizer • A closet anthropologist

3. You never really understand a person until you consider things from his point of view … until you climb into his skin and walk around in it. ~ To Kill a Mockingbird, Lee, 1960.

4. Multi-Cultural Competence: A Patient Quality Improvement Project Legislative & Ministerial Expectations Organizational Accountability Professional Standards

5. Population Considerations

6. Workforce Considerations

7. Methods • Analysis of Patient Satisfaction Surveys (2018) • Formal Analytic Report of Patient Satisfaction Surveys • Staff Survey on Cultural Competence • Focus group on Staff Survey outcomes • Semi-structured interview of 7 LDHB Interpreters • Met with the President of the Rotorua Multi Cultural Council • Attendance of the Rotorua Multi Cultural Council AGM

8. Patient Surveys (2018 Q1)

9. Staff Survey:Cultural Competence

10. Findings: Thematic Analysis & Triangulation • Need more Organizational support • Service structure and environment does not fully accommodate diverse cultures. • Interpreter training and protocol to be enhanced • A need for more patient choice • Existing mechanisms to provide feedback or complaints are difficult to access by people who are not confident in English

11. What is culture?

12. What is culture? Cultural identity is the identity or feeling of belonging to a group. It is part of a person's self-concept and self-perception. It is related to nationality, ethnicity, religion, social class, generation, locality or any kind of social group that has its own distinct culture. https://en.wikipedia.org/wiki/Cultural_identity

13. What is culture? In pairs: • Write down 5 aspects about yourself that form part of your cultural identity • But only 4 aspects can be true • The object of the game is to guess which one is false

14. Literature Review • Health disparity for Maori, Pacific Islander and Asian populations in New Zealand • Avoidable death rates for Māori 2,5 x higher • Culturally and linguistic diverse (CALD) patients are 2x more likely to experience serious adverse events. • Structural Discrimination

15. Structural Discriminiation “…when an entire network of rules and practices disadvantages less empowered groups while serving at the same time to advantage the dominant group”. The State Services Commission

16. Cultural Competence, Intelligence, Humility, Sensitivity or Empathy? Literature Review

17. The try athlete’s example Brené Brown on Empathy – YouTube https://www.youtube.com/watch?v=1Evwgu369Jw Lessons from a Recovering Racist | Andrew Judd | TEDxRuakura ...

18. Cultural Empathy: A foundational skill Empathy is the experience of understanding another person's thoughts, feelings, and condition from their point of view, rather than from your own. Psychology Today (2018).

19. Cultural Empathy: A foundational skill Cultural Empathymeans that a person has an awareness and understanding of the cultural attributes of a given society & how they differ from his or her own culture. O’Connell, J. (2018). Patient Centred care Other- Oriented perspective

20. 5 Steps to… Cultural Empathy • Personal therapeutic stance • Basic knowledge of cultural beliefs, customs and values. • Curiosity: Perspective Taking • Non-judgemental active listening. • Ability to connect in a way that acknowledges our similarities and differences. Adapted from Dr. Brené Brown

21. Multi-Cultural Empathy in a Bicultural Framework

22. The Alternation Model Trevor Noah Responds to Criticism from the French Ambassador - The Daily Show https://www.youtube.com/watch?v=COD9hcTpGWQ

23. Health navigator sample

24. Cultural Dimensions

25. Cultural DimensionsPower Distance Index (PDI) • This degree to which the less powerful members of a society accept and expect that power is distributed unequally. • Fundamentally: how does a society handle inequalities among people? • High Power Distance: acceptance of a hierarchical order • Low Power Distance: people strive to equalize the distribution of power and demand justification for inequalities of power.

26. Cultural DimensionsIndividualism versus Collectivism(IDV) • Individualism: a loosely-knit social framework in which individuals are expected to take care of only themselves and their immediate families. • Collectivism: a tightly-knit framework in society in which individuals can expect their relatives or members of a particular in-group to look after them in exchange for unquestioning loyalty. • A society’s position on this dimension is reflected in whether people’s self-image is defined in terms of “I” or “we.”

27. Cultural DimensionsMasculinity versus Femininity (MAS) • Masculinity: the society is competitive and encourages achievement, heroism, assertiveness & material rewards for success. • Femininity: the society is consensus-oriented and encourages cooperation, modesty, caring for the weak and quality of life.

28. Cultural DimensionsUncertainty Avoidance Index (UAI) • The degree to which the members of a society feel uncomfortable with uncertainty and ambiguity. • Fundamentally - how a society deals with the fact that the future can never be known: attempts to control it or just let it happen? • Strong UAI: rigid codes of belief and behaviour, and are intolerant of unorthodox behaviour and ideas. • Weak UAI: societies maintain a more relaxed attitude in which practice counts more than principles.

29. Cultural DimensionsLT Orientation versus ST Normative Orientation (LTO) • Balance between links with own past & the challenges of the present and the future. • Societies prioritize these two existential goals differently. • Low LTO - Normative approach: e.g. maintain time-honoured traditions & norms while viewing societal change with suspicion. • High LTO - Pragmatic approach: e.g. encourage thrift and efforts in modern education as a way to prepare for the future.

30. Cultural DimensionsIndulgence versus Restraint (IND) • Indulgence stands for a society that allows relatively free gratification of basic and natural human drives related to enjoying life and having fun. • Restraint stands for a society that suppresses gratification of needs and regulates it by means of strict social norms.

31. Cultural Dimensions:New Zealand

32. Cultural Dimensions:New Zealand vs USA

33. Cultural Dimensions:New Zealand vs China

34. Cultural Dimensions:New Zealand vs Aussie

35. 5 Steps to… Cultural Empathy • Personal therapeutic stance • Basic knowledge of cultural beliefs, customs and values. • Curiosity: Perspective Taking • Non-judgemental active listening. • Ability to connect in a way that acknowledges our similarities and differences. Adapted from Dr. Brené Brown

38. Key References • Campinha-Bacote, A., & Campinha-Bacote, J. (2009). Extending a model of cultural competence in health care delivery to the field of health care law. Journal of Nursing Law, 13(2), 36- • Epner, D.E and Baile, W.F. (2012). Patient-centered care: The key to cultural competence. Symposium article in Annals of Oncology, 23(3), pp. 33–42, Retrieved May 24, 2018 from https://doi.org/10.1093/annonc/mds086 • HDC (Health & Disability Commissioner). (20181). The code and your rights. Retrieved June 17, 2018 from https://www.hdc.org.nz/your-rights/the-code-and-your-rights/ • HDC. (20182).Management of thigh injury that progressed to osteomyelitis; communication with Samoan patient with limited English. Retrieved May 7, 2018 from http://www.hdc.org.nz/decisions/search-decisions/2004/02hdc04045/ • Houkamau, C. & Stronge, S. & Sibley, C. (2017). The prevalence and impact of racism toward indigenous Māori in New Zealand. International Perspectives in Psychology: Research, Practice, Consultation.6,(1), pp. 61-80. Doi: 10.1037/ipp0000070. • HQSC (Health Quality & Safety Commission). (31 October 2017). HQSC National patient experience survey Results for patients treated in August 2017. Retrieved November 30, 2017 from https://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/patient-experience/ • Human Rights Commission (HRC). (2012). A fair go for all? Rite tahitaatou katoa? Addressing structural discrimination in public services. A discussion paper by the Human Rights Commission. Retrieved May 20, 2018 from https://www.hrc.co.nz/files/2914/2409/.../HRC-Structural-Report_final_webV1.pdf • LaFromboise, T., Coleman, H.,L. & Gerton, J. (1993). Psychological impact of biculturalism: Evidence and theory. Psychological Bulletin. 114(3), pp. 395-412. • Meeuwesen, L., van den Brink-Muinen, A. and Hofstede, G. (2009). Can dimensions of national culture predict cross-national differences in medical communication? Patient education and counseling, 75(1), pp. 58-66. Retrieved March, 20, 2018 from Lakes District Health Board library database. Doi: 10.1016/j.pec.2008.09.015

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