Cultural Competence in Health Care

1. Understanding Cultural Differences and Their Affect on Medical Treatment BY : Tami Buswell, Janelle Steiner, Annie Foster, Katie Brim, Mary Anderson, and Lorna DeFreest Cultural Competence in Health Care

2. Cultural Competence is: “The ability to appreciate the cultures and customs of people from around the world that affect the way they interact with others.” • But, Culture is not only ethnic, racial or religious. Age and gender, as well as regional and national differences should be considered. What is the key to Cultural Competence?

3. Characteristics of different acculturation • People who: • Are recent immigrants to the mainland United States • Who live in ethnic enclaves • Who prefer to use their native tongue • Who were educated in their country of origin • Who migrate back and forth to the country of origin • Who are in constant contact with older individuals

4. BROAD GENERALIZATIONS OF CULTURAL DIFFERENCES Examples Different Cultural Traditions: • Japanese, Chinese and Korean patients show respect by showing agreement. • East Indians indicate acceptance or approval through silence. An up and down nod may not indicate agreement, but rather the exact opposite • Russian patients may offer you a small gift of food or chocolate. It is rude not to accept it • Muslims abstain from food and drink from dawn to sunset during Ramadan, a sacred month in usually September or October. Instructions to “take medication with meals” may be problematic during this time.

5. Improving the cultural competence of a healthcare organization increases the likelihood that the staff can relate to the diverse patient population. Lessens miscommunication between patients and providers. Heightens provider and staff sensitivity to the values, beliefs, and health-related practices of patients. All of this , in turn, leads to greater acceptance among patients and their health care provider, to improving accuracy of diagnoses and interventions, and to better patient adherence to prescribed treatment regimens. Why Cultural Competence Is Important

6. Barriers in culturally Competent Care: • Lack of diversity in health care’s leadership and workforce • Systems of care poorly designed to meet the needs of diverse patient populations • Poor communication between providers and patients of different racial, ethnic, or cultural backgrounds. Issues that arise with cultural competence: • Viewing patients as members of cultural groups (stereotypes) rather than individuals with unique experiences and perspectives can lead to inappropriate assumptions about their beliefs and behaviors • Solution: Ask direct questions! • Example: “Are there any traditions or customs that might impact the care I provide for you?” or “Do you understand your diagnosis?” Barriers/possible issues with cultural competence

7. Cultural empowerment for patients Patients primarily value: • Positive engagement • Information and involvement • Compassionate, kind and respectful treatment • The negotiated involvement of their family.

8. “If we don’t have at the table people of color and the diverse populations we serve, you can be sure that policymaking and program design are also going to be exclusionary as well…and we’re going to continue to have disparities if we don’t start increasing diversity in the health professions.” — CEO, Public Hospital Several studies have pointed to links between the racial and ethnic diversity of the health care workforce and health care quality, but minorities are underrepresented in the health care workforce., Hire staff that reflects client population

9. SPECIFIC Models of effective cultural competence KAISER PERMANENTE (SAN FRANCISCO): • Established a department of multicultural services that provides on-site interpreters for patients in all languages, with internal staffing capability in 14 different languages and dialects. • A Chinese interpreter call center is also available to help Chinese-speaking patients make appointments, obtain medical advice, and navigate the health care system. • A translation unit assures that written materials and signs are translated into the necessary languages. • A cultural diversity advisory board was also established for oversight and consultation. WHITE MEMORIAL MEDICAL CENTER FAMILY PRACTICE RESIDENCY PROGRAM/LOS ANGELES: • Family Practice Residency Program enabled several faculty members, including a director of behavioral sciences, a manager of cross-cultural training, and a director of research and evaluation, to devote time specifically to cultural competence training. • A medical fellowship position was also established with part-time clinical and supervisory responsibilities to provide a practical, clinical emphasis to the curriculum.

10. Listen with sympathy and understanding to the patient’s perception of the problem • Explain your perceptions of the problem • Acknowledge and discuss the differences and similarities • Recommend treatment • Negotiate agreement The “learn” model by Berlin and Fowkes

11. Combining knowledge of Culture • Respect and • Assessment of others world views • Sensitivity to cultural differences • Provides care with Humility in the health care system The “crash” course model by rust and colleagues

12. Respect for patients as individuals • Engagement of patients as partners • Effective communication of illness models and treatment goals • Holistic consideration of the socio-cultural context and consequences of patient’s illness experience Principles of Cross Cultural Competence:

13. “We are of course a nation of differences. Those differences don’t make us weak. They’re the source of our strength.” Jimmy Carter “Diversity is not about how we differ. Diversity is about embracing one another’s uniqueness.” Ola Joseph Can’t we all just get along? Cultural diversity and health care

14. “Cultural competence translates into better patient care and less legal risk.” Contemporary OB/GYN 51.3 (2006): 24. Health Reference Center Academic. Web. 11 Sept. 2010 “What do non-English-speaking patients value in acute care? Cultural competency from the patient’s perspective: a qualitative study” Garrett, P.W; Dickson, H; Whelan, A: Ethnicity & Health, Nov 2008, Vol. 13 Issue 5, p479-496, 18p, 3 “Ethnic and Cultural Diversity: Challenges and Opportunities for Health Law” Hendriks, Aart1 S European Journal of Health Law; Sep 2008, Vol. 15 Issue 3, p285-295, 11p “Cultural competence in health care: emerging frameworks and practical approaches “ Joseph R. Betancourt: Massachusetts General Hospital–Harvard Medical School: Alexander R. Green and J. Emilio Carrillo: New York Presbyterian Hospital–Weill Medical College of Cornell University field report (2002) “A CRASH course in cultural competence for nurses” Broome, B; McGuinness,T: Urologic Nursing, Aug 2007, Vol. 27 Issue 4, p292-304 “Developing cultural competence in health care health care settings” Ahmann, E; Pediatric Nursing, Mar-Apr 2002, Vol. 28 Issue 2, p133-137 “The COA360: A tool for assessing the cultural competency of healthcare organizations” LaVeist, T; Richardson, W and N: National Institute of Healthcare Management Foundation. Web. 20 Sept. 2010 “Achieving cultural competence: the challenge for clients and healthcare workers in a multicultural society.” Bonder, B; Martin, L; Miracle, A: Workforce issues in a changing society, Spring 2001, p35-42 References: