Progress in Setting Standards for Cultural Competence in Aotearoa/NZ

1. Progress in Setting Standards for Cultural Competence in Aotearoa/NZ Dr David Jansen MBChB, MRNZCGP, BHB, BA (Māori ), Dip Tchg Dr Peter Jansen MBChB, FRNZCGP, Cert Clin Tchg Dr Kira Bacal MD, PhD, MPH, FACEP

2. HPCA Act 2003 • Health Practitioners Competence Assurance Act 2003 • Has effect from 2004, based on earlier legislation – medical practitioners • to protect the health and safety of members of the public by providing for mechanisms to ensure that health practitioners are competent and fit to practise their professions

3. Registration Authorities • Registration Authority to set standards • clinical competency • cultural competency • ethical behaviour • Fifteen Ras under original legislation • Medical, Dental, Pharmacy, Nursing, Midwifery, Chiropractic, Dieticians, MedRadTech, MedLabTech, Physio, Optom, OT, Osteopathic, Psych • Scopes of practice, titles are protected

4. Progress this far • Some RAs have published a statement on cultural competency • Mauri Ora Associates work • MCNZ: Statement on Cultural Competence • MCNZ: Best Health Outcomes for Maori: Practice Implications • MCNZ: Best Health Outcomes for Pacific Peoples: Practice Implication • ACC: Guidelines on Maori Cultural Competencies for Providers • RNZCGP: Cultural Competence. Advice for GPs to create and maintain culturally competent general practices in NZ

5. Progress this far • Dental, Physio, cultural competence statements based on MCNZ • Pharmacy, Nursing have developed own standards

6. Progress this far • Medical Laboratory Science Board • Maori name – Te Poari Matai Oranga • Med Lab Technicians – phlebotomy, cryotech, mortuary technicians • Code of Competency and Standards 2006 • No recertification programmes exist yet • No accredited programmes yet • Drug and Alcohol Counsellors • Medical Herbal Therapists

7. Branch Advisory Bodies • RNZCGP • AFPHM – now NZ Council of Public Health Medicine • RANZCP • Others have no statements or resources.

8. RNZCGP • Practice based • Focus on equal health outcomes, relationship with community, all staff • Behaviour based • Collect correct ethnicity, pronounciation, involve family • Competence with Maori, and with multiple cultures, Pacific, Asian…

9. AFPHM / NZCPHM Identified 12 Cultural competencies: • 7 Universal cultural competencies • 3 Te Tiriti o Waitangi and Māori health • competencies • 2 Ethnic minority health competencies Need mechanism for assessing and approving cultural competency educational activities and performance measures when cultural competence standards and recertification framework reviewed (2008)

10. Next Steps • Cultural competence curricula • Multiple options: communications, professionalism, standalone • Accredited training • In-house or accredited external providers • Common shared foundation programme • Introductory, on-line, universal, amenable to further specialist staircased programmes • Require comprehensive approach • All doctors – registrars to CPD/recert

11. Branch Advisory Bodies Accident and Medical Practitioners Association Australasian Chapter of Palliative Medicine Australasian Chapter of Sexual Health Medicine Australasian College for Emergency Medicine Australasian College of Sports Physicians Australasian Faculty of Occupational Medicine Australasian Faculty of Public Health Medicine Australasian Faculty of Rehabilitation Medicine Australian and New Zealand College of Anaesthetists Family Planning and Reproductive Health Branch Joint Faculty of Intensive Care Medicine New Zealand Association of Musculoskeletal MedicineNew Zealand College of Public Health Medicine New Zealand Dermatological Society New Zealand Orthopaedic Association New Zealand Society of Otolaryngology Head and Neck Surgery Paediatric Society of New ZealandRoyal Australasian College of Medical Administrators Royal Australian and New Zealand College of Obstetricians and Gynaecologists Royal Australian and New Zealand College of Ophthalmologists Royal Australian and New Zealand College of Psychiatrists Royal Australian and New Zealand College of Radiologists Royal Australasian College of Physicians Royal Australasian College of Surgeons Royal College of Pathologists of Australasia (NZ Committee) Royal New Zealand College of General Practitioners

12. Māori Health Disparities • Disparities in access and outcomes: • preventive services, • primary care services, • hospital services • mental health, • injury services, • home help, • income support, • complaints and compensation for medical error, etc etc

13. Summary • Maori have the greatest levels of health inequality in New Zealand, with measures of mortality and morbidity showing significant gaps compared to non-Maori even after controlling for deprivation. • Research in New Zealand shows large disparities in a large number of levels (access, outcome etc), in a large number of health areas (cancer, diabetes) and in a large number of services (GP, ACC).

14. Research shows… Effective communication between patients and providers: • National Breast Cancer Centre and National Cancer Control Initiative. 2003. Clinical practice guidelines for the psychosocial care of adults with cancer. National Breast Cancer Centre, Camperdown,NSW; ^ Devine & Westlake, Oncol Nurs Forum, 1995 ;22:1369-81; ** Saxton & Finkelstein, Phys News Dig, Nov 2003; Beck et al, J Am Bd FP 2002, 15(1):25-38; DiMatteo R in Gochman DS’ Handbook of health behaviour research II, New York: Plenum Press, 1997, ***Lussier & Richard, Can FP 2004, 50:43-8 • ±Pacific Health Research Centre 2003 • Promotes a better exchange of information** • Improves decision making* • Builds trust**± • Improves medical outcomes** • Avoids medical errors** • Increases compliance with treatment plans* ^^ • Improves patient monitoring of physiological values (such as blood sugar, BP)*** • Enhances patient and provider satisfaction^ • Brings patient expectations into line with reality** • Reduces patient anxiety** • Increases behavioral change to healthier lifestyles^^ • Improves patient understanding*** • Enhances patient recall of information***

15. Issues for Identity