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Presented To

NMH Directors, Managers, and ICs with Direct Reports

March 2008

Cultural Competence: Enhancing the Workplace and Providing Personalized Patient Care

Manager-As-Trainer Workshop

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Workshop Objectives

• Define cultural competence and what it means to healthcare and NM

• Describe all components of training program

• Describe online training program and CultureVision tool

• Discuss case studies

• Explain how to conduct a case study driven discussion

• Explain your role in the training program

• Formulate strategies for handling difficult participants and issues

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Workshop Sections

• Section 1: Overview of Cultural Competence and Staff Training Program

• Section 2: Introduction and Demonstration of CultureVision tool

• Section 3: Review of Case Studies and Handling Difficult Issues/Participants

AgendaSection 1:

• Cultural competence and its importance in healthcare organizations

• Goals of training program

• Training program’s components

Break

Section 2:

• Demo of CultureVision

Section 3:

• Review of case studies and how to conduct a discussion

• Manager’s role in training initiative

• Training calendar

• Strategies for handling difficult participants and issues

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Housewide FY08 Goal

• Reach 90% of employee participation in cultural competency education.

– Enhance staff cultural competence through training programs.

– Learn about two cultures.

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What is Cultural Competency?

Cultural competency is the organizational ability to have and utilize the policies, appropriately trained & skilled employees, and specialized resources, to systematically anticipate, recognize and respond to the varying expectations (language, cultural & religious) of customers, patients, physicians, and employees of diverse backgrounds.

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Why Cultural Competency Training at NM?Goals:

• Learn to value diversity, and differences in culture and perspective, so that patient care, the workplace, and patient/employee satisfaction and engagement are improved

• Enhance communication with each patient to improve actual and perceived quality of care and patient safety

• Help to make each clinical and non-clinical staff more sensitive to the particular needs of each patient and ultimately eliminate healthcare disparities

• Enhance employee communication to improve the workplace

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The main goal is to

“Increase the ability to ASK questions and NOT reinforce stereotypes!”

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Historic Demographic Changes

0%

10%

20%

30%

40%

50%

60%

70%

80%

1967 2006 2050

Caucasian

Af. Amer/Bl

Hisp/Lat

Asian

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Chicago, Illinois Demographics by Race

City of Chicago Service Area

Other

Latino

African American

Asian/Pacific Islander

Caucasian

Source: Claritas, 2006

African American 35.6%Asian/Pacific Islander

4.6%Caucasian

29.1%Latino 28.7% Other 2.1%

Female 51.2%Male 48.8%n = 2,832,391

The City of Chicago area is made up of 62 contiguous ZIP Codes located within Cook County

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12

13

2007

42%

White Men

WhiteWomen

African Americans

Hispanics/Latinos

Asians

Native Americans

Immigrants

GLBT

PeopleWith

Disabilities

Blacks

Arab Americans

MixedRace

Muslims

ChristiansJews

Buddhists

Hindus

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Inclusion and Cultural Flexibility

White Men

WhiteWomen

African Americans

Hispanics/Latinos

Asians

Native Americans

Immigrants

GLBT

PeopleWith

Disabilities

Blacks

Arab Americans

MixedRace

Muslims

ChristiansJews

Buddhists

Hindus

“Us”

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1 2 3 4

5 6 7 8

9 10 11 12

13 14 15 16

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are needed to see this picture.

FINISHED FILES ARE THE RESULT OF YEARS OF SCIENTIFIC STUDY COMBINED WITH THE EXPERIENCE OF MANY

YEARS.

20Sick Sheep

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.Hiring

MentoringPerformance

Reviews

MarketingCommunication

Recruitment

CustomerService

Unconsciousbias

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Relationships

Expression Of Feelings

Tolerance For

Change

CompetitionVs.

Cooperation

Personal Space

Direct/Indirect

Time Orientation

Eye Contact

Gestures

Style

DecisionMaking

Taboos

FaceSaving

Conflict

Culture Shows Up in Many Ways:

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Diversity at Northwestern Memorial

Representation

Representing the diverse communities

we serve, at all levels of the

organization

Cultural Competency

Delivering healthcare in a way that is sensitive to and respectful of our

patients’ and coworkers’ cultural backgrounds and

health beliefs

NMH will have advanced

towards a workforce, physician faculty, management

team, senior leadership group, and board of directors that represent and reflect

the communities we serve. Our commitment to diversity will be visible and discussed; part of how we

work, manage the organization, and deliver care.

Elements of Diversity at NM

    

Confidential and Proprietary © 2007 Northwestern Memorial Hospital

Inclusiveness

Fostering a culture that is embracing and an environment that is

welcoming of all patients and staff

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Broad View of Training Initiative• This is the first in a series of learning opportunities on cultural

competency and different cultures

• Training is modular, uses blended approach, sequenced to be completed over time, and minimizes the time of groups off units

• As part of the training, a just-in-time (JIT) online resource on all cultures is being made available for training and ongoing use instead of provide one-time instruction on any one culture

• Cultural competence is a local issue and the manager involvement helps to ensure cultural competency becomes embedded in unit/department

• Training must be accessible to broad range of educational backgrounds—must be simple

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Overview of Staff Training Program

Module 1: Online training program

Module 2: Case studies

Module 3: Case study-driven discussion led by manager

Module 4: Online survey

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Description of Module 1: Online Training Program

• Employee driven.

• Provides core messages and importance of cultural competence to NM

• Includes demonstration on how to use CultureVision tool

• Provides access to two sets of case studies: clinical and non-clinical. Each set contains a case study on African-American culture and one on Latino culture

• All staff are automatically enrolled in activity in ELM. Appears on their My Learning Home page.

• Time for staff to complete: 40 minutes

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Demonstration of Module 1Link

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Let’s Take a 15 Minute Break

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CultureVision Tool

• Is an online JIT resource for NM staff on culture-specific healthcare information

• On-the-spot access to culturally competent patient care information:

Concept of Health Health Promotion/Disease Prevention

Beliefs, Religion, & Spirituality Physical & Mental Illness-Related Issues

Language & Communication Treatment Issues

Family Traditions Labor, Birth, & After Care

Gender Roles Death & Dying

Diet & Nutrition

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CultureVision on NM Connect

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Disclaimer

• Information contained in CultureVision applies generally to groups.

• Should not conclude these are the beliefs and practices of all individuals within that group.

• All individuals within a group are different.

• Approach the information in CultureVision with an open mind.

• Do not use it to generalize and stereotype individuals of particular cultural groups.

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CultureVision Tool DemonstrationLink

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Description of Module 2: Completing Case Studies

• Employee driven

• Provided with clinical or non-clinical case studies to do depending on your NM position

• Similar to actual patient situations that occurred at NM

• Presented in vignettes

• Questions accompany each case studies’ vignettes

• Answers found by using CultureVision tool

– Must complete case studies using paper worksheets and CultureVision and bring worksheets to manager-led discussions

• Time for staff to complete: 30 minutes

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Searching CultureVision Using Case Studies

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Description of Module 3: Case Studies Discussion

• Manager driven

• Manager-lead discussion with staff about:

– Review key messages

– Review case studies and questions’ answers

– Ask how cultural competence applies to your unit/department

– Wrap-Up and Reinforcement

• Limit discussion to 20 people at a time

• Time for discussion: 20-45 minutes

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Steps to Facilitating the DiscussionStep Est. Time

(min)

1. Welcome everyone to discussion and state what is the purpose of the discussion.

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2. Set ground rules for discussion. 1

3. Review why NM would like to become a culturally competent organization. Refer to page 46 in Appendix for key messages.

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4. Reinforce what CultureVision is. 4

5. Ask a few front end questions to open up the discussion. Refer to page 47 in Appendix for questions to ask.

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Steps to Facilitating the Discussion (cont.)

Step Est. Time (min)

6. Review the TWO case studies by asking staff to provide their answers to each case study’s questions.

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7. IMPORTANT: Ask a few questions that focus on becoming a culturally competent unit/department (apply cultural competence to unit/department). Refer to page 48 in Appendix for questions to ask.

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8. Summarize main points of discussion. 2

9. Thank everyone for participating and follow up on anything outstanding.

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Total Time for Discussion: 45

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Tips for Facilitating a Discussion• Be prepared for facilitating your discussion

• Kick off the discussion with three or four questions that require participants to share information they learned in e-learning module

• Stick to your timeframe

• Manage personalities

• Ask open-ended questions

• Give learners time to answer questions—don’t you answer them

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Tips for Facilitating a Discussion (cont.)

• Make discussion where interchanges are more learner (L) directed and manager (M) facilitates: M-L-L-L-M-L-L-L

• Be positive:

– You are not expected to be an expert on all cultures and neither should your staff be

– You are here to open staff’s eyes to different cultures

– You want to help improve communication and patient care

– Emphasis is on getting staff to ask questions, not make assumptions about anyone

• Admit when you don’t have an answer

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Description of Module 4: Online Survey

• Employee driven

• Staff person verifies:

– Completed online training program and unit-based discussions

– Understands what cultural competence is and its importance to NM

– Knows what CultureVision is and how to use it

• All staff are automatically enrolled in activity in ELM. Appears on their My Current Enrollments page.

• This is the point where the housewide goal will be tracked.

• Time for staff to complete: 5 minutes

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Review of Manager’s Responsibilities

1. Hand out copies of the case studies and CultureVision job aid to all your staff.

2. Ensure your staff completes the online training program and the two case studies using CultureVision by dates set by you.

3. Set the dates and times for your unit/department based discussion(s)

4. Prepare to facilitate the discussions that focus on the case studies.

5. Facilitate the discussions.

6. Follow up on any unresolved issues/questions from the discussions

7. Remind your staff to complete the online survey.

8. Promote and support usage of CultureVision tool and be an advocate for cultural competence.

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Training Program Calendar

Activity Start Date End Date

Managers attend Train-the-Trainer. 3/6 3/19

Online training program and survey go live on ELM. (Activities appear on staff’s My Current Enrollments page)

3/31 N/A

CultureVision made available on NM Connect. 3/31 N/A

Staff complete online training program and case studies using CultureVision.

3/31 5/31 (S)

Manager facilitates unit/department discussions about case studies.

5/1 (S) 6/15 (S)

Staff complete online survey. 6/1 (S) 6/30

(S): Suggested

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Exercise: Handling Difficult Participants and Issues

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Exercise Instructions1. Take a few minutes to complete independently questions

on pages 33-35 that correspond to how to handle difficult participants and issues in your unit/department during your discussions.

2. The instructor will split the class up into groups and you will share your responses with your group members. You can jot down any of their ideas under the Other Tips section.

3. Designate someone in your group to share with rest of class one or two good ideas for handling difficult participants or issues.

• Total time for exercise: 20 minutes

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Your Resources

• Resource guide with Appendix/Manager Toolkit containing discussion tips and various articles on cultural competence

• CultureVision tool

– www.crculturevision.com

– Username: nwmemorial Password: resource

• Online training program

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Wrap Up

• Any remaining questions?

• Please complete evaluation form.

• Please pick up packets of job aids and case studies before leaving today.

Thanks for coming!