Slide 1

Cultural Competence in Health CareUnderstanding Cultural Differences and Their Affect on Medical Treatment

BY : Tami Buswell, Janelle Steiner, Annie Foster, Katie Brim, Mary Anderson, and Lorna DeFreest

What is the key to Cultural Competence?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.

Characteristics of different acculturation People who:Are recent immigrants to the mainland United StatesWho live in ethnic enclavesWho prefer to use their native tongueWho were educated in their country of originWho migrate back and forth to the country of originWho are in constant contact with older individuals

BROAD GENERALIZATIONS OF CULTURAL DIFFERENCESExamples 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 oppositeRussian patients may offer you a small gift of food or chocolate. It is rude not to accept itMuslims 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.

Why Cultural Competence Is ImportantImproving 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.

Barriers/possible issues with cultural competenceBarriers in culturally Competent Care:Lack of diversity in health cares leadership and workforceSystems of care poorly designed to meet the needs of diverse patient populationsPoor 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 behaviorsSolution: 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?

Cultural empowerment for patients

Patients primarily value:Positive engagement Information and involvementCompassionate, kind and respectful treatmentThe negotiated involvement of their family.

Hire staff that reflects client populationIf we dont 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 welland were going to continue to have disparities if we dont 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.,

SPECIFIC Models of effective cultural competenceKAISER 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.

9The learn model by Berlin and FowkesListen with sympathy and understanding to the patients perception of the problemExplain your perceptions of the problemAcknowledge and discuss the differences and similaritiesRecommend treatmentNegotiate agreement

The crash course model by rust and colleaguesCombining knowledge of Culture Respect and Assessment of others world viewsSensitivity to cultural differencesProvides care with Humility in the health care system

Principles of Cross Cultural Competence:

Respect for patients as individualsEngagement of patients as partnersEffective communication of illness models and treatment goalsHolistic consideration of the socio-cultural context and consequences of patients illness experience

Cultural diversity and health care We are of course a nation of differences. Those differences dont make us weak. Theyre the source of our strength. Jimmy CarterDiversity is not about how we differ. Diversity is about embracing one anothers uniqueness. Ola Joseph

Cant we all just get along?

References: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. 2010What do non-English-speaking patients value in acute care? Cultural competency from the patients perspective: a qualitative study Garrett, P.W; Dickson, H; Whelan, A: Ethnicity & Health, Nov 2008, Vol. 13 Issue 5, p479-496, 18p, 3Ethnic 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, 11pCultural competence in health care: emerging frameworks and practical approaches Joseph R. Betancourt: Massachusetts General HospitalHarvard Medical School: Alexander R. Green and J. Emilio Carrillo: New York Presbyterian HospitalWeill 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, p133-137The 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. 2010Achieving 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