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Confidential and Proprietary: Not for Distribution. Cultural Competency Blue Cross Community MMAI (Medicare-Medicaid Plan) SM Blue Cross Community Long Term Supports and Services (MLTSS) SM Blue Cross Community ICP SM Blue Cross Community Family Health Plan SM
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Cultural Competency Blue Cross Community MMAI (Medicare-Medicaid Plan)SM
Blue Cross Community Long Term Supports and Services (MLTSS)SM
Blue Cross Community ICPSM Blue Cross Community Family Health PlanSM
Presenter
Presentation Notes
Welcome to the MMAI, MLTSS, ICP, and FHP module for Cultural Competency.
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Navigation Tips
• This presentation includes a voiceover • To turn off sound, select the mute button • Click on the question mark button in the lower right corner
– To email a question – To view slide notes (read rather than listen to the presentation)
Presenter
Presentation Notes
We encourage you to turn up your sound and listen to the presentation. However, if audio is not an option in your office, you can turn off sound by selecting the mute button. If you have a question for us or want to view slide notes, select the question mark in the lower right corner of your screen.
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Training Modules for MMAI, MLTSS, ICP and FHP
1. Model of Care / Medical Home (Person Centered Practice)
2. Fraud, Waste and Abuse (FWA) 3. Abuse, Neglect, Exploitation /
Critical Incident 4. Cultural Competency 5. Americans with Disabilities Act
(ADA) / Independent Living
Presenter
Presentation Notes
Here is a list training modules for MMAI, MLTSS, ICP, and FHP. You are currently viewing the fourth training module, Cultural Competency.
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What You Will Learn
1. Benefits of culturally competent health care
2. Regulatory requirements of culturally competent care
3. Working with diverse patients 4. Nonverbal communication and
patient care 5. Tools for Limited English
Proficient (LEP) patients 6. Cultural competence resources
Presenter
Presentation Notes
In this module you will learn: The benefits of culturally competent health care Regulatory requirements of culturally competent care Working with diverse patients Nonverbal communication and patient care Tools for Limited English Proficient (LEP) patients and cultural competence resources
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What is cultural competency?
Presenter
Presentation Notes
What is cultural competency? Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs and values of racial, ethnic, religious or social groups.
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What is cultural competency?
Awareness/Knowledge
Attitude
Behavior
Skill Policies
Cultural Competency enables effective work and cross-cultural situations.
Presenter
Presentation Notes
The Health Resources and Services Administration, the Bureau of Primary Health Care, defines cultural competency as “Cultural and linguistic competence as a set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals that enable effective work and cross-cultural situations.” Cultural competency is a developmental process that evolves over time. On the continuum, both individuals and organizations are at various levels of awareness, knowledge and skill.
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Cultural Competency in Medicine
Communication style Health beliefs
Satisfaction and clinical outcomes
Presenter
Presentation Notes
So why is cultural competency important? Because a patient’s health beliefs and communication style play critical roles in medical care. The issues of cross-cultural communication and variations in health beliefs impact patient satisfaction and clinical outcomes. Demographics are changing rapidly throughout the nation and Illinois. We strive to be at the cutting edge of developments in culturally competent medicine.
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Cultural Competency in Medicine
• Respects the value of the individual
• Honors the dignity of all cultures, races, religious and ethnic backgrounds.
Presenter
Presentation Notes
Cultural competency in medicine presumes health care services are provided in a manner that respects the value of the individual and honors the dignity of all cultures, races, religious and ethnic backgrounds.
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Benefits of Culturally Competent Medicine
• Effective care • Increases patient compliance • Positive clinical outcomes • Improves communication • Decreases stress • Enables trust • Satisfaction • Meet regulations and
requirements
Presenter
Presentation Notes
The benefits of providing culturally competent medicine include: Makes more effective use of time with patients Increases patient compliance with treatment protocols Positively affects clinical outcomes Improves communication with patients Decreases stress while building a relationship of trust It also increases patient and provider satisfaction And meets increasingly stringent government regulations and medical accreditation requirements
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Health Disparities
Ethnic Health Disparities Compared to European Americans
Hispanics
• Two times more likely to develop diabetes
American Indian/Alaskan
Native Americans • Highest rate of
depression and suicide
African Americans
• 29 percent more likely to die from heart disease
• 50 percent more likely to die from a stroke
Presenter
Presentation Notes
Here are some facts about health disparities in the U.S. of different ethnicities compared to European Americans. Hispanics are twice as likely as European Americans to develop diabetes (OMH Website, 2005d). American Indian/Alaskan Native populations have the highest rates of depression and suicide of all the racial and ethnic minority groups in the U.S. (Lipson & Dibble, 2005). African American adults are 29 percent more likely to die from heart disease and are 50 percent more likely to die from a stroke. (OMH web site, 2005b).
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Principles of cultural competency
Self-aware Understanding Aware of others Reflective Lifelong learner
Presenter
Presentation Notes
Now let’s review the principles of Cultural Competency. The principles of cultural competency are being self-aware, understanding, aware of others, reflective and to always be a lifelong learner.
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Principles of Cultural Competency
Be Self-aware Ensure that you are not treating people differently based on assumptions, biases and stereotypes.
Presenter
Presentation Notes
Awareness of your own beliefs and attitudes is the first step to ensuring that you are not treating people differently based on assumptions, biases and stereotypes. Ask yourself: Are you unwillingly projecting your own culturally-based values and expectations onto people whose beliefs about illness and health may differ from your own?
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Principles of Cultural Competency
Be Understanding Remember that some of your patients have experienced discrimination, lack of quality health care and successful treatment with nontraditional medical approaches.
Presenter
Presentation Notes
The next principle is to be understanding. You may encounter minority individuals with histories of experiencing discrimination, lack of quality health care, successful treatment with nontraditional medical approaches or any number of experiences unfamiliar to you.
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Principles of Cultural Competency
Be Aware of Others Remember that some patients speak to you based on a large number of cultural beliefs and expectations.
Presenter
Presentation Notes
When you communicate with someone from a different culture or ethnic group, remember they may be speaking to you based on a large number of cultural beliefs and expectations.
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Principles of Cultural Competency
Be Reflective Critically examine and continuously monitor your own beliefs and assumptions.
Presenter
Presentation Notes
Next, try to be reflective. To effectively communicate with diverse patient populations, you must critically examine and continuously monitor your own beliefs and assumptions.
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Principles of Cultural Competency
Be a Lifelong Learner Develop skills necessary for working with people of different cultures and backgrounds.
Presenter
Presentation Notes
The last principle is to be a lifelong learner. To enhance communication and to avoid being unintentionally insulting or patronizing, you must develop skills for working with people of different cultures and backgrounds. This is not a quick task. When you have a true passion for your community, your role as a health care provider and your patients, you will find that you are always learning!
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Regulatory Requirements
Culturally competent care
Language access services
Organizational support
Presenter
Presentation Notes
Let’s discuss the regulatory requirements for culturally competent care. The regulatory requirements are: Culturally competent care Language access services And organizational support
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Regulatory Requirements
Culturally Competent Care • Effective, understandable and
respectful care • Diverse staff and leadership • Ongoing education and
training
Presenter
Presentation Notes
The first of the three regulatory requirements is culturally competent care. Requirements state that Health Care Organizations should: Ensure that all staff provide patients with effective, understandable and respectful care in a manner compatible with beliefs and practices specific to their culture and preferred language. Providers should implement strategies to recruit, retain and promote a diverse staff and leadership that are representative of the demographic characteristics of the service area. As well as, ensure that all staff receive ongoing education and training in culturally and linguistically appropriate service delivery.
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Regulatory Requirements
Language Access Services • Consistent and free
language assistance services
• Inform patients of the service
• Skilled language interpretation staff
• Multilingual patient materials
Presenter
Presentation Notes
Additionally, Health Care Organizations should: Offer and provide language services, including bilingual staff and interpreter services, at no cost to each patient, during all hours of operation. Provide information, to patients in their preferred language, of their rights to receive language assistance. Family and friends should not be used to provide interpretation services (except when requested by the patient). Provide multilingual patient materials and signage in service areas.
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Regulatory Requirements
Language Access Services • Language barriers pose a
significant threat to acceptance and understanding information
• Language barriers are beyond the capabilities of your staff
Presenter
Presentation Notes
Language interpreters should be considered whenever language barriers pose a significant threat to acceptance and understanding of information, beyond the capabilities of the health care professionals involved.
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Regulatory Requirements
Organizational Support • Written strategic plan • Self-assessments • Cultural and linguistic
competence-related measures
• Integrate cultural data into information systems
• Maintain up-to-date profiles and needs assessment
Presenter
Presentation Notes
Finally, requirements state that Health Care Organizations should: Develop, a written strategic plan that outlines clear goals and policies Providers should conduct initial and ongoing organizational self-assessments of culturally and linguistically-related activities. Also, integrate cultural and linguistic competence-related measures into different quality and performance metrics. Ensure that data on patients’ race, ethnicity and spoken and written language are collected in information systems. As well as, maintain a current demographic profile of the community that responds to the cultural and linguistic characteristics of the service area.
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Regulatory Requirements
Organizational Support • Collaborate with community
and patient • Culturally sensitive conflict
and grievance resolutions
Presenter
Presentation Notes
Health Care Organizations should: Develop collaborative partnerships with communities and involve patients in developing culturally and linguistically related activities. Ensure that conflict and grievance resolution processes are culturally and linguistically sensitive.
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Communication Tips
Speech
Eye Contact
Body Language
Presenter
Presentation Notes
Communication barriers can include patients with limited English proficiency, underlying mental health conditions and literacy levels. A family or economic crisis can also create communication challenges. In order to enhance patient-provider communication, be aware of the following: Your styles of speech Your eye contact And your body language
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Communication Tips
Styles of Speech • Tolerate gaps between
questions and answers • Listen to volume and speed • Modify your speech • Tolerate patient
interruptions • Be aware of your
interruptions
Presenter
Presentation Notes
We’ll begin with looking at Styles of Speech. Here are some tips to be aware of : People vary greatly in response time and speed of speech. Be aware of gaps between questions and answers. Impatience can be seen as a sign of disrespect. Listen to the volume and speed of the patient’s speech, as well as the content. The voice is perhaps one of the most difficult forms of nonverbal communication to change. Speaking too fast, loud or too soft can be interpreted differently within cultures, gender and age. For example, speaking too loud may be interpreted as domineering. Modify your own speech to more closely match that of the patient to make them more comfortable. Don’t be offended, if no offense is intended, when a patient interrupts you. Rapid exchanges and even interruptions, are a part of some conversational styles. Be aware of your own pattern of interruptions, especially if the patient is older than you.
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Communication Tips
Eye Contact • Related to cultural and life
experience – Honest – Disrespectful – Socially aggressive
• Never force eye contact
Presenter
Presentation Notes
The way people interpret various types of eye contact is related to cultural background and life experience. Eye contact can be seen as: A sign of honesty in some cultures. Disrespectful in some cultures. And socially aggressive in other cultures.
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Communication Tips
Body Language • Follow the patient’s lead • Be sensitive to touch • Be aware of gestures and
reactions
Presenter
Presentation Notes
Sociologists say 80 percent of communication is nonverbal. The meaning of body language varies greatly by culture, class, gender and age. Follow the patient’s lead on physical distance and touching. Gestures can mean very different things to different people. Be very conservative in your own use of gestures and body language.
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Communicating with Diverse Patients
Guiding Patient Conversation • Ask about preferences • Ask open-ended questions
Presenter
Presentation Notes
English predisposes us to a direct communication style; other languages and cultures differ. For example, referring to the member using a formal title such as Mr. or Mrs. If the patient’s preference is not clear, ask how he or she would like to be addressed. Facilitate patient-centered communication by asking open-ended questions whenever possible. Avoid questions that can be answered with “yes” or “no.”
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Nonverbal Communication & Patient Care
Nonverbal Communication Subtle form of communication. Occurs within initial three seconds.
Presenter
Presentation Notes
Nonverbal communication is a subtle form of communication that takes place in the initial three seconds after meeting someone for the first time, and can continue through the entire interaction. We are rarely aware of how persons from other cultures perceive our nonverbal communication or the subtle cues we have used to assess another person. Try to be mindful of cultural generalizations and stereotypes. As a rule, ask the patient rather than assume you know the patient’s needs and wants. If asked, patients will usually share their personal beliefs, practices and preferences related to prevention, diagnosis and treatment.
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Touch and Use of Space Gestures
Body Posture and
Presentation
Nonverbal Communication & Patient Care
Presenter
Presentation Notes
The three points of nonverbal communication are: Touch and use of space, Gestures, and Body posture and presentation.
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Nonverbal Communication & Patient Care
Touch and Use of Space
• Ease into personal space
• Be aware of physical contact between male and female
Presenter
Presentation Notes
Let’s start with Touch and Use of Space. Providers should talk the patient through each exam so that the need for the physical contact is understood prior to the initiation of the examination. Ease into the patient’s personal space, allowing for adequate room. Physical contact between a male and female is strictly regulated in many cultures. An older female companion may be necessary during the visit.
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Nonverbal Communication and Patient Care
Gestures
• Different meanings across cultures
• Be conservative with hand and body gestures
Presenter
Presentation Notes
Gestures have dramatically different meanings across cultures. Think of gestures as a local dialect familiar only to insiders of the culture. Be conservative with hand or body gestures to avoid misunderstanding.
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Nonverbal Communication and Patient Care
Body Posture and Presentation
• Influenced by culture
• Presentation is not an indicator of social or economic status
Presenter
Presentation Notes
Many cultures prioritize and demonstrate family respect in their manner of dress and presentation in public. A person’s physical presentation or posture is not an indicator of their social or economic status.
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Diverse Patient Populations
Presenter
Presentation Notes
Based on the location of your health care site and member population, you may have the opportunity to interact with more diverse cultures. Certain cultures have varying approaches towards formality and attitudes towards pain, medication and family. Let’s take a closer look at a couple of cultures in Illinois.
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Communicating with Diverse Populations – Formality
Polish American • Very formal with strangers • Avoid using the first
names • Prefer to use formal and
professional titles
Asian American • May view directness as
rude • Generally appreciate
modesty and privacy
Presenter
Presentation Notes
Formality within the Polish American community is very strong. Members of this community may be very formal with strangers. Avoid using the first name of people you do not know or do not know well. Most individuals prefer to use formal titles, such as ‘Mrs.’ and ‘Mr.’ followed by their surname, and professional titles such as Professor or Doctor when appropriate. In the Asian American community, directness may be viewed as rude. Generally, this population appreciates modesty and privacy. Individuals tend not to ask questions.
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Communicating with Diverse Populations – Attitude Toward Pain/Medication
Polish American • May display stoicism
towards pain and may suffer in silence
• May use distraction as a means of coping with pain
• May prefer herbal supplements over drugs for chronic illnesses
Asian American • May want to leave things
up to God rather than seek medical treatment
• Pain tolerance may be an opportunity for spiritual growth and atonement
• Pain medication avoidance for fear of losing control, becoming addicted or being a nuisance
Presenter
Presentation Notes
Polish Americans may display stoicism towards pain and may suffer in silence. Pain relieving drugs are generally acceptable, but some people may try to use distraction as a means of coping with pain prior to using medication. Members of the Asian American community may want to leave things up to God rather than seek medical treatment. Accepting pain may be viewed as an opportunity for spiritual growth and atonement. Patients may wish to avoid pain medication for fear of losing control, becoming addicted or being a nuisance.
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Communicating with Diverse Populations – Attitude Toward Family
Polish American • Family is very important
and should be included in decisions about health care
• Family members present during treatment
Asian American • Family is very important
and should be included in decisions about health care
• Care for older relatives is important, with multigenerational arrangements being common
• Family members present during treatment
Presenter
Presentation Notes
Attitudes toward family are similar among these two cultures. For example, Family is very important and should be included in decisions about health care. Some families may wish to keep the individual from knowing his or her prognosis. Care for older relatives is an important aspect of many Asian cultures, with multigenerational arrangements being common. Additionally, individuals will likely want family members, including extended family, with them at all times during their treatment.
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Cultural Competency Tools and Resources
Presenter
Presentation Notes
The following will show you all of the many cultural competent resources available for you to view. Some examples include: Diversityrx.org, the Kaiser Family Foundation or the Administration on Aging.
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Tools for Limited English Proficient (LEP) Patients • Welcome • Bienvenido/a • Haân haïnh tieáp ñoùn
quyù vò • 歡迎
Presenter
Presentation Notes
There are many tools you can use for Limited English Proficient (LEP) patients. You may wish to mark special areas in your office to help your LEP patients. Laminate each sign and post it. For example, a “Welcome” sign can be displayed like this: English – Welcome Español – Spanish Bienvenido/a Tieáng Vieät – Vietnamese Haân haïnh tieáp ñoùn quyù vò 中文– Chinese 歡迎 You can create signs for other common areas such as restrooms, registration, bathroom and entrances.
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Cultural Competency Self-assessment
Take a culturally competent self-assessments at: http://www.asha.org/uploadedFiles/Cultural-Competence-Checklist-Personal-Reflection.pdf
Presenter
Presentation Notes
Culturally competent self-assessments are excellent tools for personal reflection and growth. If you are interested in taking a self-assessment, please visit the link listed on this slide.
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Language Access Services Interpreters
International Medical Interpreters Association (IMIA) • Illinois Chapter Member Directory
http://www.imiaweb.org/corporate/find.asp
American Translators Association (ATA) • http://www.atanet.org
Presenter
Presentation Notes
To assist you in acquiring a medical interpreter: Visit the International Medical Interpreters Association’s Illinois Chapter (IMIA) website, which is listed on this slide. There you can find an active membership directory that you can search to find medical interpreters in your area. A link to the American Translators Association (ATA) website is also provided.
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Cultural Competence Web Resources
General Diversity Rx http://diversityrx.org Office of Minority Health http://minorityhealth.hhs.gov The Cross Cultural Health Care Program http://xculture.org
Presenter
Presentation Notes
Additional Web resources include: Diversity Rx, which has health care resources for multicultural populations. Office of Minority Health website, which offers an online, nine-hour, nine-credit Continuing Medical Educational cultural competence course for providers and office staff. The Cross Cultural Health Care Program
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Cultural Competence Web Resources
General Provider’s Guide to Quality and Culture http://erc.msh.org/mainpage.cfm?file=1.0.htm&module=provider&language=English DHHS Office of Civil Rights http://www.hhs.gov/ocr Kaiser Family Foundation Minority Health http://www.kff.org/minorityhealth/index.cfm Providing care to diverse populations http://archive.ahrq.gov/news/ulp/ulpcultr.htm
Presenter
Presentation Notes
Provider’s Guide to Quality and Culture DHHS Office of Civil Rights Kaiser Family Foundation Minority Health Providing care to diverse populations
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Cultural Competence Web Resources
Aging Administration on Aging http://www.aoa.gov Center on an Aging Society http://ihcrp.georgetown.edu/agingsociety
Presenter
Presentation Notes
Web resources for aging are listed on this slide. They include: Administration on Aging Center on an Aging Society
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Diverse Population Resources
Polish • http://www.staffreliefinc.com/forms/documents/CulturalComp.pdf • http://www.diversicare.com.au/upl_files/file_35.pdf
Presenter
Presentation Notes
These are resources Diverse Population Resources for the Polish population are listed on this slide.
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Diverse Population Resources
Filipino • http://www.ebscohost.com/images-nursing/assets/NRC%20-
%20Culturally%20competent%20care%20-%20Filipino%20Patients.pdf • http://www.stanford.edu/group/ethnoger/filipino.html • http://www.calendow.org/uploadedFiles/Publications/By_Topic/Disparitie
s/General/Culture%20Health%20Among%20Filipinos.pdf • http://www.researchgate.net/publication/232561927_Filipino_American_
culture_and_family_Guidelines_for_practitioners • http://philippineculture.ph/filer/toledo-cebu/FILIPINO-AMERICANS.pdf
Presenter
Presentation Notes
Diverse Population Resources for the Filipino population are listed on this slide.
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Diverse Population Resources
Mandarin/Chinese • http://www.mindlink.org/online_courses/cultural_competency_5.html • http://depts.washington.edu/pfes/PDFs/ChineseCultureClue.pdf • http://www.stanford.edu/group/ethnoger/chinese.html • http://www.cdc.gov/tb/publications/guidestoolkits/EthnographicGuides/C
hina/chapters/chapter2.pdf
Presenter
Presentation Notes
Diverse Population Resources for the Mandarin/Chinese population are listed on this slide.
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Cultural Competence Web Resources
African American • National Black Church Initiative
– http://www.naltblackchurch.com
• NAACP Health Division – http://www.naacp.org/programs/entry
/health-programs
• National Association of Black Cardiologists
– http://www.abcardio.org
• National Caucus and Center on Black Aged, Inc.
– http://www.ncba-aged.org
• National Medical Association – http://www.nmanet.org
Presenter
Presentation Notes
Web resources for the African American population include: National Black Church Initiative NAACP Health Division National Association of Black Cardiologists National Caucus and Center on Black Aged, Inc. National Medical Association
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Cultural Competence Web Resources
American Indian/Alaskan Native • Association of American Indian
Physicians – http://www.aaip.org
• Native American Cancer Research
– http://www.natamcancer.org
• National Indian Council on Aging – http://www.nicoa.org
• National Indian Health Board – http://www.nihb.org
Presenter
Presentation Notes
Web resources for the American Indian/Alaskan Native population include: Association of American Indian Physicians Native American Cancer Research National Indian Council on Aging National Indian Health Board
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Cultural Competence Web Resources
Asian American • Asian and Pacific Islander
American Health Forum – http://www.apiahf.org
• Chinese American Medical Society – http://www.camsociety.org
• National Asian Pacific Center on Aging
– http://www.napca.org
• National Asian Women’s Health Organization
– http://www.icdri.org/api/national_asian_women.htm
• National Resource Center on Native American Aging (Native Hawaiian)
– http://ruralhealth.und.edu/projects/nrcnaa
Presenter
Presentation Notes
Web resources for the Asian American/Pacific Islander American population include: Asian and Pacific Islander American Health Forum Chinese American Medical Society National Asian Pacific Center on Aging National Asian Women’s Health Organization National Resource Center on Native American Aging (Native Hawaiian)
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Cultural Competence Web Resources
Hispanic/Latino American • Hispanic Center of Excellence in
Medicine – http://hcoe.medicine.uic.edu
• National Alliance for Hispanic Health – http://www.hispanichealth.org
• National Association of Hispanic Nurses
– http://www.thehispanicnurses.org • National Council of La Raza
– http://www.nclr.org • National Hispanic Council on Aging
– http://www.nhcoa.org • National Hispanic Medical Association
– http://www.nhmamd.org • http://www.hrsa.gov/culturalcompetenc
e/servicesforhispanics.pdf
Presenter
Presentation Notes
Web resources for the Hispanic/Latino American population include: Hispanic Center of Excellence in Medicine National Alliance for Hispanic Health National Association of Hispanic Nurses National Council of La Raza National Hispanic Council on Aging National Hispanic Medical Association http://www.hrsa.gov/culturalcompetence/servicesforhispanics.pdf
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Thank you! Medicare-Medicaid Plan provided by Blue Cross and Blue Shield of Illinois, A division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an independent licensee of the Blue Cross and Blue Shield Association. HCSC is a health plan that contracts with both Medicare and Illinois Medicaid to provide benefits of both programs to enrollees. Enrollment in HCSC’s plan depends on contract renewal. Blue Cross Community ICP is provided by Blue Cross and Blue Shield of Illinois, a division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an independent licensee of the Blue Cross and Blue Shield Association. Blue Cross Community Family Health Plan is provided by Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), an independent licensee of the Blue Cross and Blue Shield Association.
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Presentation Notes
Thank you for viewing this presentation. Please visit us online anytime at bcbsil.com/provider for the latest News and Updates on Blue Cross and Blue Shield of Illinois programs and initiatives. Or, contact your Provider Network Consultant – we’re here to assist you!
