Dr. Rovaris LSUHSC

Cultural Competence and

Diversity in Health CareDr. Dereck J. Rovaris, Sr.Associate Vice Chancellor for

Academic & Multicultural Affairs

LSU Health Sciences Center

Grand Rounds

School of Medicine

LSUHSC

7/15/11

Dr. Rovaris LSUHSC

Cultural Competence and Diversity

in Health Care

It Aint About You!

It’s About the PATIENT!

Cultural Competence has to do with perspective:

Patient Centered Perspective

Dr. Rovaris LSUHSC

Cultural Competence and Diversity

in Health Care

•The case for diversity is stronger than ever: demographic shifts and health

reform are among the many issues pushing academic medicine toward

inevitable and dramatic transformation.

•Better health for all is, and should be, at the crux of our efforts.

•Broadening the concepts of diversity and inclusion and attaching these to

excellence in medical education, research and patient care will require that

we build on and enhance our prior work in this arena.

•Moving diversity from a peripheral problem to a core solution means

making a choice between preservation and innovation.

Dr. Marc A. Nivet

Association of American Medical Colleges 11/9/10

Dr. Rovaris LSUHSC

Cultural Competence and Diversity

in Health Care

“CULTURAL COMPETENCE

STARTS WITH RECOGNIZING

YOUR OWN CULTURE AND BIASES,

BECOMING SENSITIVE TO THE

CULTURES OF OTHERS (their values

and beliefs),

AND APPRECIATING THE

DIFFERENCES”

- GALANTI -

Dr. Rovaris LSUHSC

Cultural Competence and Diversity

in Health CareObvious / Not So Obvious

Manifestations of Culture/Diversity:•Religion

•Ethnicity (Race)

•National Origin

•Language

•Gender

•Age

•Sexual Orientation

•Socioeconomic Status

•Educational Status

•Mobility (including handicaps)

•Regionalism

Dr. Rovaris LSUHSC

Cultural Competence and Diversity

in Health Care

Patient care—overall assessment (safe, timely, effective,

efficient, equitable, patient centered)

Medical Knowledge—what we must know

Interpersonal and communication skills--what we must say

Professionalism—how we must behave

Systems based practice—what is the process? On whom do we

depend? Who depends on us?

Practice based learning and improvement—What have we

learned? What will we improve?

The Six ACGME Competencies

Dr. Rovaris LSUHSC

Cultural Competence and Diversity

in Health Care

“Western”•Make it Better

•Control Over Nature

•Do Something

•Intervene Now

•Strong Measures

•Standardize – Treat Everyone the Same

•Plan Ahead – Recent is Best

“Others”•Accept With Grace

•Balance/Harmony with Nature

•Wait and See

•Cautious Deliberation

•Gentle Approach

•Individualize – Recognize Differences

•Time Honored -Take Life As It Comes –

Dr. Rovaris LSUHSC

The Cultural Competence Continuum Sockalingum adapted from Hayes, Cultural Competence Continuum and Terry Cross Cultural Competency Continuum

Dr. Rovaris LSUHSC

Cultural Competence and Diversity

in Health Care

Cultural Competence Definitions Cultural Destructiveness: forced assimilation,

subjugation, rights and privileges for dominant

groups only

Cultural Incapacity: racism, maintain stereotypes,

unfair hiring practices

Cultural Blindness: differences ignored, “treat

everyone the same”, only meet needs of dominant

groups

Dr. Rovaris LSUHSC

Cultural Competence and Diversity

in Health Care

Cultural Competence Definitions Cultural Pre-competence: explore cultural issues,

are committed, assess needs of organization and individuals

Cultural Competence: recognize individual and cultural differences, seek advice from diverse groups, hire culturally unbiased staff

Cultural proficiency: implement changes to improve services based upon cultural needs, do research and teach

Dr. Rovaris LSUHSC

Cultural Competence and Diversity

in Health Care

The Cultural Competence Continuum

Where Am I Now?

Where Could I Be?

It is a journey, not a destination

Dr. Rovaris LSUHSC

Communication and Language factors Anticipate varied understanding

Navajo: Penicillin = “the strong white medicine shot you get for a cold”

Minimize jargon, e.g., “machine to look at your heart” instead of “EKG”

Nonverbal communication - is a large part of what people understand

Nodding may indicate politeness, not comprehension

Always give the reason or purpose for a treatment or prescription.

Cultural Competence and Diversity

in Health Care

Dr. Rovaris LSUHSC

Make sure the patient understands by having them explain it themselves.

Reinforce verbal interaction with visual aids and materials written in the client’s language.

Repeat important information more than once.

Personal information may be closely guarded and difficult to obtain.

Use interpreters when necessary - better if you know the language or perhaps someone on staff

Utilize interpreters you trust (children or other relatives may not always work)

Cultural Competence and Diversity

in Health Care

Dr. Rovaris LSUHSC

In some cultures it may not be appropriate to

suggest making a will for dying patients or

patients with terminal illnesses; this is the

cultural equivalent of wishing death on a

patient.

Avoid saying “you must... Instead teach

patients their options and let them decide, e.g.,

“some people in this situation would...”

Cultural Competence and Diversity

in Health Care

Dr. Rovaris LSUHSC

The LEARN Model Berlin and Fowkes

Listen to the patient’s perception of the problem

Explain your perception of the problem

Acknowledge and discuss differences/ similarities

Recommend treatment

Negotiate treatment

Cultural Competence and Diversity

in Health Care

Dr. Rovaris LSUHSC

Acquiring Cultural Competence

Starts with AWARENESS

Grows with KNOWLEDGE

Enhanced with SPECIFIC SKILLS

Polished through Cross-Cultural ENCOUNTERS

Cultural Competence and Diversity

in Health Care

Dr. Rovaris LSUHSC

Remember…

…It’s About the Patient!

Thank you.

Cultural Competence and Diversity

in Health Care

Dr. Rovaris LSUHSC

Cultural Competence and Diversity

in Health Care

RESOURCES* Black, R., & Wells, S. (2003) Moving toward cultural competency.

Dillard, M. (1992) Culturally competent occupational therapy in a diversely populated mental health setting. American Journal of Occupational Therapy46 (8). Pgs. 721-26).

Evans, J. (1992) What occupational therapist can do to eliminate racial barriers in health care access. American Journal of Occupational Therapy 46 (8). Pgs. 679-83).

Fazio, L. (2001) Developing occupation-centered programs for the community: a workbook for students and professionals. New Jersey: Upper Saddle River

Galanti, Geri-Ann (2008) Caring for Patients from Different Cultures.

Green, L. & Anderson, C. (1982) Community health (4th ed.) St. Louis: Mosby

*list compiled by D. Rovaris & Shannon Mangum

Dr. Rovaris LSUHSC

Cultural Competence and Diversity

in Health Care

Kleinman, A., Eisenberg, L., Good, B. (1978) Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88 (2), 251-58

Mattingly C. & Beer D. (1993) Interpreting culture in a therapeutic context. In H.L. Hopkins & H.D. Smith (Eds.) Willard and Spackman’s occupational therapy (8th ed.) Philadelphia: Lippincott.

McGruder, J. (1998) Culture and other forms of human diversity in occupational therapy. In Neistadt, M., & Crepeau, E.(Eds.) Willard and Spackman’s Occupational Therapy, (9th ed). Philadelphia:Lippincott

O’Connell, M. (1988) The gift of hospitality. Evanston, IL:Center for Urban Affairs and Research.

Skloot, Rebecca. (2010) The Immortal Life of Henrietta Lacks.

Taylor, R. (2005). Addressing barriers to cultural competence. Journal for Nurses in Staff Development, 21(4), 135-144.

Dr. Rovaris LSUHSC

Cultural Competence and Diversity

in Health Care Center for Cross-cultural Health – www.crosshealth.com

Center for Multicultural and Multilingual Mental Health Services – www.mc-mlmhs.org/cultural.html

Checklist for Cultural Assessments: www.health.qld.gov.au/multicultural/checklist

Cultural Competency in Medicine – www.amsa.org

http://www.findtbresources.org/material/CCGuide.pdf

Cross Cultural Resources -www.medicine.uscf.edu/resources/guideline/culture/html

Cultural Clues – www.depts.washigton.edu/pfes/cultureclues.html

CulturedMed - www.culturemed.sunyet.edu

Diversity in Health and Illness – www.culturediversity.org/index.html

DiversityRx – www.diversityrx.org

Dr. Rovaris LSUHSC

Cultural Competence and Diversity

in Health Care EthnoMed – www.ethomed.org

Health Care Education Association @ www.hcea-info.org/html/educational.html

Health and Culture – www.health.csuohio.edu/healthculture

National Center for Cultural Competence –www.nccc.georgetown.edu

Office of Minority Health – www.omhrc.gov

Racial and Ethnic Difference in the Health of Older Americans – www.nap.edu/books/0309054893/html

Test Yourself for Hidden Bias –www.tolerance.org/hidden_bias/

Transcultural and Multicultural Health Links –www.web.nmsu.edu