Cultural Competence in Healthcare An Important Refresher for Physicians 1 Session Objectives After this session physicians will be able to: 2 Define Cultural Competence Describe why delivering Culturally Competent Care is important Understand being Culturally Competent is a continual process Use Culturally Competent Practices in the provision of care Why do we focus on Cultural Competence at Wheaton Franciscan Healthcare? It is our Mission • “Providing exceptional and compassionate health care service that promotes the dignity and well being of the people we serve.” Clinical Excellence • Ensure equal and individualized care is delivered to all patients Our Patient and Family Experience • Nothing is more important than our patient’s health and well being 3 The next few slides are common words and information to help you learn more about what cultural competence is and why it matters in healthcare and the workplace 4 What is Culture? It is the learned and shared values of a particular group that: - Guides thinking - Actions - Behaviors - Emotional reactions to daily living It is the sum of beliefs, practices, habits, likes and dislikes. 5 It is norms and customs that are learned. Culture is central to the Delivery of Healthcare • It influences patients’ healthcare beliefs, practices attitudes toward care, and trust in the system and in the individual providers • Cultural differences affect how health information and healthcare services are received, understood and acted upon. 6 *US Department of Health & Human Services/ Office of Minority Health Our Patients Represent Many Cultures Group YEAR WFH–North Market (WI) Native Hawaiian & American Indian Asian Latino/ Hispanic African American/ Black FY04 FY11 FY04 FY11 FY04 FY11 FY04 FY11 FY04 FY11 .1% .2% 1.5% 1% 2.7% 2% 27% 24% 62% 67% 71% 21% St. Joseph, Elmbrook & Wisconsin Heart Hospital WFH-Central Market (WI) White/ Caucasian SJH .5% .3% 1% 1% 12% St. Francis & Franklin & MOSH 11% 25% 7% 5% SJH 75% SFH WFH-South* Market (WI) 79% 61% SFH .4% .003% .7% .5% 8% 10% 11% 16% 79% 71% .5% .1% .8% .3% 1.6% .6% 4% 3% 93% 94% .2% .03% 1% 1% 2.6% 3% 1.4% 3.3% 89% 84% All Saints WFH-Iowa* Sartori, Mercy & Covenant Marianjoy (IL) Our Patients Represent Many Religions and Languages Religions Apostolic Church of God Greek Orthodox Methodist Baptist Congregational Hindu, Hmong Mormon Buddhist Eastern Orthodox Jehovah’s Witness Muslim/Islam Catholic Episcopal Jewish, Pentecostal Lutheran Presbyterian Christian Science Evangelical Languages Arabic Farsi Japanese Serbian Bosnian French Laotian Sign language Chinese Greek Polish Spanish Danish Hebrew Punjabi Somali Bantu English Italian Russian Vietnamese IOWA Patient data is in bold What is Cultural Competence? Cultural competence is the ongoing capacity of healthcare systems, organizations and professionals to provide for diverse patient* populations high quality care that is safe, patient- and familycentered, evidence-based, and equitable The National Quality Forum 9 * The term “patient” refers to the individual recipient of care – i.e. patient, client, legal surrogate or person. Cultural Competence in Health Care Primary concerns: 1. Eliminate misunderstandings in diagnosis or in treatment planning that my arise from differences in language or culture 2. Improve patient adherences with treatments 3. Eliminate health care disparities 10 Associations We Make What type of person do you think of when you hear the following descriptions? • • • • • 11 Alzheimer’s patient Black male Asian man Welfare recipient Teenager Associations We Make The people shown below fit into the descriptions reviewed on the previous slide Alzheimer’s victim Black male Asian man Welfare recipient Teenager President Ronald Reagan Dr. Ben Carson Jackie Chan JK Rowling Justin Beiber 12 Associations We Make • When we initially hear the profile of a patient, we all make associations and assumptions based on our past experience. We have a perception of the person before we ever meet them. • Our patients make the same associations when they meet us. • This can be described as a component of transference and counter-transference. 13 Transference • Transference occurs when the physicians or patients transfer past emotions, beliefs or experiences to the present situation. • The feelings can be positive or negative Countertransference, but are ALWAYS a distortion of realty. • Transference is an unconscious process. When transference occurs around cultural issues, it becomes a serious barrier that keeps the patient from being receptive to medical advice and treatment. It is up to us as Culturally Competent Providers to maintain and convey unconditional positive regard for our patients 14 The American Journal of Psychiatry, VOL. 157, No. 9 Cultural Competence is a Continuum • Gaining cultural competence is an ongoing PROCESS. It is developed as cultural knowledge increases • In order to achieve higher levels of competence, it is helpful to engage in self assessment SKILLS • Self assessment provides direction for improvement ATTITUDES KNOWLEDGE 15 The Center for Public Health Education Cultural Competence is a Continuum Moving From Basic Knowledge to Clinical Practice KNOWLEDGE ATTITUDES Understanding the meaning of culture and its importance to healthcare Having respect for variations in cultural norms SKILLS Eliciting patients’ explanatory models of illness Physicians must continue skill development to learn each culture 16 Journal of the Nation Medical Association, Nov. 2008 Eliciting Patient’s Explanatory Model of Illness Role of the Physician . . 1. Asking questions to elicit the patient’s understanding of their illness 2. Having strategies for identifying and bridging the different communication styles 3. Having skills for assessing decision-making preferences and the role of family 17 Journal of the Nation Medical Association, Nov. 2008 Eliciting Patient’s Explanatory Model of Illness 4. Utilizing techniques for ascertaining the patient’s perception of using biomedicine and his or her use of complementary and alternative medicine 5. Having tools for recognizing sexuality and gender issues 6. Having communication strategies for negotiating 7. Methods for bringing to bear an awareness of issues of mistrust and prejudices and of the impact of race and ethnicity on clinical decisionmaking 18 Journal of the Nation Medical Association, Nov. 2008 The Culturally Competent Physician • Knows competency involves a deeper commitment to the people for whom we provide services • Recognizes and learns to work within the context of different languages, customs, worldviews, religions, spiritual views, health beliefs, gender roles, sexuality and family relationships when interacting with clients/patients • Develops specific practice skills The Center for Public Health Education The Culturally Competent Physician • Practice Skills - Has an awareness and acceptance of difference whereby diversity is valued - Understands how his own culture influences how he thinks, acts and delivers services - Understands the dynamics of difference and is conscious of those dynamics inherent when cultures interact 20 The Center for Public Health Education The Culturally Competent Physician • Becomes familiar with the different aspects of various cultures in target areas where service is provided • Has the ability to adapt practice skills that fit the cultural context of the patient/client Physicians must continue skill development to learn each culture 21 The Center for Public Health Education Why is this important for Physicians? At Wheaton Franciscan Healthcare, we recognize our patients as individuals with unique physical, emotional, spiritual, and cultural needs. As a compassionate, faith-based health care provider, we believe developing a positive relationship with our patients and families is essential to the healing process and key to carrying out our Mission of providing exceptional and compassionate health care service. 22 The Goal of Each Physician To always provide culturally competent health care services that are respectful of and responsive to the health beliefs, practices, cultural and linguistic needs of our diverse patients 23 Additional Resources Please click on the picture for a quick reference on delivery culturally competent care. There are also CME credits: “A Physician's Practical Guide to Culturally Competent Care” at https://cccm.thinkculturalhealth.hhs.gov . 24 Diversity & Inclusion Contacts Theresa Jones Vice President of Diversity and Inclusion Strategies Theresa.Jones@wfhc.org 414-465-3433 Leslie Galloway Sherard Director, Diversity and Inclusion Programs Leslie.gallowaysherard@wfhc.org 414-465-3504 Sandy Jones Manager, Cultural Diversity Sandy.jones@wfhc.org 414-465-3005