cultural diversity and health care - lsuhsc
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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
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