tawara d. goode national center for cultural competence center for child and human development...
TRANSCRIPT
Tawara D. Goode
National Center for Cultural Competence
Center for Child and Human Development
Georgetown University Medical Center
September 24, 2009
Gainesville, FL
Employing Organizational Change Frameworks to Enhance Cultural and
Linguistic Competence
Cultural & Linguistic Competency within the Context of Organizational Change
Considering Cultural & Linguistic Competency within the Context of Organizational Change
Does making progress require
changes in people’s values, attitudes
and or habits of behaviors?
Adaptive Challenge vs.
Technical Challenge
Reference: Heifetz, R.A. (1994). Leadership Without Easy Answers. Cambridge, MA: The Belknap Press of Harvard University Press
Slide Source: National Center for Cultural Competence, 2009
“If I am asked to learn about cultural competence, then they must be implying that I am incompetent!”
“If we really get into this my colleagues will discover that I don’t know as much as I think I need to know.”
“I am a person of color. I know what it means to be culturally competent. I don’t need any special training.”
“There are too many cultures. I can’t possibly learn about all of them. This is futile.”
“If I am authentic about this, I will stir up a hornet’s nest in this place. Then there will be repercussions. I am not willing to take that risk.”
“I may discover I have more biases than I care to admit.”
Fears and Concerns about Cultural & Linguistic Competency
“I have examined studies about various cultures, changed some of my thoughts, and now I feel competent.”
Slide Source: National Center for Cultural Competence, 2009
Organizational Change Theories Applied to Cultural & Linguistic Competency
Resistance is a characteristic of any major organizational change effort and a major reason why organizational change efforts fail. (Prochaska, Prochaska and Levesque, 2001).
Resistance should be expected in different stages of multicultural organizational change because the topics of prejudice, discrimination and oppression are controversial and emotionally charged. (Brantley, Frost and Razak, 1996).
The Transtheoretical Model of Change suggests that it is counterproductive to forge ahead with action without addressing issues such as resistance, that stand in the way of individual and organizational readiness for change.
Data Source:Mayeno, L. Multicultural Organizational Development: A Resource for Health Equity, in Cultural Competence in Health Care Series, The California Endowment and Compasspoint Nonprofit Services, April 2007.
Slide Source: National Center for Cultural Competence, 2009
HEALTH EQUITY
“Of all the forms of inequality,
injustice in health is the most shocking and most inhumane.”
Martin Luther King Jr.
Slide Source: National Center for Cultural Competence,2008
Diffusion of Innovations
Data Source: Rogers E. (2003). Diffusion of Innovations: Fifth edition. New York, NY: Free Press
Diffusion is the process in which an innovation is communicated through certain channels over time among members of a social system.
The communication is not simply announcing or promoting innovation. It is a two-way process that leads to diffusion.
Slide Source: National Center for Cultural Competence, 2009
Diffusion of Innovations
Data Source: Rogers E. (2003). Diffusion of Innovations: Fifth edition. New York, NY: Free Press
Knowledge
Persuasion
Decision
Adoption
Sustaining
Stages of Diffusion
Slide Source: National Center for Cultural Competence, 2009
Diffusion of InnovationsStages of Diffusion
Data Source: Rogers E. (2003). Diffusion of Innovations: Fifth edition. New York, NY: Free Press
Knowledge Let others know the innovation exists
Persuasion Word/acceptance from within one’s trusted network. Do people like me accept it?
Slide Source: National Center for Cultural Competence, 2009
Diffusion of Innovations
Data Source: Rogers E. (2003). Diffusion of Innovations: Fifth edition. New York, NY: Free Press
Slide Source: National Center for Cultural Competence, 2009
Stages of Diffusion: Decision/Adoption
Attributes of Innovation Evaluation of Attribute
Relative Advantage Is the innovation better than their usual approach? Is it easier, more convenient, more effective, less expensive?
Compatibility Is the innovation consistent with existing values, past experiences, and needs?
Complexity Is the innovation perceived as easy to understand and use?
Trialability Can people try the innovation on a limited basis? Are there longer term commitments or expectations?
Observability Is the innovation and its benefits visible? Do adopters know others who have used and liked the innovation?
Re-invention Can the innovation be changed to suit the adopters’ needs?
Stages of Change
Data Source: Prochaska, J.O., Redding, C.A. & Evers, K.E. (1997). A Transtheoretical Model and Stages of Change. In K. Glanz, F.M. Lewis, B.K. Rimer (Eds.) Health Behavior and Health Education: Theory Research and Practice a(2 nd edition) (pp. 60-84). San Francisco: Jossey-Bass Publishers.
Precontemplation
ContemplationContemplation
Preparation
Action
Maintenance
Slide Source: National Center for Cultural Competence, 2009
Stages of Change
Data Source: Prochaska, J.O., Redding, C.A. & Evers, K.E. (1997). A Transtheoretical Model and Stages of Change. In K. Glanz, F.M. Lewis, B.K. Rimer (Eds.) Health Behavior and Health Education: Theory Research and Practice a(2 nd edition) (pp. 60-84). San Francisco: Jossey-Bass Publishers.
Precontemplation
ContemplationContemplation
Preparation
Action
Maintenance
Slide Source: National Center for Cultural Competence, 2009
no intention to take action in the foreseeable future
intention to take action in the near future – 6 mos.
intention to take action in the immediate future – 1 mo.
made overt changes within the past 6 mos.
work to prevent relapse
Managing Complex ChangeManaging Complex Change
Vision + Skills + Incentives + Resources + Action Plan = CHANGE
Skills + Incentives + Resources + Action Plan = Confusion
Vision + Incentives + Resources + Action Plan = Anxiety
Vision + Skills + Resources + Action Plan = Gradual Change
Vision + Skills + Incentives + Action Plan = Frustration
Vision + Skills + Incentives + Resources = False Starts
Used with permission: © The Leadership Spectrum : Targeting Result, Enterprise Management Limited 1994.
Slide Source: National Center for Cultural Competence, 2009
Organizational Change and the Work of the Leader
Leadership to advance and sustain cultural and linguistic competency must be cultivated at all levels of an organization, system, or community.
Some individuals lead through position, others through influence; both are valued and necessary and must be recognized.
The traditional role of the leader must be revisited and adapted to address ongoing or emerging challenges: organizational change processes, differences across and within cultures and resulting dynamics, resistance, and differences in power.
Leadership: Lessons Learned
Slide Source: National Center for Cultural Competence,2009
Eliminate the perception of cultural and linguistic competency as “add-ons” by ensuring principles and practices are woven into the culture of the system or organization. Establish a clear business case for cultural and linguistic competency within the specific contexts of the system, organization or program.
Promote the understanding that cultural and linguistic competency are integrally linked to quality of care—you can’t have one without the other.
Institutionalize cultural and linguistic competency in policies, structures, practices, procedures and dedicated resources within systems and organizations.
Establish bench marks and measure progress at regular intervals.
Weave into the Fabric of the Organization and Lessons Learned
Slide Source: National Center for Cultural Competence,2009
Get on the Balcony Identify the Adaptive Challenge Regulate Distress Maintain Disciplined Attention Give the Work Back to the People Protect Voices from Below
The Work of the Leader
Slide Source: National Center for Cultural Competence,2008
Reference: Heifetz, R.A. (1994). Leadership Without Easy Answers.
Creating a Culturally and Linguistically Competent Health
Care Organization
GROUP ACTIVITY
In five years, what is your vision for cultural and linguistic competency within the PPC?
Slide Source: National Center for Cultural Competence, 2009
GROUP ACTIVITY
Use the categories presented in the framework to design the PPC as a culturally and linguistically competent entity.
Slide Source: National Center for Cultural Competence, 2009
Framework for Cultural and Linguistic Competency
Values
Policies
Structures
Practices
Behaviors
Attitudes
Slide Source: National Center for Cultural Competence, 2009
Value Policies Structures Practices Behaviors Attitudes
Community members are full partners in decision-making.
Community participation is required in
planning, implementation, evaluation of organization’s activities
Community participation in: - committees - governing boards- task forces - focus groups- grant reviews - ad-hoc
committees- IRB committees
Provide accommodations
and other supports to assure participation(e.g.
transportation,
stipends, meetings held in accessible venues).
Provide training to ensure that necessary information for meaningful participation is
equally shared.
Actively acquire community
knowledge
Diverse perspectives
areactively
solicited, welcomed, and and respected
A Framework for Putting Values into Policy & Practicein Health and Mental Health Care Settings
T.D. Goode
Slide Source: The National Center for Cultural Competence, 2009
Value Policies Structures Practices Behaviors Attitudes
Systems and organizations must assure theincorporation of cultural knowledge into policy making, infrastructure and practice.
Pre-service and inservice training and professional development are required for all:
- Board members
- Program staff
- Volunteers
- Human resources training/professional development division
- Conference & meeting planning groups
- Annual staff development interests & needs survey or query - “Community of Learners”
- Tuition support and/or reimbursement
The system or organization:
-integrates content oncultural and linguistic competence into its training activities;
- provides incentives for participating in workshops, courses, or seminars and sanctions for non- participation
- assigns staff to serve as coaches andmentors
Achievement of professional development goals are acknowledged in staff performance evaluations, specialrecognition awards, merit pay or bonuses,
Acquiring cultural knowledge is an ongoing rather than a discreet process
A Framework for Putting Values into Policy & Practicein Health and Mental Health Care Settings
Slide Source: The National Center for Cultural Competence, 2009
T.D. Goode
Cultural competence and linguistic competence
are a life’s journey … not a destination
Safe travels!
T.D. GoodeSlide Source: National Center for Cultural Competence, 2009
CONTACT US
National Center for Cultural Competence
http://www11.georgetown.edu/research/gucchd/nccc/