Cultural Competence: A Lifetime Journey A Racial Harmony - - PowerPoint PPT Presentation

Cultural Competence: A Lifetime Journey

A Racial Harmony Immigration Forum

Sault Ste. Marie Local Immigration Partnership February 20, 2014

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Embracing Differences

Today’s Objectives

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Workshop Objectives:

• Discuss the impact of personal biases, prejudice and

discrimination on the ability to deliver excellent service to patients, families, and colleagues

• Describe the relationship between cultural

competence and service excellence in promoting health equity

• Identify how the social determinants of health affect

immigrants and refugees

• Understand how health disparities are influenced by

racism, marginalization and lack of access to quality care

Why are we here today?

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Why Are You Here Today?

New York Times, March 22, 2002 “Subtle Racism in Medicine”

“ . . . a disturbing new study by the Institute of Medicine has concluded that even when members of minority groups have the same incomes, insurance coverage and medical conditions as whites, they receive notably poorer care. Biases, prejudices and negative racial stereotypes, the panel concludes, may be misleading doctors and other health professionals.”

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The Reality Is…

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Sault Ste. Marie

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What Does Culture Mean To You?

• Above Ice

Beliefs Values Unconscious Rules Assumptions Definition of Sin Patterns of Superior-Subordinate Relations Ethics Leadership Conceptions of Justice Ordering of Time Nature of Friendship Fairness Competition vs Co-operation Notions of Family Decision-Making Space Ways of Handling Emotion Money Group vs Individual Festivals Clothing Music Food Literature Language Rituals

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Iceberg Concept of Culture

VISIBLE NON‐VISIBLE

What are the visible and non-visible aspects of culture?

Christopher

I suppose something that would not be perceived immediately would be my having cancer. I don't have it anymore, I've been treated for it, but nonetheless, my experience with it has a large say in who I am. I am a humble person and I don't feel as if I love to share everything with everyone, just like my experience with cancer, though I suppose now I am telling everyone who reads this about my experience….I come off frequently as either being very formal and polite or as being

• coldhearted. The real me, however, is very emotional and
• understanding. When I got chemotherapy I saw children not even five

years old with more severe cases of cancer or intestinal problems and I felt . . . I knew something was wrong with this, with young, innocent children being sick in the way they were, and I wished I could take their pain and suffering from them. From then on, I look at people with a different outlook, and I see how ignorant many people are from events like that, and it lifts me to a new level of understanding.

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Why is health equity better than health equality?

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Health Equity Equity in health care refers to ensuring quality care regardless of race, religion, language, income or any other individual characteristic.

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Key Definitions to Know

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Culturally competent health care is one strategy for addressing and ideally reversing health disparities

Cultural Competence and Health Equity

What is Cultural Competence?

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Cultural competence in health care describes the ability to provide care to patients with diverse values, beliefs and behaviors, including tailoring health care delivery to meet patients’ social, cultural and linguistic needs

Health Research & Educational Trust (2011)

Yearly Immigration in Canada

= 10,000 people (CIC, 2011)

The Importance of Cultural Competence

The Importance of Cultural Competence

• Ontario is the destination of choice for 42% of all new

immigrants to Canada (Stats Canada, 2010)

• Toronto is the destination of choice for 33% of all new

immigrants to Canada (Stats Canada, 2010)

• By 2031, 63% of Toronto’s population will be members of

racialized groups (Stats Canada, 2010)

• 190 languages spoken in GTA

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Importance of Cultural Competence

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24,190 22,140 18,780 18,125 17,990 16,005 9,480 8,110 7,330 3,640 5,000 10,000 15,000 20,000 25,000 30,000 English Canadian French Scottish Irish Italian North American Aboriginal

• rigins

German First Nations (North American Indian) Ukrainian

Top 10 Ethnicities: Sault Ste Marie, 2011

19 Anglican, 4,730 Baptist, 1,170 Catholic, 29,920 Christian Orthodox, 230 Lutheran, 1,980 Pentecostal, 1,230 Presbyterian, 1,335 United Church, 7,150 Other Christian, 7,000 Buddist, 25 Hindu, 165 Jewish, 190 Muslim, 135 Traditional (Aboriginal) Spirituality, 60 Other religions, 225 No religious affiliation, 18,080

Sault Ste Marie, Religion 2011

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Mother Tongue Non –Official Language Spoken Most at Home Non-Official Language Spoken Regularly at Home Percentage of Respondents of total SSM Population (non aboriginal)

9%

(6950 out of 78670 respondents)

2.8%

(2175 out of 78665 respondents)

3%

(2550 out of 78665 respondents) Total number of languages identified (non aboriginal)

51 40 43 Sault Ste. Marie 2011 Census Results for Non-Official Languages

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5 10 50 40 20 115 135 20 25 105 90 630 10 540 35 45 35 60 5 5 20 20 5 60 25 5 5 15 160 75 10 30 25 20 5 5 30 10 10 35 60 10 30 20 200 5 165 15 5 30 20

Language

Mother Tongue Spoken MOST at home Spoken REGULARLY at home

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South Asian 22% Chinese 25% Black 21% Filipino 3% Latin American 9% Arab 7% Southeast Asian 3% West Asian 0% Korean 3% Japanese 4% Multiple visible minorities 3%

2011 Sault Ste. Marie Visible Minorities Census (n=1270)

Clinical Cultural Competence Framework

Improved Health Outcomes

Clinical Cultural Competence Organizational Cultural Competence Structural Cultural Competence

Adapted from Betancourt (2003) Equitable hiring Supportive policies On‐site interpreters Cultural competence training

Culturally Competent Practice: What does it look like?

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Final Review

Social Determinants

• f Health

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Perspectives on Power and Privilege

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“Tackling health inequity is a matter of social justice; it is also essential in

• rder to provide the best care possible.

Preventive measures that improve the conditions in which people live can lengthen the people’s lives and year spent in good health, improve services and save money.”

Sir Michael Marmot (2013). Working for Health Equity: The role of Health Professionals

Social Determinants of Health

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What could we have done differently?

Cross-Cultural Communication

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Assigning Meaning

Discuss at your tables: What it means to me What it might mean to another Not making eye contact Often saying “YES” Spending time on small talk Arriving late for an appt./class/work Needing to consult family 31

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The Joy Luck Club: Dinner Scene

Collaborative Conversation: A Communication Tool

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Collaborative Conversations

3 Steps 2 Ingredients Key phrases Empathy - Understanding Two concerns I’ve noticed . . . Help me understand . . Tell me more . . Can you explain that a bit more? What else are you thinking? Define the Problem What I’m thinking . . . I’m concerned that . . . I’ve been considering . . Invitation to Generate Solutions Win/win solutions Would you be open to . . .. Could we consider . . . . What can we do about this? Let’s consider . . . What about . . . I wonder if there is a way . . . .

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(Greene & Ablon, 2006)

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Cultural Assessment Tool

Potential topics to explore:

(Andrews & Boyle, 2003) Communication (language/style) Health Related Beliefs and Practices Bio-cultural Variations and Cultural Aspects of the Incidence of Disease Kinship and Social Network Cultural Affiliation Nutrition Cultural Sanctions and Restrictions Religious Affiliation Developmental Considerations Values Orientation Educational Background

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Potential Assessment Questions

These questions, developed by Arthur Kleinman, MD, a professor of medical anthropology at Harvard Medical School, Cambridge, MA, will help you evaluate a culturally diverse population. Consider how you would need to adapt them for the individual patient or family member:

• 1. What do you call the problem?
• 2. What do you think has caused the problem?
• 3. Why do you think it started when it did?
• 4. What do you think the sickness does?
• 5. How severe is the sickness? Will it have a short or long

course?

• 6. What kind of treatment do you think you (or the patient, if

asking a family member) should receive? What are the most important results you hope to receive from this treatment?

• 7. What are the chief problems the sickness has caused?
• 8. What do you fear most about the sickness?

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(Saver, 2007)

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Cross Cultural Communication

Cultural Assessment

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Cultural Assessment Tool

Potential topics to explore:

(Andrews & Boyle, 2003) Communication (language/style) Health Related Beliefs and Practices Bio-cultural Variations and Cultural Aspects of the Incidence of Disease Kinship and Social Network Cultural Affiliation Nutrition Cultural Sanctions and Restrictions Religious Affiliation Developmental Considerations Values Orientation Educational Background

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Interpreter Services

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Costs of Not Providing Interpretation in Healthcare

A literature review described inequitable care with regard to three specific factors:

• Inappropriate tests and procedures
• Increased adverse events
• Lack of or inappropriate hospital utilization

(Access Alliance, 2009)

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Things to Consider…

Availability of interpreters

• At all times, strategies are needed to support effective

communication (ex. OPI or AboutKidsHealth.ca) Trained versus untrained interpreters

• Untrained interpreters were 70% more likely to make

medical interpretation errors than trained interpreters

(Gany et al., 2010)

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How to Assess a Patient’s or Family’s Need for an Interpreter

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Ask the family what language they speak at home Observe what language the family speaks among themselves Explore with the family when having an interpreter may be helpful Explain to the family why YOU want to have an interpreter if they are resistant How to Assess a Family’s Interpreter Needs

Face to Face vs. Over the Phone

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versus

Health Literacy

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Canadians with the lowest literacy scores are two and a half times as likely to see themselves as being in fair or poor health

(Rootman & Gordon-El-Bihbety, 2008)

Health Literacy

We should not assume people understand words or their meaning, even in their first language

Health literacy is more than:

• giving a family a pamphlet in their own language

(English or otherwise)

• providing interpretation in the language of their choice

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What is Health Literacy?

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Health Literacy is a key component of

patient and family -centred care:

• Share information in a way that can be

understood

• Provide information for informed treatment

and decision making

• Empower clients to become self-advocates

and partners in their care

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Explore Health Literacy of Patients and Families

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DO

• Let patients and families know you

will ask questions to better help them

• Ask them about how they learn

best

• Ask them about their reading

habits at home

• Ask in which language they read (if

LEP)

• Ask them what their

understanding of the condition is

• Use visual aids

DON’T

• Assume that they can read and

write in their native tongue

• Assume that they understood your

directions or information

• Assume that they know their
• ptions and available services
• Assume that they have the same

access to technology and resources as others you help

• Ignore body language and non‐

verbal cues

Reducing Health Disparities Through Culturally Competent Care

Diverse Populations Cultural Competence Techniques Clinician/ Patient Behavioural Change Appropriate Services Improved Outcomes Reduction of Health Disparities

(Brach & Fraser, 2002)

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An Inspiration

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Looking Beyond the Obvious

THANK YOU!!

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Karen Sappleton, Manager, CFCC & Health Equity 416‐813‐7654 ext. 228375 Karen.sappleton@sickkids.ca

THANK YOU!