culturally competent care: what does this look like? · explore health literacy of patients and...
TRANSCRIPT
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Culturally Competent Care: What does this look like?
Cultural Competency Learning Symposium,Learning Together, Growing Together
18 March 2014
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Introductions
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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• Recognize the impact of Social Determinants of Health in providing excellent care • Understand how health disparities are influenced by racism, marginalization and lack of access to quality care
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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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Why are you here today?Why Are You Here Today?
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Implicit Association Test
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https://implicit.harvard.edu/implicit/takeatest.html
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Look at the two photos below –write down the very first 5 things that come to your mind
Picture 1
Picture 2
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Why is health equity better than health equality?
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Perspectives on Power and Privilege
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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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Culturally competent health
care is one strategy for
addressing and ideally
reversing health disparities
Cultural Competence and Health Equity
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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)
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Clinical Cultural Competence Framework
Improved Health
Outcomes
Clinical Cultural
Competence
Organizational Cultural
Competence
Structural Cultural
Competence
Adapted from Betancourt (2003)
Equitable hiringSupportive policies
On‐site interpreters
Cultural competence training
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Culturally Competent Practice:
What does it look like?
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Final Review
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Health Literacy15
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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)
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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?18
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Health Literacy is a key component of patient and family –centred, culturally competent 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 20
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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
• 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 options 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
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Social Determinants of Health
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Social Determinants of Health
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What could we have done differently?
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Cross-Cultural Communication
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Assigning MeaningDiscuss at your tables: What it
means to meWhat 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
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Collaborative Conversation:A Communication Tool
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Collaborative Conversations
3 Steps 2 Ingredients Key phrasesEmpathy -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 QuestionsThese 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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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…Better Outcomes
Length of stay for LEP patients was significantly longer when interpreters were not utilized for admission and or admission/discharge
(Lindholm, Hargraves, Ferguson, & Reed, 2012)
Availability of interpreters
At all times, strategies are needed to support effective communication (ex. OPI or AboutKidsHealth.ca)
Trained versus untrained interpretersUntrained 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 homeObserve what language the family speaks among themselves Explore with the family when having an interpreter may be helpful Explore with the family why they may not want to have an interpreter Explain to the family why YOU want to have an interpreter if they are resistant
How to Assess a Family’s Interpreter Needs
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Face to Face vs. Over the Phone36
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versus
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DARE Approach
Discover
Acknowledge & Recognize
Enable
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Reducing Health DisparitiesThrough Culturally Competent Care
Diverse Populations
Cultural Competence Techniques
Clinician/ Patient
BehaviouralChange
Appropriate Services
Improved Outcomes
Reduction of Health
Disparities
(Brach & Fraser, 2002)
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THANK YOU!!
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Karen SappletonManager, CFCC & Health Equity & Interpreter Services
416‐813‐7654 ext. [email protected]
Thank You!