Requires system integration and this requires leadership. E.G: EHR; ACO;
PSA’s and Mammograms. Patient 95 with broken hip – replace? Or a brain tumor.
Schein: basic assumptions driving life in an organization.
Cultural competency is not for every one. It necessitates either vision or pain.
Competent: Someone who meets the standard of proficiency in the role performed.
The etiology of disease and the connection to epidemology.
A patient’s explanatory model frames the success of the patient/clinician encounter. Achieving success is a function of patient safety.Setting the stage to introduce cultural safety and shared decision making.
G. H. Hochbaum, AmberRosenstockThe health belief model proposes that a person's health-related behavior depends on the person's perception of four critical areas:1. the severity of a potential illness,2. the person's susceptibility to that illness,3. the benefits of taking a preventive action, and4. the barriers to taking that action
The clinician’s words and actions are credible and can be relied upon. ► The physician will act in the patient's best interest► The physician will provide support and assistance during health interventions
Health literacy is defined as being able to process and understand information about health and medical treatments to make basic decisions. It is the degree to which an individual can obtain, process, and understand information to communicate with others or make basic decisions
The syphilis and sterilization experience
Getting at specific questions to elicit information regarding alternative or complimentary methods being used.
Hindu healthcare customs and beliefs often contribute to the decisions for medical care and choice of healthcare services. The actions of supernatural forces and certain human excesses may be considered important in illness causation among Hindus, regardless of educational level. Deep-rooted beliefs about illnesses can inhibit the acceptance of scientific causes for disease, resulting in treatment challenges. Hindus believe in reincarnation and view death as the soul moving from one body to the next on its path to reach Nirvana, heaven.
The Regulatory BasisAccreditation organizations, such as the Joint Commissionon Accreditation of Healthcare Organizations (JCAHO),following up on standards of the National Standards forCulturally and Linguistically Appropriate Services in HealthCare, commonly called the CLAS, require that health careprofessionals receive training in delivery of services todiverse populations, so do some state contracts forMedicaid and Medicare.The Centers for Medicare and Medicaid Services (CMS) arerecommending that health care organizations with whom they contractfor these services provide culturally and linguistically appropriate care.5
Service Delivery MechanismsDemographicsThe Clinical Community InitiativesCompetitionQuality ExpectationsCommunity PartnershipsConsumerism6
The Institute of Medicine (IOM):Healthcare should be safe,effective, patient-centered,timely, efficient and equitable7
The Etiology of DiseaseComparing thepatient’s explanatorymodel with theclinician’s explanatorymodel18
The inherently unequal nature of power in allclinical-patient relationships and whyBut where does powerultimately rest and how isit exercised?19
Shared Decisions MakingThe False-Consensus Effect:“Across a wide range of beliefs and behaviors,people assume that we are more like them thanwe really are.”**Scientist and physician Dr. Peter UbelHow to move from patient empowerment toclinician-patient partnership20
What’s the the difference between patient trustand patient satisfaction?Two recent studiesshow that when patientstrust a doctor stronglythis will influencemedication adherence.21
Health Literacy – What Is It & What Does It Mean?Health literacy depends on cultural and linguistic factors, and patientassessment tools that can efficiently collect information on patienthealth literacy, linguistic ability, and cultural beliefs.(Andrulis & Brach, 2007)Key terms that explain via casestudies how culture and languageneed to be considered in anyinteraction designed to addresshealth literacy of culturally diversepatients22
A Cultural EncounterA cultural encounter is the direct engagement incross-cultural interactions. It allows for validation,negation, or modification of existing culturalknowledge, and provides allparties with a culturally specificframe-work from whichculturally competentinterventions can be designed.Clinician: “Different people have very different ways ofunderstanding health and illness. Please help me understand what youbelieve.”23
Cultural SafetyConnecting patient safety,self-determination and trust*What do we learn from thesterilization of US citizensand the inoculation of syphilis?*Madeleine Leininger and Irihapeti Ramsden24
The Pachter Inquiry*LP: “I’ve been told that there are ways of treating(specific illness) that doctors don’t know about,but people such as your grandparents and olderpeople know about.”*Lee Pachter, OD, Chairman, Department of Pediatrics, Children’s Hospital, Drexel University Medical School25
HospiceHospice care provides humaneand compassionate care forpeople in the last phases ofincurable disease so that theymay live as fully and comfortablyas possible.It is loaded with beliefs, ritualand actions that impact howcare at this stage is delivered.26
Leadership OpportunitiesBecome familiar with the issues affecting and influencinghealthcare disparity and its connection to cultureAdvocate for those who are receiving less than satisfactorycare because of cultural factorsAssist in educating, equipping and advocating for those whohave a sense of powerlessness during healthcare encounterswhere culture may be an influencerInsist on respectful, safe, and culturally competent care duringevery healthcare intervention for you and your loved ones27