Healthcare ledership
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A conversation on the key issues that affect the delivery of cultural and literacy competent healthcare.
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Healthcare ledership
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- 5. The Regulatory Basis Accreditation organizations, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), following up on standards of the National Standards for Culturally and Linguistically Appropriate Services in Health Care, commonly called the CLAS, require that health care professionals receive training in delivery of services to diverse populations, so do some state contracts for Medicaid and Medicare. The Centers for Medicare and Medicaid Services (CMS) are recommending that health care organizations with whom they contract for these services provide culturally and linguistically appropriate care. 5
- 6. Service Delivery Mechanisms Demographics The Clinical Community Initiatives Competition Quality Expectations Community Partnerships Consumerism 6
- 7. The Institute of Medicine (IOM): Healthcare should be safe, effective, patient-centered, timely, efficient and equitable 7
- 8. Seven Domains of Healthcare Quality 8 SEVEN
- 9. GROUP CULTURE Accepted ways of behaving within the organization or the group. This typically includes attitudes, communications, conduct, beliefs, values and actions. 9
- 10. Demographics & Its Influence on Healthcare Population Demographics Practitioner Demographics Patient Demographics 10
- 11. 11
- 13. What is Competency? Why is it relevant to cultural healthcare? 13
- 14. 14 Your Explanatory Model* *Dr. Arthur Kleinman
- 15. Four Centers Where the Explanatory Model Intrudes 1. Pediatric Care 2. Primary Care 3. Palliative Care 4. Hospice/End of Life Care 15
- 16. Eliciting the patient’s explanatory model (PEM) Predisposing vs Enabling Factors and the Fundamental Question 16
- 17. 17
- 18. The Etiology of Disease Comparing the patient’s explanatory model with the clinician’s explanatory model 18
- 19. The inherently unequal nature of power in all clinical-patient relationships and why But where does power ultimately rest and how is it exercised? 19
- 20. Shared Decisions Making The False-Consensus Effect: “Across a wide range of beliefs and behaviors, people assume that we are more like them than we really are.”* *Scientist and physician Dr. Peter Ubel How to move from patient empowerment to clinician-patient partnership 20
- 21. What’s the the difference between patient trust and patient satisfaction? Two recent studies show that when patients trust a doctor strongly this will influence medication adherence. 21
- 22. Health Literacy – What Is It & What Does It Mean? Health literacy depends on cultural and linguistic factors, and patient assessment tools that can efficiently collect information on patient health literacy, linguistic ability, and cultural beliefs. (Andrulis & Brach, 2007) Key terms that explain via case studies how culture and language need to be considered in any interaction designed to address health literacy of culturally diverse patients 22
- 23. A Cultural Encounter A cultural encounter is the direct engagement in cross-cultural interactions. It allows for validation, negation, or modification of existing cultural knowledge, and provides all parties with a culturally specific frame-work from which culturally competent interventions can be designed. Clinician: “Different people have very different ways of understanding health and illness. Please help me understand what you believe.” 23
- 24. Cultural Safety Connecting patient safety, self-determination and trust* What do we learn from the sterilization of US citizens and the inoculation of syphilis? *Madeleine Leininger and Irihapeti Ramsden 24
- 25. 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 older people know about.” *Lee Pachter, OD, Chairman, Department of Pediatrics, Children’s Hospital, Drexel University Medical School 25
- 26. Hospice Hospice care provides humane and compassionate care for people in the last phases of incurable disease so that they may live as fully and comfortably as possible. It is loaded with beliefs, ritual and actions that impact how care at this stage is delivered. 26
- 27. Leadership Opportunities Become familiar with the issues affecting and influencing healthcare disparity and its connection to culture Advocate for those who are receiving less than satisfactory care because of cultural factors Assist in educating, equipping and advocating for those who have a sense of powerlessness during healthcare encounters where culture may be an influencer Insist on respectful, safe, and culturally competent care during every healthcare intervention for you and your loved ones 27
- 28. 28 Kudos to you!
Editor's Notes
- 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.