Cultural Diversity in Health Care

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Presentation transcript:

Cultural Diversity in Health Care It is a major influence in the health care arena today The world has become a global village especially the us a land of immigrants we are blessed with so many cultures But do we understand what is cultural diversity, how do we know how do we diagnose to address it we need to understand and recognize it when do you and I as health care providers conciously ask opurselves what cultural issues maybe influencing this encounter, because only then can we truly take care of the pt and not just a symptom or an abnormal chest xray maybe a few clinical scenarios may highlight the points

What is the Goal of the American Medical System? If the goal is to provide optimal care for all patients health care providers must understand cultural differences that create conflicts and misunderstandings and that can result in inferior medical care. Caring for Patients from Different Cultures Geri-Ann Galanti

Role of Cultural Competence in Healthcare

What is Cultural Competence? “…a set of academic and personal skills that allow us to increase our understanding and appreciation of cultural differences between groups.” Archbold, 1996

Can We Achieve Cultural Competence? 5

Continuum of Acculturation Separation: Individuals value holding onto their original culture and avoid interaction with other cultural groups. Marginalization: Low interest in cultural maintenance and relationships with individuals from other cultures. Integration: Cultural integrity is maintained while the individual participates in the larger social network. Assimilation: Individual from a non-dominant group does not wish to maintain their original culture and actively participates in dominant culture.

Should We Achieve Cultural Awareness First……….?

Model of Cultural Competence

Why is Cultural Competence Important? Cross-cultural misunderstandings may play a role in perpetuating health care disparities Legislative, policy and accreditation mandates for the inclusion of cultural competence training in medical schools and health care institutions Gregg, J, et al. Cultural Competence Training in Medicine: Should We? SGIM Task Force Recommendations 10 10

Why the concern with culture competence? Increasing ethnic diversity of the United States Health care inequities experienced by non-white Americans

Current health care providers trained in a less culturally diverse environment and may be less prepared to deal with diversity They may also be less likely to offer valuable therapies to certain patients Over 600 disparities documented in the Institute of Medicine Report

Cultural Competence Fundamental Elements Understand the dynamics of difference Implement policies and procedures Value diversity Perform a cultural assessment Question self-desire and motivation for positive change Bigby, J. Cross-Cultural Medicine. 2003

Dynamics of Difference Differences among patients and providers Avoid cultural blindness Belief that color or culture makes no difference All people are the same Difference in quality of care Cardiovascular disease: Differential treatment after coronary arteriography, even controlling for disease severity Cancer: Racial differences in mortality rates, analgesia, diagnostic tests and treatment Pain Management Elective procedures

Incorporating Cultural Competency into Healthcare Systems Community engagement Cultural perspectives Reciprocal transfer of knowledge and skills Healthcare organizations Consensus statements Call for action and research Accreditation Develop competencies and curricula Taylor, 1997

Value Diversity Lack of Diversity in Leadership Workforce Diversity Improve early education Recruitment and retention Mentoring Workforce Diversity Different perspectives Improve communication Comfortable environment

Cultural Assessment for Patients What do you think caused your problems? Why do you think it started it when it did? What does your sickness do to you? How severe is your sickness? What problems has your sickness caused you? What do you fear about your sickness? What are the results you expect to receive? Adapted from Kleinman, 1978

Internal Motivation and Self-Awareness Recognize biases Management decisions influenced by race and ethnicity Physicians less likely to recommend catheterization for black females (Schulman) Male physicians prescribed more analgesia for white patients vs. blacks (Wiesse)

What provider behaviors contribute to disparities? What are the Consequences of Patient’s Experiences of Bias in Health Care Setting?

What provider behaviors contribute to disparities? Provider perceptions of symptoms Provider perception of worthiness of patient Provider misunderstanding of racial and ethnic differences Poor communication skills Bigby, 2003

Consequences of Patient’s Experiences of Bias in Health Care Setting Hold negative assumptions about providers Interpret provider behavior from baseline of mistrust Withhold important information Delay presentation for care Do not follow recommendations Bigby, 2003

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