1. Display as participants enter and explain that this training was developed and created based on industry and educator input in conjunction with the Health Workforce Initiative Statewide Advisory Committee, California Community Colleges Chancellor’s Office, and Workforce and Economic Development Program. This is just one soft skills module of the comprehensive training package: “Hi-Touch Healthcare: The Critical 6 Soft Skills.”
Hi-Touch Healthcare

2. Tolerance

3. What to Expect in this Presentation
Crayons Activity
Definition of Tolerance
Equality
Diversity
Draw It Activity
Steps to Building Tolerance
Claim It Activity
Tolerance Quote
Squares Activity
Quickly preview the session.

4. Importance of Communication and Soft Skills
Communication is “the skill that can possibly have the greatest impact on effective healthcare delivery. It really is the key to clinical governance and demands as much attention, respect and sustaining as other seemingly ‘harder’ targets. However, often the mere mention of the importance of communication causes less than positive reactions in healthcare professionals.”
(Jelphs, 2006, senior fellow at the
Health Services Management
Centre at the University of Birmingham)
Explain that dismissing the value of learning about how to be a more competent communicator is not peculiar to the healthcare field, but a result of the “hindsight bias” or the “I already knew that” phenomenon. The hindsight bias is a phenomenon in which people overestimate their prior knowledge. To demonstrate the concept ask the participants if they have watched TV shows such as Jeopardy, Are You Smarter Than a 5th Grader and/or Who Wants to Be a Millionaire. Remind them of the context in which music is playing while the question or answer is displayed WITHOUT the answer to the question, but when the answer is provided everyone comments, “I knew that.” The reality is that they did not know the answer, but seeing the answer rang true to their personal experience which resulted in an overestimation of their prior knowledge. Because we have been communicating our whole lives and we have communication competencies, it is easy for us to hear information about effective communication and think “I already know that,” but it is important not to fall prey to the hindsight bias or to discount the value of enhancing one’s communication competencies.

5. Crayons Activity Pick out ONE crayon
Draw a picture on one of the sheets of paper using just ONE crayon
(See detailed procedures on page 5 of the Trainer Manual.)
Goal – This activity provides an opportunity for participants to visually see the value of differences and variety.
Materials:
Two blank sheets of paper for each participant
A box of crayons for each group of 5-6 participants
Procedures:
Instruct participants to pick out one crayon.
Instruct participants to draw a picture on one sheet of paper, using one crayon.
After 5 minutes, advance to next slide.

6. Crayons Activity
Now draw the same picture using as many crayons that you want.
After 5 minutes have them draw the same picture on the second sheet of paper using as many crayons as they want.

7. Crayons Activity Hold up both pictures. Which do you like best? Why?
Which might you actually hang on your refrigerator?
Have participants hold up both pictures and ask the following questions –
Which picture do you like best? Why?
Which might you actually hang on your refrigerator?
Usually participants choose the picture with more than one color. Compare this to tolerance of those that are around us that are different.
Wouldn’t the world be boring if everyone was exactly the same? In our pictures, the sky was blue, the grass was green, the sun was yellow. Those are things that made the drawings beautiful. So it is with people. It is the wide variety of people that makes the world colorful. So being tolerant of those differences is essential.

8. Tolerance
“Tolerance is respect, acceptance and appreciation of the rich diversity of our world’s cultures, our forms of expression and ways of being human.”
-United Nations Educational, Scientific
and Cultural Organization

9. Definition of Tolerance
Acceptance
Respect
Explain that the concept of tolerance is broken down into two concepts - acceptance and respect. Respect means understanding that each individual is unique and recognizing and accepting our individual differences. Acceptance means being willing to acknowledge that individuals are comprised of different races, sexual orientation, socio-economic status, age, disability, religious belief, political belief, etc.
Tolerance goes beyond just not pointing out differences and not making fun of differences. Tolerance requires the safe exploration of those differences with the purpose of understanding. It means embracing and celebrating our differences. In order to effectively do our jobs in healthcare settings, we must accept and respect our patients for who they are.
Again, tolerance is vital in the healthcare setting. Not only with patients, but also with coworkers. Patients are in a very vulnerable position, often even life threatening. Patients need to feel safe and accepted. Acceptance of co-workers is equally critical because healthcare workers must work together to achieve optimal outcomes for patients. Without acceptance, genuine health CARE is nearly impossible.

10. Equality Everyone is treated the same
Equality is ensuring that individuals or groups of individuals are treated fairly and equally, with treatment specific to individual needs, without favoritism and with respect of race, gender, disability, religion, belief, sexual orientation or age.
Do you ever do something extra for a patient that you really like or identify with? What happens to other patients? What about the patient that you feel less regard for? Are you are unwilling to do that same something extra?
If a coworker wants to trade shifts and this coworker is someone you have determined has opposite political views, are you willing to trade? How about if it is a coworker that you agree on almost everything?

11. Diversity Different from the normal or expected
Diversity aims to recognize, respect, and value people’s differences in order to realize the full potential of each individual and to promote an inclusive culture for all staff and patients.
Remember, once we interact with individual patients, we quickly learn that each is unique, even when patients have the same diagnosis and appear to be very similar on paper.
We have to learn to value diversity whether it is our coworkers or patients that we interact with.

12. Draw it Activity Draw one of the following A model
A person who plays football
An athlete
A physician’s receptionist
A construction worker
(See detailed procedures on page 6 of the Trainer Manual.)
Goal – This activity will help participants face their own biased view of the different roles of people.
Materials:
One piece of paper for each participant
Crayons for group of 5 – 6 participants
PowerPoint Slides 12 – 17
Procedures:
1. Instruct participants to draw a picture of one of the following –
A model
A person who plays football
An athlete
A physician’s receptionist
A construction worker
2. Show slides 13 – 17, one at a time, and ask participants to compare their drawing to the picture on the PowerPoint slide.

13. A Model
Jean-Paul Gaultier shook the modeling world in 2006 using outsized models

14. Footballers
England’s women's football team

15. Athlete
Tanni Grey Thomson 9 Gold Medals in the Paralympics, 30 world records
Oscar Pistorius World record holder in amputee races

16. Physicians’ Receptionist
Frank

17. Construction Worker Meet Samantha
Ask - How do your drawings compare with the pictures on the slides?
What was depicted by the drawings of the participants?
What did the pictures on the slides depict?
Point out that whether participants realize it or not, we all fall into the trap of thinking of the norm and what is expected when these roles are mentioned.
Does this apply to our patients as well? Do we predetermine how a patient will react or what they will say or do without even giving them a chance?

18. Steps to Building Tolerance
Be yourself! Be authentic!
Be fair
Don’t treat others differently because of race, sex, or culture
Explain that steps can be taken to help build tolerance.
First we have to be ourselves. Don’t put up a false pretense. Relax and just be you. Be authentic.
Next we need to be fair. Don’t prejudge. Don’t jump to conclusions.
We have to monitor ourselves and be willing to be honest. Do we treat others differently because of their race, sex, or culture? If so, we must stop ourselves and be willing to change that behavior.

19. steps to Building Tolerance
Change our own beliefs first
Don’t rely on the media when forming opinions of others
Educate yourself on healthy communication
Explain that often we expect the whole world to change and think that we can stay the same. We can’t with tolerance. We have to be willing to examine our own thinking and prejudices and be willing to change them.
Often times we base our opinions of groups, or cultures, based on what we saw and heard from the media. Whether it is a sit-com, or social media, those sources play a role in our opinion. Be aware of the source of our opinion. Is it a credible source?
Be willing to improve our communication skills. No one is a perfect communicator. Be aware how culturally appropriate communication can aid in our tolerance of those that are different.

20. Claim It Activity Everyone line up against one wall.
As statement is read that is true about you “claim it” by crossing the room to the opposite wall.
Continue “claim” statements as they are read.
(See detailed procedures on page 7 of the Trainer Manual.)
Goal – This activity will encourage us to claim parts of our own identities while observing and respecting the parts of other’s identities.
Materials:
Room with two open walls opposite each other and enough room to allow participants to line up against a wall and cross to the other wall
PowerPoint Slide 20 
Procedures:
Participants all line up on one side of the room against the wall.
As a statement is read, if the statement holds true for a person, those participants who can “claim it” should cross to the other side of the room. For example, if the statement is “You are a woman,” then all the women would “claim it” and cross to the wall on the other side of the room and then turn and face the center again.
“Claim It” Statements:
I am a student
I have a driver’s license
I have one or more siblings
I speak a language other than English
I have plans for this weekend
I have a veteran in my immediate family
I have a Spanish-speaking heritage
Neither of my parents has a college degree
Someone close to me has died
Someone in my family has been addicted to alcohol or drugs
I have been to a concert in the past year
Have participants share how they felt –
How did you feel when you had to “claim” a group and walk to the other side of the room?
How did you feel when you were in the group that didn’t move?
Were you surprised that you had things in common with others?
Were there any groups that you wished you could claim? Why?
Will you change how you interact with others based on what group they claimed?

21. “Tolerance is giving to every other human being every right that you claim for yourself.”
-Robert Green Ingersoll

22. Squares Activity
(See detailed procedures on page 8 of the Trainer Manual.)
Goal – This activity will allow participants to recognize self-deception and how it can play a role in tolerance.
Procedures:
Have participants stare at the figure on slide 22 of the Tolerance PowerPoint module.
Ask participants what they see.
Ask participants if they see gray dots at the white intersections.
Ask if the gray dots are really there.
Explain that the gray dots are an example of how we sometimes see things that are not really there when we are trapped in our boxes.
Continue to explain that patients and coworkers easily fall into that category of seeing misconceptions that don’t really exist.

23. Thank you!
Questions? Comments?