Cultural Competency In Health Care

“Transforming Barriers into Assets”

Trainers

Dijana RizvanovicDov Sellem

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Active Listening

Level 1Basic Acknowledgements

Level 2Silence

Level 3Questions

Level 4Paraphrasing

Level 5Reflective Listening

LMC Learning Design Center** Adapted from the work of Jerry Wisinski

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Why Cross Cultural Training

Raise the level of consciousness of cultural issues and how they impact health care

Share and discuss culture and cultural generalizations that relate to health care

Develop skills for cross-cultural communication and interaction with patients and families

Identify your own specific values that may impact how you view people from other cultures

Create individual action plans for continual self-improvement related to improving each individual’s response to the opportunities/learning that can result from serving culturally diverse populations

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Definitions of Culture

An agreed upon set of norms, values, and behaviors.

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“One’s own culture provides the lens through which we view

the world; the logic... by which we order it; the grammar... by which it makes

sense.”(Avruch and Black)

Definitions of Culture

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Culture Simulation

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The Cultural Iceberg…an illustration of the components and levels of culture

Note: Use this diagram to bring to mind areas of interaction in which careful problem-solving may be needed to facilitate clear understanding and open communication

Touching, space, eye contact, body contact, tone of voice, non-verbal communication (learned through modeling, usually in early childhood)

Unconscious Rules: (“completely below sea level”) Because emotional loading at this level is intense, violations are taken personally, affecting relations between people.

Unspoken Rules: (“partially below sea level”) Because emotional loading at this level is very high, violations result in negative feelings about the violator.

Courtesies; use of time, punctuality; conduct in restaurants, social occasions, shopping (learned by trial and error)

Food, music,language, architecture (learned cognitively)

Visible Culture:(“above sea level”) Because emotional loading at this level is relatively low, few misunderstandings are produced at this level

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What is Cultural Competence?

•A process “in which an individual or agency continuously strives to achieve the ability to effectively work within the cultural context of an individual, family, or community from a diverse cultural/ethnic background,” ~Josepha Campinha-Bacote

•Culturally congruent care takes into account the cultural background of the patient. It involves decisions and actions that are acceptable to the consumer and matches the consumer’s expectations. In order to meet the consumer’s expectations, the provider must take into account the consumer’s world views, systems of values and norms, and orientation to health and illness; it must be culture specific. ~Leininger, 1988

•“A culturally competent system of care acknowledges and incorporates – at all levels – the importance of culture, the assessment of cross-cultural relations, vigilance towards the dynamics that result from cultural differences, the expansion of cultural knowledge, and the adaptation of services to meet culturally unique needs. ~T. Cross, 1988

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Stages of Cultural Competence Development: The Bennett Model

Stage 1- Denial

Stage 2- Defense

Stage 3- Minimization

Stage 4- Acceptance

Stage 5- Adaptation

Stage 6- Integration

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Stereotypes

How can we manage and overcome these stereotypes both in the moment and in the longer term?

How can you give patients more information, so that they can change their perceptions of you?

Learning to reflect on what other people

might think of you is an important way of

building self-awareness, and of eventually building

greater better relationships with

your patients

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Overcoming Stereotypes

• Understand the distinction between Cultural Patterns and Stereotypes

• Acknowledge the existence of our preconceptions

• Understand how preconceptions impact us

• Know our labels and who we relegate them to

• Slow down, check it out, get information

• Adjust your understanding of cultural patterns when you get new information

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Barriers to Intercultural Communication

Assumed Similarity

Nonverbal Communication

Verbal Language

Tendency to Judge

Preconceptions and Stereotypes

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Bridging Barriers to Cross Cultural

Communication

• Raise self-awareness

• Don’t act on your stereotypes

• Listen with respect

• Increase culture-specific awareness

• Treat each person uniquely

• Seek out information

• Tolerate ambiguity

• Establish trust and show concern and empathy

• Show sensitivity to face-saving needs

• Have a sense of humor and patience

• Notice non-verbal cues

• Listen for hidden meanings

• Avoid confusing language

• Try to see things from the other person’s perspective

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Personal Communication Styles Mode of interaction:Initiating……………………………….…..…….…verses………..…….…………………….……….ListeningThe degree to which one initiates discussion or listens and responds as a primary mode of interaction.

Reference Point:Individual…………………………………..….…..verses………....………………..……………………Group The degree of emphasis placed on personal involvement and achievements versus group involvement and

achievements in communications.

Authority Base:Facts……………………………………….………...verses………….…….….…………………….……IntuitionThe degree to which one relies on factual data versus intuitive judgments as the basis for reasoning and

persuading.

Degree of Self-Disclosure:Impersonal…………………………………….…....versus……………………………..………….……PersonalThe emphasis placed on tasks versus sharing personal data in building new relationships and communicating

with others.

Mode of Expression:Rational……………………………………...……...versus………………….………….……..………..EmotionalThe degree of reliance on rational descriptions and facts only versus emotional reactions and

embellishments.

Method of Support:Challenge…………………………….…………..…versus……………….…………….………….....AgreementThe degree of challenge versus praise and agreement used to support others’ ideas, views, and so on.

Method of disagreement:Confrontation…………………………………..…..versus………….…….………………………….ComplianceThe degree of confrontational versus compliant behavior exhibited in conflict situations.

Vocal Characteristics:Low………………………………………….…….…versus……………….……………………………..…….HighThe pitch, accent, and volume displayed in verbal communications.

Method of assertion:Direct………………………………………….……..versus………….….…….……………………………IndirectThe degree of reliance on direct statements describing one’s position or point of view versus indirect

references, use of questions, and so on.

Physical proximity:Distant………………………………………….…....versus…………….……….…………………………….CloseThe degree of physical versus closeness maintained and preferred in interactions with others.

Reliance on Protocol:High…………………………………….…………….versus….……………….………...………………………LowThe degree of emphasis placed on formality and tradition versus spontaneous behavior in communications

with others.

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Communicating With Limited English Proficient (LEP) Patients

Miscommunication and lack of complete understanding often occurs between people who speak the same language. When communication is attempted between two people who do not speak the same native language, frustration and miscommunication are even more likely.

The following are some strategies that may help ensure that the desired communication actually occurs:

•Speak more slowly than usual, but do not use unnatural language.

•Be conscious of the beginning and ending of sentences, speaking as distinctly as possible.

•Present ideas or facts in a logical order.

•Pause frequently to give the listener adequate time to process the language and content.

•Watch for body language which may aid the communication or indicate confusion.

•Check for understanding by active listening or paraphrasing what the speaker has said.

•Provide adequate space for the communication; do not rush the listening-and-speaking flow of conversation.

•When there is uncertainty regarding the communication, reframe the sentence, using alternate words or phrases.

• Avoid idioms, slang or jargon. Define acronyms and abbreviations.

•Demonstrate, use visuals, and reinforce with written material whenever possible.

•Assume communication can occur. Handle your fear.

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Action Plan

What can you personally do to help your organization be more culturally competent?

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Crisis

In Chinese the word crisis is represented by two characters. Each character combined with other characters have different meanings:

The upper symbol can mean danger, while the lower can mean opportunity.