The Importance of The Importance of Establishing Cultural Establishing Cultural Competency for Allied Competency for Allied Health Professionals Health Professionals

Health Professions NetworkHealth Professions Network

March 17, 2006March 17, 2006

Denise Chapman-Winn PT Denise Chapman-Winn PT PhDPhD

OPENOPEN

MINDEDMINDED

HONESTHONEST

SHARESHARE

UNIQUEUNIQUE

Five Things That Five Things That

Make You Make You UniqueUnique

DIVERSITYDIVERSITY

DIVERSITYDIVERSITY• Diversity is "otherness," or those Diversity is "otherness," or those

human qualities that are different human qualities that are different from our own and outside the groups from our own and outside the groups to which we belong, yet are present to which we belong, yet are present in other individuals and groups in other individuals and groups

DIVERSITYDIVERSITY

WHY??????WHY??????

US AND DIVERSITYUS AND DIVERSITY

DIVERSITYDIVERSITY

• RACERACE• GENDERGENDER• SEXUAL ORIENTATIONSEXUAL ORIENTATION• DISABILITYDISABILITY• RELIGIONRELIGION• CULTURECULTURE• ECONOMIC STATUSECONOMIC STATUS

CULTURALCULTURAL

COMPETENCCOMPETENCYY

CULTURAL CULTURAL COMPETENCYCOMPETENCY

• Definition of cultural competenceDefinition of cultural competence • "culture" refers to integrated patterns of "culture" refers to integrated patterns of

human behavior that include the language, human behavior that include the language, thoughts, communications, actions, customs, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, beliefs, values, and institutions of racial, ethnic, religious or social groups ethnic, religious or social groups

• "competence" implies having the capacity to "competence" implies having the capacity to function effectively as an individual and an function effectively as an individual and an organization within the context of the cultural organization within the context of the cultural beliefs, behaviors, and needs presented by beliefs, behaviors, and needs presented by consumers and their communities consumers and their communities

A set of congruent behaviors, A set of congruent behaviors, attitudes, and policies that come attitudes, and policies that come together in a system, agency, or together in a system, agency, or among professionals and enable that among professionals and enable that system, agency or those system, agency or those professionals, to work effectively in professionals, to work effectively in cross-cultural situations.* cross-cultural situations.*

WHY IS CULTURAL WHY IS CULTURAL COMPETENCY COMPETENCY IMPORTANT?IMPORTANT?

When health care services are delivered When health care services are delivered without regard for cultural differences, without regard for cultural differences, patients are at risk for sub-optimal care. patients are at risk for sub-optimal care. Patients may be unable or unwilling to Patients may be unable or unwilling to communicate their healthcare needs in a communicate their healthcare needs in a culturally insensitive environment, culturally insensitive environment, reducing the effectiveness of the reducing the effectiveness of the healthcare process. Understanding the healthcare process. Understanding the fundamental elements of culturally and fundamental elements of culturally and linguistically appropriate services is linguistically appropriate services is necessary when striving for cultural necessary when striving for cultural competency in healthcare delivery competency in healthcare delivery

CULTURAL CULTURAL COMPENTENCYCOMPENTENCY

• Four Rationales for Cultural Competency Four Rationales for Cultural Competency in Healthcare Deliveryin Healthcare Delivery

• To respond to demographic changesTo respond to demographic changes • To eliminate disparities in the health To eliminate disparities in the health

status of people of diverse racial, ethnic, status of people of diverse racial, ethnic, and cultural backgroundsand cultural backgrounds

• To improve the quality of healthcare To improve the quality of healthcare services and health outcomesservices and health outcomes

• To gain a competitive edge in the To gain a competitive edge in the healthcare market and decrease the healthcare market and decrease the likelihood of liability/malpractice claims.likelihood of liability/malpractice claims.

• (HRSA BRIDGING CULTURES AND ENHANCING CARE-(HRSA BRIDGING CULTURES AND ENHANCING CARE-CONFERNCE SUMMARY-MAY 2002)CONFERNCE SUMMARY-MAY 2002)

CULTURAL CULTURAL COMPENTENCYCOMPENTENCY

““In 2002, the IOM published a In 2002, the IOM published a groundbreaking report, titled Unequal groundbreaking report, titled Unequal Treatment: Confronting Racial and Ethnic Treatment: Confronting Racial and Ethnic Disparities in Health Care, which Disparities in Health Care, which illuminated one of the most critical health illuminated one of the most critical health care challenges facing the United States. care challenges facing the United States. The IOM’s findings that racial and ethnic The IOM’s findings that racial and ethnic minorities receive lower-quality health minorities receive lower-quality health care than white people – even when care than white people – even when insurance status, income, age and severity insurance status, income, age and severity of conditions are comparable – for the first of conditions are comparable – for the first time gavetime gave

Evidence-based credence to the assertion Evidence-based credence to the assertion that the U.S. health care system is not that the U.S. health care system is not color blind. The report offered color blind. The report offered comprehensive evidence to an comprehensive evidence to an uncomfortable reality – come people in uncomfortable reality – come people in the United States were more likely to die the United States were more likely to die from cancer, heart disease, and diabetes from cancer, heart disease, and diabetes simply because of their race or ethnicity, simply because of their race or ethnicity, not just because they lace access to not just because they lace access to health care. The report found:health care. The report found:

CULTURAL CULTURAL COMPENTENCYCOMPENTENCY

Members of minority groups are less likely Members of minority groups are less likely than whites to be given appropriate than whites to be given appropriate cardiac medicines or undergo coronary cardiac medicines or undergo coronary bypass surgery;bypass surgery;

Minorities are less likely than whites to Minorities are less likely than whites to receive kidney dialysis or kidney receive kidney dialysis or kidney transplants;transplants;

Minorities are less likely than whites to Minorities are less likely than whites to receive the best diagnostic test or receive the best diagnostic test or treatments for stroke or cancer;treatments for stroke or cancer;

CULTURAL CULTURAL COMPENTENCYCOMPENTENCY

Minorities are more likely to receive less Minorities are more likely to receive less desirable treatments than whites.”desirable treatments than whites.”

The IOM acknowledged that there are The IOM acknowledged that there are many possible reasons for racial and many possible reasons for racial and ethnic disparities in health care, ethnic disparities in health care, including:including:

Cultural and language barriersCultural and language barriers

Time limitations imposed by the Time limitations imposed by the pressures of clinical practice;pressures of clinical practice;

CULTURAL CULTURAL COMPENTENCYCOMPENTENCY

A woeful lack of minority physicians A woeful lack of minority physicians who may be more culturally sensitized who may be more culturally sensitized to the needs of their patients;to the needs of their patients;

Conscious or subconscious biases, Conscious or subconscious biases, prejudices, and negative racial prejudices, and negative racial stereotypes or perceptions that affect stereotypes or perceptions that affect the way providers deliver care.”the way providers deliver care.”

Addressing Racial and Ethnic Health Care DisparitiesAddressing Racial and Ethnic Health Care Disparities

Where Do We Go From Here?Where Do We Go From Here?

CULTURAL CULTURAL COMPENTENCYCOMPENTENCY

CulturalCultural

IncompetenceIncompetence

CULTURAL CULTURAL COMPENTENCYCOMPENTENCY

Cultural CompetencyCultural Competency^̂^̂^̂^̂

Health LiteracyHealth Literacy

Can You BecomeCan You Become

Culturally Culturally

Competent???Competent???

YESYES

NONO

What Can You Do?????What Can You Do?????