Cultural Competence in Healthcare Management A Prescription for Success. Diversity 2004 Hear It! Feel It! Live It! Greater Rochester Diversity Council

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1 Cultural Competence in Healthcare Management A Precription for Success Diversity 2004 Hear It! Feel It! Live It! Greater Rochester Diversity Council Presented by: The Towers at Forty-Fifth 310 East 4500 South Suite 420 Salt Lake City, Utah Tel: (801) Fax: (801) Web: innovationsintl@qwest.net William A. Guillory, Publishing Division. All rights reserved. No part of this material may be reproduced in any form without the written permission of 0704

2 Cultural Competence in Healthcare Management Overall Objectives: The overall objectives of this presentation are to: 1. Define diversity and cultural competence. 2. Define the three dimensions of culture that critically impact the quality of healthcare delivery. 3. Learn your workplace cultural orientation and the extent to which it supports the health, performance, and well-being of patients and co-workers. 4. Experience the critically important step for becoming culturally competent personal transformation with respect to differences. 5. Learn your relationship/communication style and how to compatibly function within a multicultural environment. i

3 Cultural Competence in Healthcare Management A Prescription for Success Diversity Defined Diversity is an inclusive and caring environment where differences are valued and integrated into an organization s day-to-day operation in order to: provide quality patient care exceptional workplace and business performance ensure the mental, physical, and emotional well-being of employees ensure community outreach Cultural Competence Cultural Competence is an experiential understanding and acceptance of the beliefs, values, and ethics of others as well as the demonstrated skills necessary to work with and serve diverse individuals and groups. Three Fundamental Components Cultural Competence is a composite of cultural intelligence, cultural transformation, and cross-cultural skills: Cultural intelligence is knowledge of others (or their culture) Cultural transformation is a process of experiencing irreversible change with respect to cultural differences Cross-cultural skills are the ability to relate, communicate, and facilitate the delivery of healthcare services across divergently different cultural dimensions Diversity 2004 Hear It! Feel It! Live It!

4 4 Culture Culture refers to the beliefs, values, ethics, etc. that control and influence the behaviors of an individual or a group. One s personal culture (or worldview) continually changes as a result of experience and learning Culture and language are inseparable Culture creates unspoken/unwritten boundaries for acceptable and unacceptable behaviors The presently existing culture creates the observable practices, policies, and results we observe The organizational culture is imbedded in the minds of the people who make decisions and policies for others to follow, behaviorally Cultural transformation requires the irreversible change of presently existing unconscious belief structures held by leadership Culturally Competent Organization A culturally competent organization consists of culturally competent employees operating within a culturally inclusive environment.

5 5 Cultural Intelligence Holistic Dimensions of Cultural Competence The diagram below represents the holistic nature of cultural competence. It is important to realize that all three dimensions are simultaneously experienced. Organizational (race, gender, culture, background, position, religion, traditions, etc.) Polychronic/Monochronic (unstructured/structured) High Context/Low Context (implicit/explicit) High/Low Context values or assumptions are considered to be truths Polychronic/Monochronic values or assumptions are more flexible and change, in form, over time Organizational dimensions that result in misunderstanding and conflict have their genesis in the cultural values and assumptions from high/low context and polychronic/monochronic dimensions.

6 6 High Context/Low Context Cultures Context defines the nature of transactions of a group either implicit or explicit interactions. High Context is implicit; the meaning is dominantly non-verbal, e.g., Japanese, Chinese, Vietnamese, etc. Low Context is explicit; the meaning is dominantly what is verbalized or written, e.g., Swiss, English, American, etc. High/Low Context Values High Context Group Consensus Obligation to Others Fate (Karma, Joss, Fates) Cooperation Spirituality Truth comes from Within Low Context Individualism Democracy Personal Freedom Fairness Competition Religion Science Truth

7 7 Cultural High/Low Context Assumptions The following are cultural assumptions that impact healthcare delivery. High Context Cultural Assumptions in Healthcare Illness is due to the will of a higher power, e.g. God Illness is due to a lack of spiritual balance Self-treatment is an inherent part of healing, e.g. prayer, folkhealers, or home remedies Mental, physical, and spiritual are inseparable Touching across gender is unacceptable Male is the ultimate decision maker Spirituality is an inherent part of death and dying Spirit is lost if a person dies in a hospital Society is responsible for healthcare (group) Low Context Cultural Assumptions in Healthcare Mental state has little or nothing to do with the physical ailment (also spiritual) Illness can be explained by medical, scientific model and treated as such Illness is caused by the breakdown of a vulnerable body function Physician knows what is best for the patient; patient believes physician knows best Patients are not medically intelligent Physicians control life or death Individual is responsible for healthcare (individualism)

8 8 Polychronic Culture A polychronic culture is one where several activities occur simultaneously. It involves an unstructured, flexible mode of operation. This way of operating gives rise to Polychronic (unstructured, flexible) Time. (P-Time) Monochronic Culture A monochronic culture is one where one activity occurs at a time (typically to conclusion). It involves a structured, more defined mode of operation. This linear way of operating gives rise to Monochronic (structured, fixed) Time. (M-Time) Polychronic/Monochronic Operation Polychronic Operation P-time is unstructured Preset schedules are flexible People-involvement is maximized People s well-being is of prime importance Profit and productivity are the result of the well-being of employees Monochronic Operation M-time is linear and structured Schedules are precise People have specific functions within a greater whole People s well-being is personal and a non-business issue Profit and productivity are the result of efficiency of operation Polychronic cultures tend to be high context Monochronic cultures tend to be low context

9 9 Cultural Polychronic/Monochronic Assumptions Polychronic Cultural Assumptions Involvement of the extended family is essential Respect for the person is essential Trusting relationship is essential Patient is included in decision making Meditation is important for self-healing Very important to maintain harmony Patient important in the healing process Diet, lifestyle, reduced stress important to wellness Monochronic Cultural Assumptions Homeopathic remedies have little or no impact on healing/ wellness Only values empirical, medical data Physician alone attends the patient Medication is most effective in addressing certain chronic conditions Direct eye contact indicates communication understanding Physician makes the decision Just tell me about the physical ailment, not social conditions You have a right to buy the best healthcare if you have the money

10 10 What s Your Style? Polychronic, Monochronic, a Combination, or No Clue? Execution of your most important work day responsibilities may dominantly occur in a polychronic or monochronic manner depending on your natural style of operation. Check one choice below for each numbered pair that represents your dominant style, even though you may do both on occasions. (Take into account how others would describe you) Polychronic Style Relationship-oriented Do several activities simultaneously Socially expressive Open expression of feelings and emotions Focus on communication, trust, respect People-oriented Informal Indirect Flexible Focused on the process Task-oriented Monochronic Style Do activities in a linear manner Socially reserved Limited expression of feelings and emotions Focus on structure, systems, strategy Individually oriented Formal Direct Fixed Focused on the goal Total Total Quick Debrief: Self-select into teams of two (or three where necessary). Share with your partner(s) that (those) characteristic(s) that is (are) the source of presently existing conflict with someone you work with, someone you have the greatest difficulty managing, or a type of patient you serve.

11 11 What s Your Style? Based upon your score from the previous page, locate where you best fit on the Monochronic/Polychronic scale below: (Use your score in the Polychronic column from the previous page.) Monochronic Polychronic Polychronic Score ; Monos and Polys! Quick Hints for Monochronics 1. Lighten up, chill out, and don t be so rigid. 2. Be flexible and you ll live a longer life. 3. Be more spontaneous and follow your intuition. 4. Learn the magic of teamwork other people can really be fun! 5. Share the credit and rewards with others they ll love you more. Quick Hints for Polychronics 1. You can t be all things to all people give up on saving others or the world. 2. Lighten your load let others be responsible for their own lives. 3. Do fewer things, with more quality your life will be richer. 4. Learn to focus on the vitals to completion. 5. Organize your chaos.

12 12 Cultural Transformation Second-Order Change A person s attitude is determined by what he or she believes, which in turn creates his or her mind-set. A person s mind-set determines his or her behavior. To understand your mind-set, examine the results you produce. Mind-set Attitude Beliefs Behavior Results First-order change Second-order change First- and Second-Order Change* First-order change is characterized by making several behavioral changes where the original problem or situation remains or returns, e.g., diets that don t work, behavioral approach to diversity, time management, no change in core beliefs or values. Second-order change is characterized by transformation of one s attitude, values, or belief structures and results in permanent change of one s mindset, e.g., mid-life career change, personal or organizational transformation, acceptance of others with fundamentally different values. * Bateson, Gregory. Mind and Nature: A Necessary Unity. New York: Dutton, Berquist, William. The Modern Organization: Mastering the Art of Irreversible Change. San Francisco: Jossey-Bass, 1993.

13 13 The Characteristics of First-Order Change First-Order Change Adjustments within the existing structure Doing more or less of something, with no difference made Reversible change Restoration of balance (homeostasis) Non-transformational New learning is not required The more things change, the more they stay the same The Characteristics of Second-Order Change Second-Order Change New way of seeing things (resulting from an Aha!) Fundamental shift in thinking and experiencing Irreversible change Often begins with the counterculture Personal transformation Requires openness to new learning Doing the same things creates a different result

14 14 Personal Transformation Exercise Second-Order Change Complete the following exercise by responding to the question and statement below. What is the personal characteristic you dislike most about caregivers that deliver inadequate quality healthcare services? e.g., admitting personnel, nurse, physician, service personnel, etc. List three behaviors you experience this individual exhibits that are consistent with the person above:

15 15 The Experience of Humility A Paired Exercise That which we do not want others to see or admit about ourselves That which we dislike in others is a mirror reflection of ourselves. 7 { Hidden Visible } Side Side 6 That which we want others to see and believe about ourselves Questions for Reflection, Introspection, and In-depth Sharing: 1. Do you believe the characteristic you described on the previous page is also true about you? Yes No Why? (shared exercise) 2. Have there been times in your life when you behaved consistent with each of the descriptions on the previous page? Yes No Explain (shared exercise) 3. If the behaviors you wrote on the previous page were true about you, what do you perceive the consequences to you would be? What type of person would you perceive yourself to be? (shared exercise) Rite of Passage Personal transformation involves engagement, introspection, inner confrontation, and transformation which results in humility. Humility is the experience of equality William A. Guillory Spirituality in the Workplace

16 16 Cross-Cultural Relationship / Communication Styles (Circle even numbers only) In terms of Time, I tend to be Punctual Flexible With respect to Relationship, I tend to be Formal In terms of Feelings and Emotions, I tend to be Reserved When interacting with others, I am more comfortable with physical Distance Informal Highly expressive Closeness My Communication Style is Least verbal My personal preference is to work Alone Problem Solving is most effective when Processes change In general, major Life Events are controlled by People My comfort level with very different people or different cultures is Very low True learning comes from Being taught Add only the number you circled for each pair and enter your total Highly verbal With others People change Fate Very high Experience Total

17 17 Interpretation of Scores: If your score is 0 25, you are highly task-oriented. If your score is 26 50, you are moderately task-oriented. If your score is 51 75, you are moderately relationship-oriented. If your score is , you are highly relationship-oriented. Task-oriented people tend to be (left-brain): logical focused linear detailed on-task formal individually-oriented direct goal-oriented conservative with respect to differences and change focused on getting things done Relationship-oriented people tend to be (right-brain): intuitive flexible non-linear verbal team-oriented consensus decisionmaking people-oriented indirect open to differences open to change informal trusting

18 18 Guidelines for Workplace Behaviors in a Multicultural Environment 1. Be aware of your relationship/communication style and avoid using it for preferential inclusion and/or exclusion. 2. Use cross-cultural conflict as a vehicle for continuous personal learning as a means of resolving ethnocentrism. 3. Listen for key words to determine the relationship/communication style of others a humanistic or performance oriented context. Relationship orientation trust, caring, and respect Task-orientation time, cost, and strategy Both are vital for business/organizational success. 4. Learn to view the two orientations as a spectrum of choices (become holistic), depending on the situation: Task- Orientation Relationship- Orientation 9 Left Brain Right Brain 9 5. Learn to be open and non-judgemental to those who are opposite in style by using three nuggets of wisdom. Nugget 1 Humility (as opposed to arrogance) Nugget 2 Openness to learn (rather than teach) Nugget 3 Willingness to change (as opposed to changing others) 6. Be authentic align your words, emotions, and behaviors in concert with your conscious and unconscious intentions; measured by the results you produce.

19 19 Guidelines for Workplace Behaviors in a Multicultural Environment continued Levels of Communication Behavioral (verbal or non-verbal) Emotional (non-verbal) Subliminal (non-verbal) Behavioral communication is what is stated or implied non-verbally. It is direct, not emotional or subliminal, e.g., speaking, touching, gestures, body language, etc. Emotional communication is determined by how we experience each other. It is an expression of our emotional state, e.g., enthusiasm, joy, neutrality, anger, or fear. Behavior and emotion are obviously coupled. Subliminal communication is based on what we believe and value. It is often an expression of what we truly intend to happen. Communication is an expression of intent. Realizations William A. Guillory, Ph.D.

20 20 Critical Questions for Cultural Competence A Self Evaluation 1) What am I like? Principally, Relationship-oriented Task-oriented 2) How tolerant/accepting am I of divergently different cultures, workstyles, and people? (Select and circle only even numbers below) Least Accepting Highly Accepting 3) How aware am I of how my relationship/communication style affects my co-workers and/or patients? Least Aware Highly Aware 4) How skilled am I at coaching myself and others through conflict resolution (personal transformation) where diversity differences are concerned? Least Skilled Highly Skilled