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1 Strategies and Challenges to Integrate Cultural Competence for Providers and Organisations – The British Case Carol Baxter Head of Equality & Diversity.

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Presentation on theme: "1 Strategies and Challenges to Integrate Cultural Competence for Providers and Organisations – The British Case Carol Baxter Head of Equality & Diversity."— Presentation transcript:

1 1 Strategies and Challenges to Integrate Cultural Competence for Providers and Organisations – The British Case Carol Baxter Head of Equality & Diversity NHS Employers, UK

2 2 Contents An historical perspective From the margins to the mainstream The emergence of a policy agenda A paradigm shift from goodwill to competence Joining up the agenda Close

3 3 An Historical Perspective Response rate: 76% Number of schools: 176 _____________________________________ Pre-dominance of a cultural model Theory / Practice dichotomy Teacher preparation The role and position of BME staff Survey of Schools of Nursing, 1993

4 4 RESPONSESNO. OF INSTITUTIONS % Culture and health8793.3 Specific client groups6461.5 Racism and discrimination3028.8 Communication skills2423.0 Racial inequalities in health2221.1 Practical hospital care1514.4 Demography / Migration1413.5 Care in the Community1211.5 Patterns of illness87.7 No. of institutions replying to this question104 Table 1. Subject areas reported by nurse teachers to be covered in teaching on race equality

5 5 Survey of Schools of Nursing, 1993 WORDS WHICH TOGETHER REFLECT A CULTURAL PERSPECTIVE TOTAL FOR ALL DOCUMENTS WORDS WHICH TOGETHER REFLECT AN ANTI-RACIST PERSPECTIVE TOTAL FOR ALL DOCUMENTS Culture / Cultural91Racism12 Special needs88Prejudice10 Ethnic50Multiracial8 Customs16Black4 Spiritual / Religious16Racial4 Multicultural13Discrimination4 Immigrants12Stereotypes3 Habits / Practices10Inequalities3 Taboos5Colour2 Rituals4White1 TOTAL305TOTAL51 Table 2. Content analysis: Implied meaning in documents – word frequency

6 6 Challenging racism and racial stereotypes - when using material which gives cultural information the following questions should first be asked: Who has been involved in compiling the information? Is it written by someone from the community being addressed? Is the material dealing with the culture of: − an entire society? − a particular social class or group? − a particular area of the country? − a small localised group? Is it clear what sections of the population the information refers to? Does the material simply describe patterns of behaviour? − are the patterns described in a way that makes them seem absurd or bizarre? adapted from Mares, Henley & Baxter (1985) Guidelines for Evaluating Information on Cultural Norms

7 7 − does it suggest possible explanations? − does it discuss the underlying reasons for unfamiliar patterns of behaviour? − is it clear whether the patterns described are ideal or actual norms? Does the author make value judgements about the cultural patterns described? eg: does the author’s attitude strike you as positive, neutral or negative? Is culture seen as a fixed state or a dynamic phenomenon? Is this aspect discussed or ignored? Does the information analyse the situation of minority cultural groups in Britain purely in terms of culture and cultural differences? Does it make any reference to important economic and social factors (eg: unemployment and racial discrimination)? What specific new insight have you gained from the information? Has it increased your understanding of the culture described, or created further questions in your mind about aspects you were not previously aware of? Guidelines for Evaluating Information on Cultural Norms

8 8 which generates misinformation and ignorance about these groups of people which become socially sanctioned attitudes, beliefs, feelings and assumptions which become the justification for further mistreatment Systematic mistreatment of people of colour and third world people Racism is one consequence of a self-perpetuating imbalance in economic, political and social power Racism hurts all of us, whether or not we are members of the targeted group Adapted from Ricky Sherouer-Marcuse, Unlearning Racism Workshops, 6501 Dana, Oakland CA 94609, USA Racism

9 9 Racism is part of the culture within British society and individuals within it have been socialised from childhood into this Racism encompasses not only our prejudice but also the power held by white society to translate its prejudices into practices that initiate and perpetuate injustice Both black and white people are hurt by racism but in different ways. In the process of becoming aware of our own racism the pain of that hurt must be made conscious Racism Awareness training is concerned with enabling individuals to explore how racism is part of themselves, the organisations in which they work and in society as a whole Individuals are required by the teacher to take responsibility for their own learning. The teacher thus acts primarily as a facilitator who helps to build a group sense of trust; has an understanding that guilt can block change; and is willing to confront racism and help individuals to make choices about future assumptions and behaviours. Basic Premise and Principles of Racism Awareness Training

10 10 The teacher therefore requires a deep knowledge and understanding of how racism operates, as well as skills as a groups facilitator and sensitivity to group process and individual emotions Racism Awareness does not take place in one-off short workshops. It is part of a broader programme of organisational development towards equality of opportunities in which the overall aim is to confront and change institutional structures and procedures The ultimate value of Racism Awareness training lies in its generation of both individual and group commitment to action for changing racist practices and achieving justice. This is achieved by overcoming emotional blocks that can undermine other initiatives such as Equal Opportunity Programmes or antiracist confrontations Basic Premise and Principles of Racism Awareness Training

11 11 EXAMPLE:MULTIRACIALMULTICULTURAL CAUSES OF INEQUALITIES Largely due to racismLargely due to cultural differences FOCUS OF TRAINING AND DEVELOPMENT Specific issues arising from black / white relations Perception of BME cultures contributing to inequality and disadvantage Lifestyle of various cultural groups 2 PERSPECTIVES: “Multiracial” vs “Multicultural”?

12 12 From Margins to Mainstream LANGUAGE OF OPPRESSIONRESPONSES Discrimination Prejudice Exclusion Power Marginalisation Anti-oppressive practices Anti-racism Anti-sexism Anti… LANGUAGE OF INCLUSIONRESPONSES Engagement Consultation Involvement Rights and responsibilities Genuine choices Valuing diversity

13 13 Competency: “The behaviours that employees must have, or must acquire, to input into a situation in order to achieve high levels of performance” - CIPD Building Cultural Competence Within the Organisation

14 14 “Cultural Competence”: Cultural Awareness: Cultural Knowledge: Cultural Sensitivity: Recognition that others might be different from you Understanding of specific cultural needs Knowing that cultural differences as well as similarities, exist, without assigning values eg. better or worse, right or wrong etc Understanding Organisational Competence

15 15 There is such an entity as cultural competence – which can be acquired It is possible to describe and to provide training to improve the cultural competence of healthcare professionals which will improve the competence of the organisation The employment of ethnic minority healthcare staff (particularly nurses) will improve organisational competence Cultural Competence - Assumptions

16 16 Attitudes / Values: Stereotypes Prejudice Personal racism Institutional racism Knowledge: Demographic and population issues Inequalities in health Specific illnesses Concepts of health and illness Race Equality in Healthcare and Education, Baxter, 1997 Building Cultural Competence Within the Organisation

17 17 Skills: Communication across cultural and language barriers Practical hospital care – physical and spiritual Care in the community Specific client groups Approaches: Change management Policies and strategies Building networks Sharing experiences, good practice and ideas Building Cultural Competence Within the Organisation Race Equality in Healthcare and Education, Baxter, 1997

18 18 Sex Ethnicity Disability Age Sexual Orientation Religion and Belief Human Rights The Emergence of a Policy Agenda

19 19 Sex / Gender Race / Ethnicity Disability Age Sexual Orientation Religion and Belief Human Rights 1970s 1980s1990s2000s employment goods, facilities, services both EPASDA RRA RR(A)A EA DDA EE(A)R EE(SO)R EE(RB)R HRA EA(SO)R EA(RB)R GRA Equality Legislation: Quickening Pace

20 20 Gender Race Disability Age Sexual Orientation Religion and Belief Human Rights EMPLSERVGENERAL DUTY:SPECIFIC DUTIES: Equality Impact Assmts etc Gender Equality Duty Race Equality Duty Disability Equality Duty Race Equality Scheme Disability Equality Scheme Gender Equality Scheme Equality Impact Assmts etc √√ √ √ √ √ √ √ √ √ √ √ √ 2009? Equality Legislation: Equality Duties

21 21 From Goodwill to Competence Promote equality and value diversity Act in ways that support equality and value diversity Develop a culture that promotes equality & diversity Support equality and value diversity NHS KNOWLEDGE AND SKILLS FRAMEWORK CORE DIMENSION 6 Equality & Diversity Core 2 3 4 1 = This is a key aspect of all jobs that everyone does. It underpins all dimensions in the NHS KSF LEVELS:

22 22 Act in ways that support equality and value diversity KSF CORE DIMENSION 6 Equality & Diversity 1 Indicators: The worker: a) acts in accordance with legislation, policies, procedures and good practice b) treats everyone with whom s/he comes into contact with dignity and respect c) acknowledges others’ different perspectives d) recognises that people are different and makes sure they do not discriminate against other people e) recognises and reports behaviour that undermines equality and diversity Examples of application: a) around: age, racial group, disability, gender, human rights, mental health etc b) – e) may include: what they do or say what they do not do or say when interacting with colleagues when interacting with service users when working with the public when working with visitors to the organisation

23 23 KSF CORE DIMENSION 6 Equality & Diversity 2 Indicators: The worker: a) recognises the importance of people’s rights and acts in accordance with legislation, policies and procedures b) Acts in ways that: acknowledge and recognise people’s expressed beliefs, preferences and choices respect diversity value people as individuals c) takes account of own behaviour and its effect on others d) identifies and takes action when our own or others’ behaviour undermines equality and diversity Examples of application: a) around: age, racial group, disability, gender, human rights, mental health etc b) might relate to: food and drink how they like to be addressed and spoken to personal care privacy and dignity the information they are given the support they would like their faith or belief d) would include: recognising when equality and diversity is not being promoted and doing something about it recognising when someone is being discriminated against and doing something about it Support equality and value diversity

24 24 KSF CORE DIMENSION 6 Equality & Diversity 3 Indicators: The worker: a) interprets equality, diversity and rights in accordance with legislation, policies and procedures and relevant standards b) evaluates the extent to which legislation is applied in the culture and environment of own sphere of activity c) identifies patterns of discrimination and takes action to overcome discrimination and promote diversity and equality of opportunity d) enables others to promote equality and diversity and a non-discriminatory culture e) supports people who need assistance in exercising their rights Examples of application: a) around: age, racial group, disability, gender, human rights, mental health etc b) might relate to: communication with different people health, safety and security / risk management quality systems standards and guidelines the allocation of resources the availability of services the development of services c) might relate to: the learning and development offered to different people the recruitment, selection and promotion of staff Promote equality and value diversity

25 25 KSF CORE DIMENSION 6 Equality & Diversity 3 Indicators: The worker: d) enables others to promote equality and diversity and a non-discriminatory culture e) supports people who need assistance in exercising their rights Examples of application: d) might include: acting as a role model being aware of the wellbeing of all members of the work team and supporting them appropriately enabling others to reflect on their behaviour identifying training and development needs e) might relate to: advocacy enabling people to make the best use of their abilities intervening when someone else is discriminating against someone on a one-off basis or routinely making arrangements for support representing people’s views Promote equality and value diversity

26 26 KSF CORE DIMENSION 6 Equality & Diversity 4 Indicators: The worker: a) interprets legislation to inform individuals’ rights and responsibilities b) actively promotes equality and diversity c) identifies and highlights methods and processes to resolve complaints as a consequence of unfair and discriminatory practice d) supports those whose rights have been compromised consistent with legislation policies and procedures and good and best practice Examples of application: a) and d) around: age, racial group, disability, gender, human rights, mental health etc b) would include: acting as a mentor to people from diverse groups acting as a role model actively working in partnership with diverse groups developing and supporting own team in relation to equality and diversity ensuring that development opportunities are available to all staff ensuring the fair recruitment and selection of staff Develop a culture that promotes equality and diversity

27 27 KSF CORE DIMENSION 6 Equality & Diversity 4 Indicators: The worker: e) actively challenges individual and organisational discrimination f) evaluates the effectiveness of equality and diversity policies and procedures within the service / agency and contributes to the development of good and best practice Examples of application: b) would include: focusing resources to deliver equitable outcomes involving the local population in the development of services listening to the experiences and views of different groups and acting on them modelling good practice promoting an open and fair culture throughout the organisation promoting equality and diversity during partnership working Develop a culture that promotes equality and diversity

28 28 NHS Leadership Qualities Framework

29 29 Joining up the Agenda “An environment where all staff feel valued and enjoy a fair and equitable quality of working life, and where different backgrounds, perspectives, knowledge and experiences are welcomed and the benefits that this diversity can bring are actively sought and embraced.” “A service which continuously seeks to improve the quality of healthcare provided to an increasing diversity of patients and clients, through nurturing, supporting and developing its staff.” Vision for the NHS

30 30 Cultural Awareness Policies Procedures Standards Behaviours BY / OF INDIVIDUALSSYSTEMATIZED WITHIN AN ORGANISATION Quality Of Service CULTURE STRATEGY POLICIES & PROCEDURES CLIMATESYSTEMS STRUCTURE Cultural Sensitivity Cultural Knowledge Making cultural competence effective

31 31 LINK TO HUMAN RIGHTS DOMAIN AND STANDARDHOW TO MEASURE eg: THE RIGHT NOT TO BE DISCRIMINATED AGAINST IN RELATION TO ANY OF THE RIGHTS Leadership and Governance Healthcare organisation demonstrates culturally Competent leadership and governance Leadership Being representative of its community Individual and collective knowledge Non-discriminatory decision-making and attention to vulnerable groups Individual and collective responsibility for the organisation’s performance in meeting the needs of minority and vulnerable groups RIGHT TO LIFECommissioning and Procurement Health care organisations will apply Human Rights principles in procuring goods and services Commissioning Involvement and participation of minority and vulnerable groups in the commissioning process The use of up-to-date and reliable population data in the commissioning process The Regulators: UK NHS Healthcare Commission – Draft Strategic Cultural Competence Framework

32 32 CLOSE

33 33 Glossary EA - Equality Act, 2006 EA(RB)R- Equality Act (Religion or Belief) Regulations, 2007 EA(SO)R- Equality Act (Sexual Orientation) Regulations, 2007 DDA- Disability Discrimination Act, 1995 - Disability Discrimination Act, 2005 DED- Disability Equality Duty DES- Disability Equality Scheme EE(A)R - Equality in Employment (Age) Regulations, 2006 EE(RB)R - Equality in Employment (Religion and Belief) Regulations, 2003 EE(SO)R - Equality in Employment (Sexual Orientation) Regulations, 2003 EPA - Equal Pay Act, 1970 GED- Gender Equality Duty GES- Gender Equality Scheme GRA- Gender Recognition Act, 2004 HRA - Human Rights Act, 1998 RED- Race Equality Duty RES- Race Equality Scheme RRA - Race Relations Act, 1976 RR(A)A - Race Relations (Amendment) Act, 2000 SDA- Sex Discrimination Act, 1975 SES- Single Equality Scheme


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