1. An Important Refresher for Physicians
Cultural
Competence
in Healthcare
Session Topic: Cultural Competence in Healthcare: A Refresher for Physicians
Audience: Physicians
Length: 30 Minutes
Suggested Facilitator Comments: Welcome to Cultural Competence in Healthcare: An Important Refresher for Physicians
(Introduce yourself, including your department and title)
Thank you in advance for your full attention to this important topic. Our presentation will last about 30 minutes. It is designed to give you additional resources and communication tools to help the patients we are here to serve.
Cultural Competence in Healthcare: An Important Refresher for Physicians is described as refresher training because the majority of physicians were introduced to cultural diversity in healthcare during their first year of medical school and every year thereafter, as well as throughout their residency training.
However I want to emphasize, reaching cultural competence is a continual process. Training physicians in the skills of cultural competence must be continuous - that is throughout all years of training and medical practice. Our ability to demonstrate cultural competence in health care continues to increase as a result of the changing demographics in our patient population.
Instructions: Next slide
An Important Refresher for Physicians

2. Session Objectives After this session physicians will be able to:
Define Cultural Competence
Describe why delivering Culturally
Competent Care is important
Understand being Culturally
Competent is a continual process
Use Culturally Competent Practices
in the provision of care
Suggested Facilitator Comments:
State the session objectives:
After this sessions physicians will be able to:
Define Cultural Competence
Describe why delivering Culturally Competent Care is important
Understand being Culturally Competent is a continual process
Use Culturally Competent Practices in the provision of care
Instructions: Next slide

3. Why do we focus on Cultural Competence at Wheaton Franciscan Healthcare?
It is our Mission
“Providing exceptional and compassionate health care service that promotes the dignity and well being of the people we serve.”
Clinical Excellence
Ensure equal and individualized care
is delivered to all patients
Our Patient and Family Experience
Nothing is more important than our
patient’s health and well being
Culturally competent care meets the needs of our culturally diverse patient population!
Important reminder!
Suggested Facilitator Comments:
Why do we focus on Cultural Competence?
We focus on cultural competence at Wheaton Franciscan Healthcare because it is an important part of our Mission which states:
Wheaton Franciscan Healthcare is committed to living out the healing ministry of Jesus by providing exceptional and compassionate health care service that promotes the dignity and well being of the people we serve.
We also have this focus because it ensures that our Clinic Excellence is equal and individualized care is delivered to all patients.
Finally, the goals we have regarding our Patient and Family Experience are achieved. Nothing is more important than the health and well being of our patients.
Instructions: Next slide

4. The next few slides are common words and information to help you learn more about what cultural competence is and why it matters in healthcare and the workplace
Suggested Facilitator Comments:
The next few slides are common words and information to help you learn more about what cultural competence is and why it matters in healthcare and the workplace
Facilitator Instructions: Read and advance to next slide.

5. What is Culture?
It is the learned and shared values of a particular group that:
Guides thinking
Actions
Behaviors
Emotional reactions to daily living
It is the sum of beliefs, practices, habits, likes and dislikes.
It is norms and customs that are learned.
Suggested Facilitator Comments:
What is “Culture?”
Can anyone give me a brief definition of culture?
If not, you don’t have to feel bad. Culture is difficult to describe because it means several different things . We are a society made up of many cultures.
Culture is the learned and shared values of a particular group that:
Guides thinking
Actions
Behaviors
Emotional reactions to daily living
It is the sum of beliefs, practices, habits, likes and dislikes.
It is norms and customs that are learned.
Facilitator Instructions: Read and advance to next slide

6. Culture is central to the Delivery of Healthcare
It influences patients’ healthcare beliefs, practices attitudes toward care, and trust in the system and in the individual providers
Cultural differences affect how health information and healthcare services are received, understood and acted upon.
Suggested Facilitator Comments:
Culture is central to the Delivery of Healthcare. It influences patients’ healthcare beliefs, practices attitudes toward care, and trust in the system and in the individual providers. Cultural differences affect how health information and healthcare services are received, understood and acted upon.
Additional background information:
Health, healing and wellness beliefs: what a person believes to be healthy, the reasons they are sick, the way healing or recovery from sickness can occur and what a person believes to be types of medications – can be tea’s, herbal remedies and prescription medication
Examples of health beliefs include: For some Hispanic/Latino and Asian people the eating of hot or cold foods for certain health conditions may be followed. Pregnancy and labor are “hot” conditions and cold food and drinks are avoided
Perceived: the way a person sees or understands something
Trust and communication: The more a patient trusts his or her healthcare provider the more a patient will talk about his or her health beliefs, ask questions and participate in their own care. – Joint Commission Resources, 2006
*US Department of Health & Human Services/ Office of Minority Health

7. Our Patients Represent Many Cultures
Group
YEAR
WFH–North Market (WI)
St. Joseph, Elmbrook & Wisconsin Heart Hospital
WFH-Central Market (WI)
St. Francis & Franklin & MOSH
WFH-South* Market (WI)
All Saints
WFH-Iowa*
Sartori, Mercy & Covenant
Marianjoy (IL)
Native Hawaiian & American Indian
FY04
FY11
.1%
.2%
.5%
.3%
.4%
.003%
.03%
Asian
FY04
FY11
1.5% 1%
.7%
.5%
.8%
.3%
Latino/ Hispanic
FY04
FY11
2.7% 2%
12%
11%
25% SFH 8%
10%
1.6%
.6%
2.6% 3%
African American/ Black
FY04
FY11
27%
24%
62% SJH 7% 5%
11%
16% 4% 3%
1.4%
3.3%
White/ Caucasian
FY04
FY11
67%
71%
21% SJH
75%
79%
61% SFH
93%
94%
89%
84%
Suggested Facilitator Comments:
Patients visiting Wheaton Franciscan Healthcare facilities represent many different cultures.
This slide compares the patient population seen in 2004 to those seen in 2011.
Let’s look at the demographic of our patients within a seven year time span.
Instructions: Continue to click mouse to advance chart. Spend time analyzing data and advance to next slide.
Facilitator Instructions: Read and advance to next slide.

8. Our Patients Represent Many Religions and Languages
Apostolic
Church of God
Greek Orthodox
Methodist
Baptist
Congregational
Hindu, Hmong
Mormon
Buddhist
Eastern Orthodox
Jehovah’s Witness
Muslim/Islam
Catholic
Episcopal
Jewish,
Pentecostal
Christian Science
Evangelical
Lutheran
Presbyterian
Languages
Arabic
Farsi
Japanese
Serbian
Bosnian
French
Laotian
Sign language
Chinese
Greek
Polish
Spanish
Danish
Hebrew
Punjabi
Somali Bantu
English
Italian
Russian
Vietnamese
IOWA Patient data is in bold
Suggested Facilitator Comments:
Let’s look at our patient demographics in terms of their religious faith and the variety of languages they speak.
Instructions: Continue to click mouse to advance chart. Spend time analyzing data and advance to next slide.
Facilitator Instructions: Read and advance to next slide.

9. What is Cultural Competence?
Cultural competence is the ongoing capacity of healthcare systems, organizations and professionals to provide for diverse patient* populations high quality care that is safe, patient- and family- centered, evidence-based, and equitable
The National Quality Forum
Facilitator Instructions: Read and advance to next slide.
* The term “patient” refers to the individual recipient of care – i.e. patient, client, legal surrogate or person.

10. Cultural Competence in Health Care
Primary concerns:
Eliminate misunderstandings in diagnosis or in treatment planning that my arise from differences in language or culture
Improve patient adherences with treatments
Eliminate health care disparities
Facilitator Instructions: Read and advance to next slide.

11. Associations We Make What type of person do you think of when
you hear the following descriptions?
Alzheimer’s patient
Black male
Asian man
Welfare recipient
Teenager
Suggested Facilitator Comments:
When you look at the descriptive words on this slide, what type of person, personality, characteristics or cultural traits do you imagine?
What type of patient to you think you will encounter if you were told you would be seeing an Alzheimer’s patient, Black male, Asian man, Welfare recipient or a Teenager?
Instructions: If time permits, wait for one or two responses.
Facilitator Comments:
The images that come to mind are certainly expected, whether positive or negative. Your thoughts are based on your past experiences with individuals from the cultures listed on the slide. They may also be the result of unintentional biases or perceptions we ALL have as a result of our lack of exposure and interpersonal skill when interacting to other cultures.
Instructions: Next slide

12. Associations We Make The people shown below fit into the descriptions
reviewed on the previous slide
Alzheimer’s victim
Black male
Asian man
Welfare recipient
Teenager
President Ronald Reagan
Dr. Ben Carson
Jackie Chan
JK Rowling
Justin Beiber
Suggested Facilitator Comments:
As I forward this slide, would you be surprised to learn:
President Ronald Regan, was an Alzheimer’s patient. Also, we know he was the 40th President of the United States, serving from 1981 to Prior to that, he was the 33rd Governor of California from 1967 to 1975 and a radio, film and television actor.
Dr. Ben Carson, a Black male, is a full professor of neurosurgery, oncology, plastic surgery, and pediatrics at the Johns Hopkins School of Medicine, and he has directed pediatric neurosurgery at the Johns Hopkins Children’s Center for over a quarter of a century. He also performed the first separation of craniopagus (Siamese) twins joined at the back of the head in 1987, the first completely successful separation of type-2 vertical craniopagus twins in 1997 in South Africa, and the first successful placement of an intrauterine shunt for a hydrocephalic twin.
Many of us have also seen Jackie Chan, Asian man, in movies such as Rush Hour, I, II and III where he performed his own stunts fighting off criminal and villains. He’s not the image of an Asian man that may have come to mind.
What do you think of welfare recipient, JK Rowling, who earned approximately $480 million in three years after writing the first three books in the Harry Potter series. This does not include the additional millions she earned for her next three books or the movie deals that followed.
And there is Justin Bieber, teenager, who became famous after recording himself on YouTube. He was awarded Artist of the Year at the 2010 American Music Awards — and has been nominated for numerous awards, including Best New Artist and Best Pop Vocal Album at the 53rd Grammy Awards.
Instructions: Next slide.

13. Associations We Make
When we initially hear the profile of a patient, we all make associations and assumptions based on our past experience. We have a perception of the person before we ever meet them.
Our patients make the same associations when they meet us.
This can be described as a component of transference and counter-transference.
Facilitator Instructions: Read and advance to next slide.

14. Transference
Transference occurs when the physicians or patients transfer past emotions, beliefs or experiences to the present situation.
The feelings can be positive or negative Counter-transference, but are ALWAYS a distortion of realty.
Transference is an unconscious process. When transference occurs around cultural issues, it becomes a serious barrier that keeps the patient from being receptive to medical advice and treatment.
It is up to us as Culturally Competent Providers to maintain and convey unconditional positive regard for our patients
Suggested Facilitator Comments:
Facilitator Instructions: Read slide and share your own experience. This should be a situation you have personally experienced or an observation you have made.
Read and advance to next slide.
The American Journal of Psychiatry, VOL. 157, No. 9

15. Cultural Competence is a Continuum
Gaining cultural competence is an ongoing PROCESS. It is developed as cultural knowledge increases
In order to achieve higher levels of competence, it is helpful to engage in self assessment
Self assessment provides
direction for improvement
SKILLS
ATTITUDES
Facilitator Instructions: Share what you do to continue your own development and learning about other cultures.
Read and advance to next slide.
KNOWLEDGE
The Center for Public Health Education

16. Cultural Competence is a Continuum
Moving From Basic Knowledge to Clinical Practice
KNOWLEDGE
ATTITUDES
SKILLS
Understanding the meaning of culture and its importance to healthcare
Having respect for variations in cultural norms
Eliciting patients’ explanatory models of illness
Suggested Facilitator Comments:
Several different models have been proposed to describe cultural competence in health care. Nearly all of them include dimensions of:
Knowledge -understanding the meaning of culture and its importance to healthcare delivery
Attitudes -having respect for variations in cultural norms), and most of all
Skills (our main focus today). Eliciting the patient’s explanatory model of his/her illness. The Explanatory Model, developed by Arthur Kleinman (1978), provides a series of questions to ask at illness presentation in individuals of different backgrounds.
The arrows on the right and left-hand side of the slide are a reminder that skill development must continue. This is necessary because a physician can become proficient in one cultural dimension, however, he may still be lacking in another. For example, he may become very skilled at interacting with an African American female. However, he may not be as skilled in interacting with a Hispanic male with limited English proficiency, or an Asian male who wants to depend on his faith and herbal remedies instead of the recommendations of a physician.
Facilitator Instructions: Read and advance to next slide.
Physicians must continue skill development
to learn each culture
Journal of the Nation Medical Association, Nov. 2008

17. Eliciting Patient’s Explanatory Model of Illness
Role of the Physician . .
Asking questions to elicit the patient’s understanding of their illness
Having strategies for identifying and bridging the different communication styles
Having skills for assessing decision-making preferences and the role of family
Suggested Facilitator Comments:
The Explanatory Model, developed by Arthur Kleinman (1978), provides a series of questions to ask at illness presentation in individuals of different backgrounds.
Let’s revisit the Explanatory Model . . .
Facilitator Instructions: Read and advance to next slide.
Journal of the Nation Medical Association, Nov. 2008

18. Eliciting Patient’s Explanatory Model of Illness
Utilizing techniques for ascertaining the patient’s perception of using biomedicine and his or her use of complementary and alternative medicine
Having tools for recognizing sexuality and gender issues
Having communication strategies for negotiating
Methods for bringing to bear an awareness of issues of mistrust and prejudices and of the impact of race and ethnicity on clinical decision-making
Facilitator Instructions: Share your own experience. This can be a situation you have personally experienced or an observation you have made.
Read and advance to next slide.
Journal of the Nation Medical Association, Nov. 2008

19. The Culturally Competent Physician
Knows competency involves a deeper commitment to the people for whom we provide services
Recognizes and learns to work within the context of different languages, customs, worldviews, religions, spiritual views, health beliefs, gender roles, sexuality and family relationships when interacting with clients/patients
Develops specific practice skills
Suggested Facilitator Comments:
Let’s describe some of the behaviors demonstrated by a culturally competent physician. This slide provides us with some examples.
The next two slides give examples of specific practice skills for the competent physician.
Facilitator Instructions: Read and advance to next slide.
The Center for Public Health Education

20. The Culturally Competent Physician
Practice Skills
Has an awareness and acceptance of difference whereby diversity is valued
Understands how his own culture influences how he thinks, acts and delivers services
Understands the dynamics of difference and is conscious of those dynamics inherent when cultures interact
Facilitator Instructions: Read and advance to next slide.
The Center for Public Health Education

21. The Culturally Competent Physician
Becomes familiar with the different aspects of various cultures in target areas where service is provided
Has the ability to adapt practice skills that fit the cultural context of the patient/client
Facilitator Instructions: Read and advance to next slide.
Physicians must continue skill development
to learn each culture
The Center for Public Health Education

22. Why is this important for Physicians?
At Wheaton Franciscan Healthcare, we recognize our patients as individuals with unique physical, emotional, spiritual, and cultural needs. As a compassionate, faith-based health care provider, we believe developing a positive relationship with our patients and families is essential to the healing process and key to carrying out our Mission of providing exceptional and compassionate health care service.
Facilitator Instructions: Read and advance to next slide.

23. The Goal of Each Physician
To always provide culturally competent health care services that are respectful of
and responsive to the health beliefs, practices, cultural and linguistic needs
of our diverse patients
Facilitator Instructions: Read and advance to next slide.

24. Additional Resources
Please click on the picture for a quick reference on delivery culturally competent care. There are also CME credits: “A Physician's Practical Guide to Culturally Competent Care” at .
Suggested Facilitator Comments:
A new resource is available for physicians to increase their cultural competency. It is a tool provided by the United States Department of Health and Human Services (HHS), the Office of Minority Health.
It is a website called The Physician’s Guide to Culturally Competent Care.
We have also developed an in-house resource to assist you. It is an easy-to-read document entitled CULTURAL COMPETENCE AWARENESS
CONTINUING EDUCATION FOR PHYSICIANS. We have illustrated how Patient-Centered Care and Cultural Competency intersect and how both are necessary to provide the best possible care to our patients.
Facilitator Instructions: Click on the document to enlarge it. It is hyperlinked. After viewing the document, press Esc to escape. Afterwards, click on the link to go to the website provided by the US. Dept. of Health and Human Services.
Briefly review the document and the website to demonstrate how to access both.

25. Diversity & Inclusion Contacts
Theresa Jones
Vice President of Diversity and Inclusion Strategies
Leslie Galloway Sherard
Director, Diversity and Inclusion Programs
Sandy Jones
Manager, Cultural Diversity
Facilitator Instructions: Read the names of the contacts from the Diversity and Inclusions Strategy team.
Encourage participants to use the resources introduced during the session.
Thank the participants for being engaged and attentive.
End of session.