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

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

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

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.

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

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

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.

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.

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.

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.

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

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 1989. 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.

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.

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

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

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

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

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

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

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

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

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.

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.

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 https://cccm.thinkculturalhealth.hhs.gov . 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.

Diversity & Inclusion Contacts Theresa Jones Vice President of Diversity and Inclusion Strategies Theresa.Jones@wfhc.org 414-465-3433 Leslie Galloway Sherard Director, Diversity and Inclusion Programs Leslie.gallowaysherard@wfhc.org 414-465-3504 Sandy Jones Manager, Cultural Diversity Sandy.jones@wfhc.org 414-465-3005 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.