1. MODULE 2
Marie

2. Learning Objectives
Apply models of effective cross cultural provider-patient communication to open and build a relationship
Gain skills to elicit specific information from a patient about his/her cultural base
Gain skills to elicit the patient’s explanatory model for his or her illness
Know when and how to utilize language interpreters and patient navigators

3. Format Questions to ponder Watch first video Share observations
Introduce new concepts and tools
Watch second video
Make comparisons

4. Every Encounter is Cross Cultural
Hispanic/Latino Culture
Healthcare Culture

5. Experiences with other cultures Ethnicity/ Family of Origin
Personal Culture
Medical Education
Experiences with other cultures
Education, socio-economic
Language
Age, gender, family position
Ethnicity/ Family of Origin

6. Personal Experiences
Limited?
Positive?
Negative?

7. Expectations of Workplace
Healthcare Culture
Time Constraints
Expectations of Workplace
Hierarchy in Workplace
Specialty Education and Language
Health Profession Education

8. Clinical Cultural Constraints
Insurance billing
10 minute appointments
Shift change
Long hours
Patient load expectations
Decreased staffing

9. Cross Cultural Encounters
Hispanic/Latino Culture
Healthcare Culture

10. Attitudes
Process not Product
Cultural Humility

11. Potential Cultural Themes?
Family Centered
Relationship Based
Mutual Respect

12. Provider: Purpose of Encounter
Information to give
Tests to order

13. Opening the encounter
Time
Respeto
Greeting
Eye contact

14. Giving Information Information for motivation
Information within relationship

15. Hearing Information Spoken language Non verbal
Accuracy of interpretation

16. Patient Engagement? Time constraints
Understanding his language vs. understanding the concepts
Is she engaged in the process?

17. Verbal and Non-verbal
Interpreter
Respeto
Questions

18. What can we learn? Purpose of the encounter Give information Received?
Refer to tests
Follow through?

19. Two Experts You are the expert on the disease.
Your patient is the expert on how she experiences the illness.

20. Clear Definitions
Disease
Illness

21. Beyond Assumptions Gain background about the culture
Learn which cultural values ARE held by individuals
Learn which experiences HAVE influenced

22. Personalismo: Relationship Centered
The shortest distance between 2 points?
Not always a straight line
Take time up front
Establish a relationship.

23. The Patient’s Understanding
Waste time or save time ?
Knowing how her illness affects her sets a baseline
Learn her truth

24. Differences Can Offer Richness
Need not hinder or complicate
Can support and provide richness to medical encounters

25. Introduce Video: Cultural Inclusion
Notice differences between the encounters
Are the 2 purposes accomplished?
Giving Information
Getting started with tests
Knowledge
Skills
Attitudes

26. Debrief Encounter with Cultural Inclusion

27. Respeto and Dignidad Introductions Verbal and non verbal Formal title
Handshake
Eye contact
Familismo
Welcomes daughter
Mutual respect
Dignity
See section 0:00 to 0:18 of the video “Dr.’s Office Culturally Appropriate” in the Module 2 Playlist

28. Goal: Understanding Respeto Nod, be attentive Cooperative
Speaking the same language doesn’t guarantee understanding
But speaking different languages assures confusion!

29. Use Interpreters Ask! Translate: Written Interpret: Spoken
Watch assumptions---A person:
may speak, not read
may be Latino, speak English
may have regional dialect
may be quite intelligent
Ask!

30. Legal Rights
Title VI of the Civil Rights Act of 1964 states that all federally funded service providers ensure adequate Language Access Services (LAS).
Health care organizations must offer and provide language assistive services,
including bilingual staff and interpreter services,
at no cost to each patient/consumer with limited English proficiency
at all points of contact,
in a timely manner
during all hours of operation.

31. Not Family or Friends Disadvantages: Possible mistakes
Change the meaning
Soften the news
No confidentiality

32. How to Use Interpreters
Both patient and provider will have better experiences when they are understood
Youtube video

33. Palliative Care Interpreters
New concepts
Lack of life experience
Find bilingual and bicultural interpreters
Develop a working relationship

34. Confianza Recognize that patients may be cautious
Relationships based on trust
Based on confidence that someone has your best interest in mind
Recognize that patients may be cautious
See this as a positive trait
Allow time
Be dependable
Be real

35. Traditional and Acculturation
Time in this country
Ethnic identity
Age
Gender
Acculturation—level of US culture that is adopted

36. Eliciting Her Understanding
Key skill for cross cultural communication
Relationship centered
Conversation instead of Q and A
Listen to the patient’s story
Listen about her medical condition
Listen about her life and culture

37. Fatalismo Empathy without platitudes Fatalismo: What will be, will be
fate or God’s will cannot be changed
Medical: Heal and cure
Empathy without platitudes

38. Redefine Non-compliance
Provider’s vantage point
Lost time
Desire to heal
Lost money
Use of ER

39. Behind “Non-compliance”
Cultural difference
Misunderstanding
Spoken
Written
No agreement
Family disagreement
Fatalism or Spiritual beliefs
Experience with medical system
Communication
Awareness
Genuine curiosity
Delve deeper

40. Social Determinants and “Non-compliance”
Possible Social Determinants
No time off work
Cannot afford treatment No insurance
No documentation
Immigration status
Survival today vs. focus on future

41. Getting Better Compliance
Continue to listen
Their understanding changes
Relationship of trust
Learn about their expectations
What were you hoping?
What doesn’t seem to be working?
Find out what is behind the lack of compliance

42. Getting Better Compliance
What is it you don’t like about your medication?
Please tell me how/how often/how long you take it.
How do you feel when you take it?
Get specific
Clarify

43. Addressing Social Determinants
Problem-solve social barriers
Ask what might work best
Do you have insurance?
Assist in free or low cost drugs
Can you make daytime appointments?
Miss work
Childcare
Schedule many on same day
What location will work best?
Transportation
Hours

44. As they proceed together
How serious do you think your illness is?
What problems does your illness cause you?
How do you imagine it will proceed?
What kind of treatment do you think you should get?
Are there treatments besides what I offer?
Begin each session with listening.
Talk and listen to all family members.

45. Beyond Q and A “Formal friendliness” Helpfulness Please tell me
Can you tell me
Helpfulness
It is important for me to understand
I would like to know more about
So that I understand

46. Balance talking with listening
Be aware:
Trigger words
English words with double meanings
Euphemisms don’t translate
When you do all the talking

47. Familismo Keep your ultimate goal in sight
Broader than nuclear family
Independence…………interdependence and solidarity
 Decision making
Made within the family unit.
May seem delayed.
Keep your ultimate goal in sight
Talk with other family members
Conferences and sub conferences
Ask who else to inform and how
Get to know the family preferences

48. Without Family Support
Do not assume family support
Can you find solutions to gaps of support?
Patient Navigators
Social Service Support
Financial Support
Ask what would be helpful

49. Keep them engaged
Talk
Listen

50. A lot to take in
Stop and wait
Ask questions

51. Next Session Culturally Appropriate Communication Tools
Working with a Patient Navigator

52. Check Understanding Use yourself (engage cooperation)
Without “parroting”
Use yourself (engage cooperation)
Use family members

53. Utilize Patient Navigators
Benefits both the provider and patient
Bilingual AND Bicultural
Where to find
Hospital social worker
Local Hispanic organization

54. Familismo Importance of Family She is not alone
Will offer emotional support
In future decision-making

55. Meeting Goals with Cultural Sensitivity
Poll: What is your prediction of the outcome of each visit?
What is the Return on Investment of using cultural competence?
FOR THE PATIENT:
More likely follow through
Higher health literacy
Better health outcomes

56. Meeting the Goals with Cultural Competence
What is the Return on Investment of using cultural competence?
FOR THE PROVIDER:
Time now saves time in future
Better level of compliance
Giving best possible care
Better health outcomes
Time pressures can lead to stereotyping
Take time to get information about individuals

57. Summary You are the expert of the disease.
Your patient is the expert of how her illness affects her.
Find out the patient’s understanding.
Use possible cultural elements to connect.
Utilize interpreters and navigators.
Increase health literacy and improve health outcomes by:
Look behind non-compliance
Give information in culturally sensitive ways
Address socio economic barriers
Recognizing cultural strengths enriches the process.