1. The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a This material (comp2_unit1a) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015.

2. An Overview of the Culture of Healthcare Learning Objectives 2 Distinguish between disease and illness (Lecture a) Discuss the relationship between health and the healthcare system (Lecture a, b) Define 'culture' in the classic sense, as well as in the modern sense of the term, and what it means for culture to be partial, plural, and relative (Lecture a, b) Explain the concept of 'cultural competence’ (Lecture a) Explain the concepts and distinguish between 'culture', 'cultural safety', and 'safety culture', as applied to organizations (Lecture a) Be aware of the multiple cultures that interact in healthcare delivery (Lecture a, b) Define 'acculturation' and how it relates to working in healthcare settings (Lecture a) Be able to give examples of health informatics applications of the study of culture (Lecture a, b) Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a

3. The Culture of Healthcare 3 This lecture: What is meant by the word “culture” when we talk about healthcare and healthcare professionals? Next lecture: Why is this important? What can we learn from it? Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a

4. Defining Terms: Health 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a Health, Illness, Disease (Kleinman, 1978) Health as Artifact – something produced through culture (Bateson, 1989) Acute Illness: temporary interruption of health –Goal: restore complete health –examples: common cold, simple fracture Chronic illness: stable disability or symptoms –Goals: minimize symptoms, maximize function –examples: diabetes, asthma, back pain

5. Defining Terms: Healthcare 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a Health is a product of broad social and environmental factors, not just healthcare –Food, sanitation, housing Healthcare: actions principally and explicitly directed at maintaining or restoring health –Actions by patient, family, etc. (70-90%) –Actions by healthcare system Healthcare System – collection of structures and actions directed delivering healthcare

6. Infectious Disease Deaths Controlled With Broad Social Improvements: Food, Housing, Sanitation 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a 2.1 Chart (Health Sentinel, n.d.) Used with Permission.

7. Chronic Care Model Coordinates Community Resources with Health System to Enable Interaction Between Team and Patient 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a 2.2 Figure (Wagner, 1998) Used with Permission.

8. Defining Terms: Culture 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a “Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.” (US HHS Office of Minority Health, 2005)

9. Defining Terms: Culture 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a “A collective expression for all behavior patterns acquired and socially transmitted through symbols. Culture includes customs, traditions, and language.” (National Library of Medicine MeSH, 2011)

10. Defining Terms: Culture of Healthcare 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a Patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of the healthcare system. (US HHS Office of Minority Health, 2005) Behavior patterns in the healthcare system acquired and socially transmitted, including customs, traditions, and language. (National Library of Medicine MeSH, 2011)

11. The Language, Behaviors, Traditions, Customs We Observe in the Healthcare System 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a (Gorman, n.d.) Used with Permission.

12. Culture of Healthcare Main Themes in Current Literature 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a Patient diversity: caring for people from diverse backgrounds: national, ethnic, racial, religious Workplace diversity: working with people from diverse backgrounds: national, ethnic, religious Organizations and culture: safety culture, organizational culture, measuring culture Health professional culture: nurses and physicians, medical and surgical, traditional and alternative

13. Culture of Patients 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a Impact of patient’s culture: inequities in care Language, Concepts, Models of Illness Cultural Competence, culturally sensitive care Specific cultures and our healthcare system Geographic: SE Asian, African-American Religious: Hmong, Islam Language: Spanish, Telugu, Ethnic: Romany Special Groups: deaf culture, street culture, adolescent culture

14. Cultural Competence Awareness and respect for cultural differences Issue specific not culture specific avoid stereotypes Approach every person as an individual Examples Traditional beliefs re: transfusion, vaccines Modesty issues in physical examination Application to HIT workforce Assumptions built into HIT Stereotypes about HIT interest or proficiency of health professionals. 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a

15. Culture of Healthcare Workforce Cultural diversity in workgroups, e.g. within a nursing unit Physician gender, race, ethnicity International Medical Graduates Impact or role of health professional culture on patient care “Just Culture” 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a

16. Just Culture Blame Culture organizational rigidity emphasis on compliance with existing practices Unintentionally evolves from –rigid, rule oriented –focus on individual blame for system failure Fear of punishment Risk avoidance Distrust Silence the predominant response to error, near misses 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a Just Culture organizational learning culture members believe they can question existing practices, etc. management openness to worker input overall commitment to quality uninhibited reporting of problems extensive information sharing about problems organizational response to f/u e.g. staff training, etc.

17. Organizational Culture Desirable properties in organizations –Culture of Innovation –Culture of health (employee wellness) –Culture of privacy –Culture of cost effective care Safety Culture –organizational correlates of safety Measurement of Culture Culture change 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a

18. Features of Safety Culture Safety culture is a concept defined at the group level or higher, which refers to the shared values among all the group or organization members. Safety culture is concerned with formal safety issues in an organization, and closely related to, but not restricted to, the management and supervisory systems. Safety culture emphasizes the contribution from everyone at every level of an organization. The safety culture of an organization has an impact on its members’ behavior at work. Safety culture is usually reflected in the contingency between reward systems and safety performance. Safety culture is reflected in an organization’s willingness to develop and learn from errors, incidents, and accidents. Safety culture is relatively enduring, stable and resistant to change. 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a

19. What Works? A Climate of Safety A system. Many elements, working together: 1.Management Commitment 2.Safety Practices and Behaviors 3.Safety Knowledge and Training 4.Safety Communication 5.Safety Equipment and Supplies 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a

20. Health Professional Culture Western biomedicine compared to alternatives –Allopathic Medicine, Osteopathic Medicine –Complementary and alternative medicine Chinese medicine and acupuncture traditions Naturopathic and homeopathic Nursing culture, physician culture –nursing as a holistic, caring profession –physicians as disease focused, benign paternalism, autonomy, Surgery, Medicine, ICU, OR, ER cultures 20 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a

21. Other Professional Cultures in Healthcare Settings Management, business culture Customers IT culture Users Librarian Patrons Counselors Clients Doctors Patients 21 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a

22. Observations Most literature is about 'other' cultures –the culture you don't notice is your own Many resources about culture, cultures on web What is acculturation? US person in another country; immigrant in US IT professional in health system; health professional in IT 22 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a

23. An Overview of the Culture of Healthcare Summary – Lecture a 23 ‘Culture’ has many meanings that are relevant to healthcare and health IT healthcare takes place in a complex mix of cultures: professional, organizational, etc. Culture is not apparent from within – taken for granted We work more effectively when we are aware of the differences – cultural competence applied to health/IT/ as well as to management/patients One job of informatics professionals is to bridge these cultures and translate across boundaries Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a

24. An Overview of the Culture of Healthcare References – Lecture a 24 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare An Overview of the Culture of Healthcare Lecture a References Bateson, M. C. (1989, November). Health as artifact. Journal of Professional Nursing, 5(6), 322-325. Culture - 2011 MeSH Descriptor Data. (2011). Retrieved December 14, 2011, from National Library of Medicine - Medical Subject Headings website: http://www.nlm.nih.gov/cgi/mesh/2011/MB_cgihttp://www.nlm.nih.gov/cgi/mesh/2011/MB_cgi Kleinman, A., Eisenberg, L., & Good, B. (1978, February 1). Culture, Illness, and Care - Clinical Lessons from Anthropologic and Cross-Cultural Research. Annals of Internal Medicine, 88(2), 251-258. What Is Cultural Competency? (2005, October 19). Retrieved November 20, 2011, from U.S. Department of Health & Human Services website: http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=11http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=11 Charts, Tables, Figures 2.1Chart: http://www.healthsentinel.com/joomla/images/stories/graphs/us-deaths-1900-1965.jpg. (n.d.). Retrieved November 20, 2011, from Health Sentinel website: http://www.healthsentinel.com. Used with Permission.http://www.healthsentinel.com 2.2 Figure: Wagner, E. H. (1998). Chronic disease management: What will it take to improve care for chronic illness? Retrieved from Improving Chronic Illness Care website: http://www.improvingchroniccare.org/change/model/components.html. Used with Permission. http://www.improvingchroniccare.org/change/model/components.html Images Slide 11: Gorman, P. (Photographer). (n.d.). [Untitled images of healthcare professionals], Retreived from author, Used with Permission.