Diversity Issues, Challenges, & Opportunities in Health Care Rani H. Srivastava RN, PhD Deputy Chief, Nursing Practice CAMH Rani_Srivastava@camh.net
Greetings, I am pleased to see that we are different. May we together become greater than the sum of both of us Vulcan Greeting, Star Trek R. Srivastava, February 24, 2010
Overview Issues & Challenges • Nature & Complexity of Cultural Diversity • What gets in the way Opportunities • Principles & Approaches to move forward R. Srivastava, February 24, 2010
Embracing Diversity Embracing diversity in the workplace means a commitment to culturally competent practices that eliminate discrimination and disparity , affirm differences , and actively engage in strategies that draw on the strength of the differences to develop innovative and transformative health strategies that maximize the health, economic and social benefits. RNAO, 2007 R. Srivastava, February 24, 2010
Most people want to embrace diversity, just not sure how to Understanding of diversity needs to shift from a Value Added to an Essential Ingredient R. Srivastava, February 24, 2010
So what gets in our way? • Ethnocentrism • Invisibility – Discrimination and disparities are hard to see , hard to measure , and hard to account for • Fears & Worries – Sense of Inadequacy – Fear of offending / harming others – Desire for political correctness – Fear of looking foolish R. Srivastava, February 24, 2010
Ethnocentrism The tendency to evaluate other groups according to the values and standards of one's own ethnic group, especially with the conviction that one's own ethnic group is superior to the other groups � Little tolerance, respect, understanding for people from “opposing” cultural points of view. � People who see the world differently than they do are seen as being dangerous, misinformed, or less informed and even dangerous R. Srivastava, February 24, 2010
Difference in Worldviews The opposite of a correct statement is a false statement, but the opposite of a profound truth may well be another profound truth Neils Bohr, Nobel prize winning physicist R. Srivastava, February 24, 2010
Some questions to consider … • What difference does difference make? • Which differences matter in which circumstances? Cultural differences are not about right or wrong, true or false, superior or inferior, they are simply about being different. R. Srivastava, February 24, 2010
Dynamics of Difference • Exist in every interaction - the degree[s] of difference may vary • When one culture interacts with the population of another, both may misjudge the other’s actions based on learned expectations. • Each party brings to the relationship unique histories with the other group and the influence of the current political relationship between the two groups. R. Srivastava, February 24, 2010
Dynamics of Difference • Both bring culturally-prescribed patterns of communication, etiquette, and problem solving. Both may bring stereotypes or underlying feeling about serving—or being served by—someone who is “different.” • Although both professionals and clients should be vigilant against misinterpretation and mis-judgment, look to see who is in the position of privilege and dominance. R. Srivastava, February 24, 2010 .
Key Messages from the Literature • Culture matters & plays a significant role in health, illness, care and cure. • Culture of the clinician and the health care system also affects diagnosis, treatment and availability of services. • Leadership matters & plays a significant role in influencing the extent to which diversity initiatives are successful R. Srivastava, February 24, 2010
Why does culture matter? • Culture as Patterns – Differences in worldviews (values, beliefs, assumptions) • Culture as Power – Some worldviews are privileged and others are marginalized - Differences in recognition of needs and issues - Differences in access to resources R. Srivastava, February 24, 2010
What do we mean by culture? • Identity(ies) • Relationships between identities • Layers • Legacies R. Srivastava, February 24, 2010
Cultural Identity s u e t g a t a S u l g a Lifestyle n n S o o a i c s L s i o e f e o c r o P n / o l a m i c i Gender o c S S t a Race t u s Culture Culture ...formed by the unique combination of several Petals! The unique combinations create patterns which reflect the Diversity and Universality of Culture . R. Srivastava, February 24, 2010
Legacies & Layers: Legacies: Events and traditions experienced by our ancestors that continue to have a ripple effect in our lives / practice today. Layers: Various dimensions of our identity and experiences that shape perception and behavior R. Srivastava, February 24, 2010
Each person is to some extent like • ALL other persons • Some other persons • No other person R. Srivastava, February 24, 2010
Culture is multi-level… Culture is an aggregate construct which is a reflection of /consists of: • Multiple identities at an individual level • Actions and Interactions at a group level • Assumptions / policies / politics at an organizational or systems level R. Srivastava, February 24, 2010
Levels of Cultural Competence Individual (Micro) TEAM (MESO) TEAM PROCESSES CULTURE Organizational (Macro) LHIN Critical to Focus on the Meso / Middle level R. Srivastava, February 24, 2010
What is the roadmap for change? • No roadmap • Principles and approaches • Chart a course: – Set Goals – Measure Progress – Look out for intended and unintended effects • Take Action & Monitor – Promising practices – Measure (Quantitative & Qualitative), share, reflect R. Srivastava, February 24, 2010
Key Values for Embracing Diversity • Inclusivity • Respect • Valuing differences • Equity • Commitment R. Srivastava, February 24, 2010
What are the motivators? • Mission - this is what we are about • Meeting the needs of patients - patient satisfaction • Quality and safety issue • Supporting our staff • Market niche – provider of choice • Good business sense • Requirement for …??? • Is there a need for standards? R. Srivastava, February 24, 2010
Where is the evidence? • Inconsistent but considerable… • RNAO Guidelines on Embracing Diversity: Developing Cultural Competence (2007) www.rnao.org • Hospitals, Language, and Culture: A Snapshot of the Nation Exploring Cultural and Linguistic Services in the Nation’s Hospitals (Joint Commission / California Endowment, 2007) One Size Does Not Fit All. www.jointcommission.org www.jointcommission.org R. Srivastava, February 24, 2010
Where is the evidence? • Evidence that culture matters with respect to health disparities • Negative evidence – lack of cultural competence leads to threats to patient safety / health disparities; legislative non- compliance; exposure to risk /liability • Challenges in measurement make it difficult to gather evidence • Lack of evidence does not equal ineffectiveness R. Srivastava, February 24, 2010
Approaches & Promising Practices R. Srivastava, February 24, 2010
Culture Care Framework Srivastava, 2007 Culture Culture Knowledge Sensitivity Culture Resources R. Srivastava, February 24, 2010
Culturally Congruent Care Equity in Health Care Quality & Outcomes R. Srivastava, February 24, 2010
Quadripartite Framework Awareness Knowledge EQUITY Power Skills R. Srivastava, February 24, 2010
Shift from viewing culture as a barrier to culture as a leverage point Clarify links to goal: EQUITY, QUALITY, SAFETY R. Srivastava, February 24, 2010
Seeing beyond … R. Srivastava, February 24, 2010
Systems & Systematic Change • Move beyond acknowledging & celebrating diversity towards meaningful change • Cultural competence is not about adjustment to cultural differences and keeping the system unchanged • Access is not the answer! – Focus on what the underserved populations/groups need NOT what we have to give R. Srivastava, February 24, 2010
Systems & Systematic Change • Education & Training – All levels of health care providers – Focus not just on awareness but also knowledge, skills, and most importantly - APPLICATION • Measure & Monitor (the need for DATA!) • Capacity building - In practice, community, & leadership - Through education, recruitment, mentorship R. Srivastava, February 24, 2010
Be Courageous… • Challenge own thinking and assumptions • Be Vulnerable • Create Safe spaces for dialogue • Take Risks … Be prepared for mistakes • Have difficult conversations • Commitment is critical – not doing it is not an option! R. Srivastava, February 24, 2010
Each one of us must be the Each one of us must be the change we want to see in the change we want to see in the world world Gandhi Gandhi R. Srivastava, February 24, 2010
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