culture, professionalism and the practice of pharmacy
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Culture, Professionalism Culture, Professionalism
and the Practice of and the Practice of
PharmacyPharmacy
Billy FutterBilly FutterRhodes UniversityRhodes University
South AfricaSouth Africa
Key questionsKey questions
1.1. What is Culture?What is Culture?
2.2. How does Culture influence:How does Culture influence:
• Practice of Pharmacy? Practice of Pharmacy?
• Professional status?Professional status?
Communication
3. Professionalism
1. Pharmacy Practice
2. Culture
4. Cultural Competence
Emphasis on Product
1.1. Pharmacy Practice Pharmacy Practice
Emphasis on People
People People
Need medicine Need medicine
PeoplePeople
have have
Medicine-related problemsMedicine-related problems
Pharmaceutical carePharmaceutical care services services
Based on Based on
Relationship of trustRelationship of trust
People are differentPeople are different
But . . .But . . .
See & do things differentlySee & do things differently
How many legs?How many legs?
Old lady?Old lady?Young lady?Young lady?
Need to understand Need to understand
differences differences
between peoplebetween people
So . . .?So . . .?
• Important differences?Important differences?
• Impact on pharmacy practiceImpact on pharmacy practice??
What is Culture?What is Culture?
2. Culture2. Culture
Society has many sub-groupsSociety has many sub-groups
Each has its own cultureEach has its own culture
SocietySociety
2. Culture2. Culture
Society has many sub-groupsSociety has many sub-groups
Each has its own cultureEach has its own culture
Society
2. Culture2. Culture
Society has many sub-groupsSociety has many sub-groups
Each has its own cultureEach has its own culture
Society
Generic?
Generic?
Generic?
Generic?
Generic?
Generic?
Generic?
Society
Generic?
Different cultural groupsDifferent cultural groups
group
group
group
group
group
group
group
Society
Generic group
SocietySociety
Generic
Japanese
Australian
European African
Swedish
American
IndianChinese
Society
GEOGRAPHICGEOGRAPHIC
SocietySociety
Generic
Russian
Italian
French Xhosa
Zulu
English
HindiChinese
Society
LANGUAGELANGUAGE
SocietySociety
Generic
Tao
Jew
SectsAncestor worship
Mormon
Christian
HinduMuslim
Society
RELIGIONRELIGION
SocietySociety
Generic
Male
ElderlyMature adults
Early Adults
Teenagers
Kids
BabiesFemale
Society
AGE and GENDERAGE and GENDER
SocietySociety
Generic
Lower class
Destitute
Poor Middle
Rich
Super rich
Upper classMiddle class
Society
ECONOMICECONOMIC
SocietySociety
Generic
Minority
Minority
Minority Minority
Minority
Minority
MinorityMAJORITYMAJORITY
Society
SIZE and POWERSIZE and POWER
1.1. No generic cultural groups!No generic cultural groups!
2. Each group has its own culture2. Each group has its own culture
people
people
people people
people
people
peoplepeople
SocietyThereforeTherefore
Group CultureGroup Culture
Group Behaviour Group Behaviour
Routine, Predictable Routine, Predictable
Difficult to changeDifficult to change
Prescribed limitsPrescribed limits
people
people
people people
people
people
peoplepeople
Society
Cultural boundariesCultural boundaries
“ “Right way of doing things”Right way of doing things”
B.E.V.A.N.SB.E.V.A.N.S..
people
people
people people
people
people
peoplepeople
Society
Different B.E.V.A.N.SDifferent B.E.V.A.N.S
BBeliefseliefs
EExpectationsxpectations
VValuesalues
AAssumptionsssumptions & & AAttitudesttitudes
NNormsorms
SSymbolsymbols
people
people
people people
people
people
peoplepeople
Society
BBeliefseliefs – – what is right and wrongwhat is right and wrong
EExpectationsxpectations – – what should happenwhat should happen
VValuesalues – – priorities, standardspriorities, standards
AAssumptionsssumptions & & AAttitudes ttitudes – – positive/ negativepositive/ negative
NNorms orms – – traditional way of doing thingstraditional way of doing things
SSymbols ymbols - - group identity, convey meaninggroup identity, convey meaning
people
people
people people
people
people
peoplepeople
SocietyDifferent B.E.V.A.N.SDifferent B.E.V.A.N.S
Cultural SymbolsCultural Symbols
age, gender, age, gender, language, racelanguage, race
Status symbols Status symbols Wheels!Wheels!
Other Status symbolsOther Status symbols
The Five FriendliesThe Five Friendlies
Beibei JingJing Huanhuan Yingying NiniBeibei JingJing Huanhuan Yingying Nini
Fish Panda Olympic Antelope SwallowFish Panda Olympic Antelope Swallow
flameflame
sea forest fire earth skysea forest fire earth sky
Bei jing huan ying niBei jing huan ying ni
Welcome to BeijingWelcome to Beijing
Cultural symbolsCultural symbols
Influence of Culture on BehaviourInfluence of Culture on Behaviour
BBeliefseliefs
EExpectationsxpectations
VValuesalues
AAttitudesttitudes
NNormsorms
SSymbolsymbols
Behaviour
‘BEVANS’
Routine
Patterns
people
people
people people
people
people
people
Society
people
Outcomes
Qualityof life
Quality of service
So:So:How does Culture influenceHow does Culture influence
1. 1. Health behaviour?Health behaviour?
* Patients? * Patients? * Health professionals? * Health professionals?
2. 2. Health outcomesHealth outcomes??
Health Beliefs of different culturesHealth Beliefs of different cultures
Yin yang Yin yang YogaYoga
Tai ChiTai Chi
GymGym
Traditional HealersTraditional Healers
RitualsRituals
ExpectationsExpectations
Queuing for health careQueuing for health care
CareCare
CourageCourage
Respect, FairnessRespect, Fairness
Competition, Equality, InformalityCompetition, Equality, Informality
Values pyramidValues pyramid
CareCare
RespectRespect
Fairness, HonestyFairness, Honesty
Cooperation, Status, FormalityCooperation, Status, Formality
Values pyramidValues pyramid
NormsNorms
Right handRight hand
Greetings Greetings
Responding to Visual cuesResponding to Visual cues
Responding to Visual cuesResponding to Visual cues
OprahOprah
How do you respond to HIV/ AIDSHow do you respond to HIV/ AIDS
LOGO?LOGO? Response to HIV/ AIDSResponse to HIV/ AIDS??
ACTIVISTS?ACTIVISTS?
VICTIMS?VICTIMS?
BBeliefseliefs – – Diagnosis?Diagnosis?Cause of illness?Cause of illness?
StressStress
Yin Yang Yin Yang imbalance imbalance
Lack of Lack of chichi
Hot cold Imbalance Hot cold Imbalance
Punishment for sinsPunishment for sins
Evil spellEvil spell
HereditaryHereditary
EnvironmentEnvironment
Bad habitsBad habits
Old age Old age
Microbe or VirusMicrobe or Virus
How do you respond to Symptoms?How do you respond to Symptoms?
Visit Doctor or Pharmacist Visit Doctor or Pharmacist
Get a prescriptionGet a prescription
Self-medicateSelf-medicate
Vitamins Vitamins
Herbal treatmentsHerbal treatments
Rest and relaxRest and relax
Restore balance Restore balance
Avoid hot / coldAvoid hot / cold
Remove “spell”Remove “spell”
Visit Traditional healersVisit Traditional healers
Consult ancestorsConsult ancestors
Response to Symptoms?Response to Symptoms?
ConclusionsConclusions Culture influencesCulture influences
Signs and SymptomsSigns and Symptoms
– Interpretation Interpretation different different
– Response Response differentdifferent
CommunicationCommunication differentdifferent
Consequences Consequences
Professional adviceProfessional advice
Not soughtNot sought
Not trustedNot trusted
Not followedNot followed
Serious? Serious?
Health outcomesHealth outcomes
Cultural inequalitiesCultural inequalities
Unmet medicine needsUnmet medicine needs
Medicine related problemsMedicine related problems
Serious?Serious?
AccessAccess
Quality of careQuality of care
Quality of lifeQuality of life
3. Implications 3. Implications
Professional Status Professional Status
of pharmacists?of pharmacists?
33.. Professional statusProfessional status
Level of Level of authorityauthority given by society given by society
toto
– make make judgementsjudgements
– give give directionsdirections
Who decides?Who decides?
Society decides the Society decides the rolesroles it needs it needs
Social institutionsSocial institutions give and limit give and limit
authority to practiceauthority to practice
Criteria forCriteria for Professional Status? Professional Status?
CompetentCompetent CommittedCommitted
to satisfy to satisfy needsneeds that are:that are:
Valued
Complex
Personal
Evidence?Evidence?
CompetentCompetent Committed Committed
to satisfy to satisfy needsneeds that are: that are:
Valued
Complex
Personal
Perceptual hazePerceptual haze
Combining criteriaCombining criteria
HiHi
LoLo
Lo HiLo Hi
Competence
Co
mm
itm
ent
Combining criteriaCombining criteria
HiHi
LoLo
ProfessionalProfessional
Lo HiLo Hi
Competence
Co
mm
itm
ent
Combining criteriaCombining criteria
Combining criteriaCombining criteria
HiHi
LoLo
CaregiverCaregiver ProfessionalProfessional
Lo HiLo Hi
Competence
Co
mm
itm
ent
Combining criteriaCombining criteria
Combining criteriaCombining criteria
HiHi
LoLo
Caregiver Professional
Robot
Lo HiLo Hi
Competence
Co
mm
itm
ent
Combining criteriaCombining criteria
Combining criteriaCombining criteria
HiHi
LoLo
CaregiverCaregiver ProfessionalProfessional
Thief RobotRobot
Lo HiLo Hi
Competence
Co
mm
itm
ent
Combining criteriaCombining criteria
Combining criteriaCombining criteria
HiHi
LoLo
CaregiverCaregiver ProfessionalProfessional
Thief RobotRobot
Lo HiLo Hi
Competence
Co
mm
itm
ent
Combining criteriaCombining criteria
ThereforeTherefore
Professional status can be increasedProfessional status can be increased
Show Show evidenceevidence of of
Competence Competence
Commitment Commitment
ThereforeTherefore
Professional status can be increasedProfessional status can be increased
Show Show evidenceevidence of of
Competence – Competence – applied applied
Commitment – Commitment – service before selfservice before self
But: But: REAL WORLD - not laboratoryREAL WORLD - not laboratory
group
group
group
group
group
group
Generic group
group
Society
REAL WORLD IS CHANGINGREAL WORLD IS CHANGING
In the next 20 years . .In the next 20 years . . . .
Global driftGlobal drift more people visiting foreign countriesmore people visiting foreign countries
Urban rushUrban rush 60 - 80% will live in town60 - 80% will live in town
Population explosion Population explosion additional 1.6 billion people on the planetadditional 1.6 billion people on the planet
REAL WORLD IS CHANGINGREAL WORLD IS CHANGING
REAL WORLD REAL WORLD
CommunicationCommunication
Digital RevolutionDigital Revolution
MobilesMobiles
Information on Web Information on Web
Web based marketingWeb based marketing
REAL WORLD IS CHANGINGREAL WORLD IS CHANGING
Professional toolsProfessional tools
Communication challenges
Digital divide Digital divide - less access - less access
Efficiency Pressure Efficiency Pressure - Impatience - Impatience
Cultural filters Cultural filters - Misunderstanding - Misunderstanding
Minorities Minorities - Intolerant - Intolerant
Cultural diversity increasing Cultural diversity increasing
Communication challengesCommunication challenges
ConclusionConclusion
So . . . So . . . What can pharmacists doWhat can pharmacists do
Agenda Agenda
Competence, Commitment?Competence, Commitment?
Communication? Communication?
Professional status?Professional status?
TheThe Solution?Solution?
Develop Develop
Cultural Competence!Cultural Competence!
Cultural CompetenceCultural Competence
Ability of health system to deliver Ability of health system to deliver consistentconsistent quality health care to quality health care to patients in cross cultural situationspatients in cross cultural situations
irrespective of the irrespective of the cultureculture of of
fellow professionalsfellow professionals oror
patientspatients..
Cultural ChallengeCultural Challenge
LoLo
Incompetent Incompetent 1.1. IntolerantIntolerant
2.2. ImpatientImpatient
3.3. Dismissive Dismissive
4.4. JudgementalJudgemental
Hi Hi
CompetentCompetent1.1. EmpathyEmpathy
2.2. Concerned Concerned
3.3. Caring Caring
4.4. RespectRespect
Cultural ladderCultural ladder
CulturalCultural ProficiencyProficiency
CulturalCultural CompetenceCompetence
CulturalCultural Pre-competencePre-competence
CulturalCultural BlindnessBlindness
CulturalCultural IncapacityIncapacity
CulturalCultural DestructivenessDestructiveness
Pre-competence to Competence Pre-competence to Competence
HiHiCOMPETENTCOMPETENT
(Empathy, concerned, caring, respect)(Empathy, concerned, caring, respect)
DesireDesire
EncounterEncounter
SkillSkill
KnowledgeKnowledge
AwarenessAwareness
LoLoINCOMPETENTINCOMPETENT
(intolerant, impatient, dismissive, judgemental)(intolerant, impatient, dismissive, judgemental)
Everyone benefits!Everyone benefits!
Patients Patients - - better QoC & QoLbetter QoC & QoL
Health professionalsHealth professionals - higher esteem - higher esteem
Health system Health system - - more cost more cost
effectiveeffective
MedicineMedicine - - improved useimproved use
EmployersEmployers - - Legal protection Legal protection
- Satisfied staff - Satisfied staff
- Loyal patrons- Loyal patrons
And Pharmacists improve And Pharmacists improve professional status!professional status!
HiHi
LoLo
Lo HiLo HiCultural
Competence
Co
mm
itm
ent
ProfessionalProfessional
This is not the end This is not the end but the but the beginning! beginning!
Thank youThank you
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