providing excellent health care in a multicultural world · “defining cultural competence: a...
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Providing Excellent Health Care in a Multicultural World
Health Literacy & Cultural Competency
Objectives
Setting the stage for excellent care Define health literacy and explain the extent of the
problem Highlight the importance of cultural competence Review ways to improve patient understanding
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Who Is Our Customer?
Patient Patient’s family or significant others External customers
Accreditors Regulating agencies
Colleagues
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Service Excellence
On-stage: where patients and other customers see us. Off-stage: with coworkers (without customer contact).
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Off-stage: Can speak and act with
familiar courtesy Discuss problems with
intent of fixing Take breaks Sharing feelings, venting
On-stage: Smile Show professional courtesy Introduce yourself and your
role in patient’s care Undivided attention for
patient and family
Service Excellence
As Bs Cs Anticipate what the patient may need
Body Language makes up 93% of our message
Care
Ask the patient what he/she wants
Behaviors say more than our words
Concern
Answer questions so that patient understands
Bonds are formed when we meet customers
Commitment
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Body Language
Communication is: 93% body language and other
communication cues. Paralinguistic cues: pitch, volume,
tone of speech.
Only 7% of communication is comprised of words themselves.
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James Borg, Body Language: 7 Easy Lessons to Master the Silent Language. Upper Saddle River, NJ: New FT Press, 2009.
Body Language
Which video demonstrates service excellence through body language and speech?
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Insert demonstration video #1 here
Insert demonstration video #2 here
A B
Improve Patient Understanding
Health Literacy
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Cultural Competency
Race
Ethnicity
Language National Origin
Customs
Education
Gender
Sexual Orientation
Disabilities
Religion/Faith
Tastes/ Preferences
Age
Health Literacy
Definition: Capacity of an individual to obtain, process and understand basic health information and services needed to make appropriate health decisions.
Patient may need: Visual literacy Computer literacy Information literacy Numerical or computational literacy
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“Health Literacy,” National Network of Libraries of Medicine, http://nnlm.gov/outreach/consumer/hlthlit.html; IOM, “Health Literacy: A Prescription to End Confusion,” 2004.
Largest Study Conducted to Date on Health Literacy Found
Williams MV, Parker RM, Baker DW, et al. “Inadequate Functional Health Literacy Among Patients at Two Public Hospitals.” JAMA 1995 Dec 6; 274(21):1,677–82.
33% Were unable to read basic health care materials
42% Could not comprehend directions for taking medication on an empty stomach
26% Were unable to understand information on an appointment slip
43% Did not understand the rights and responsibilities section of a Medicaid application
60% Did not understand a standard informed consent
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Health Literacy
Approximately 40 to 44 Million Adults in the US Are Functionally
Illiterate
Approximately 50 Million Are Marginally Illiterate
Average Reading Skills of Adults in the US Are Between the 8th and 9th
Grade Levels
More Than 90 Million People in the US Have Difficulty Reading
Cannot Perform Basic Reading Tasks
Required to Function in Society
Have Trouble Reading Maps and
Completing Standard Forms
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Health Literacy
National Assessment of Adult Literacy, 2003, Louisiana statewide estimate, http://nces.ed.gov/naal/estimates/StateEstimates.aspx, accessed 2 December 2013; Stedman L, Kaestle C. Literacy and Reading Performance in the US From 1880 to Present. In: Kaestle C, Editor. Literacy in the US: Readers and Reading Since 1880. New Haven (CT): Yale University Press; 1991. P. 75–128.
Louisiana: 16% of adults
lack basic proficiency
Health Literacy 12
Implications of low health literacy: Poor health outcomes Underutilization of preventive services Overutilization of health services Unnecessary expenditures Limited effectiveness of treatment Needless patient suffering Higher patient dissatisfaction Higher provider frustration
Low Health Literacy costs the U.S. at
least $106 billion annually.
Vernon, J. A., Trujillo, A., Rosenbaum, S., & DeBuono, B. (2007). Low health literacy: Implications for national health policy. Washington, DC: Dept of Health Policy, School of Public Health and Health Services, GW Univ.
Cultural Competence
Definition: Acknowledgement and use of cultural and social factors that surround health, healing, illness, and the delivery of healthcare. Recognition and respect for different traditions. Responsiveness to health beliefs, practices and needs of
diverse patient populations.
Lack of cultural awareness is a reason for health care disparities.
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NIH, “Cultural Competency,” http://www.nih.gov/clearcommunication/culturalcompetency.htm; Betancourt J et al, “Defining Cultural Competence: A Practical Framework for Addressing Racial/Ethnic Disparities in Health and Health
Care,” Pub Health Reports 2003 118:293-302.
Cultural Competence
Changing demographics in Louisiana: 2000-2010: 28% increase in Asian population. 78% increase in Hispanic or Latino population. 58% increase in Native American or Other Pacific native
population. Essentially stable African-American population 0.70% decrease in white, non-Hispanic population.
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Census Viewer, “Population of Louisiana: Census 2000 and 2010 Interactive Map, Demographics, Statistics, Quick Facts,” http://censusviewer.com/state/LA.
Cultural Competence
An Amish woman undergoes a cesarean delivery. After surgery, the woman and her husband are interviewed by a social worker who was called by a nurse to see the couple because they had no health insurance. The social worker immediately begins to tell them how to enroll in Medicaid. They are visibly upset and will no longer talk to the social worker. They refuse to complete any paperwork for Medicaid. They ask to leave the hospital as soon as possible.
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Social worker did not recognize that Amish people generally do not accept what they consider to be welfare.
SW could help the couple contact other Amish community members to provide financial, other needed assistance to the couple.
ACOG, “Cultural Sensitivity and Awareness in the Delivery of Health Care,” May 2011.
Improve Patient Understanding
Consider: What language does patient prefer?
Every patient has the right to a validated medical interpreter.
What does the patient want to know? Can the patient to repeat back what you have said?
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Improve Patient Understanding 17
1. Tailor communication skills to individual. 2. Tailor health information to the intended user. 3. Develop written materials that reinforce the imparted
information.
US Department of Health and Human Services, Quick Guide to Health Literacy, 2006.
Tailor Communication Skills
Use open-ended questions. Use medically-trained interpreters.
Every patient has the right to a certified medical interpreter.
Check for comprehension by asking questions. Train staff and colleagues in patient communication with
cultural competency.
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Joint Commission, “Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals,” 2010; Chen AH et al, “The Legal Framework for Language Access in Healthcare Settings: Title VI and Beyond,” J Gen Intern Med 2007; 22(Suppl 2): 362-367.
Tailor Information to Intended Users
Health information should reflect users’ age. Include target users in development (pre-test) and
implementation (post-test) of written materials. Consider cultural factors – race, ethnicity, language,
religion, nationality, age, gender, sexual orientation, income level and occupation.
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US Department of Health and Human Services, Quick Guide to Health Literacy, 2006.
Developing Written Materials
≥12 point font. Limit to one simple message if possible. Focus on the action. Use active voice. Use familiar language. Avoid jargon. Use visual aids whenever possible.
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US Department of Health and Human Services, Quick Guide to Health Literacy, 2006.
Improve Patient Understanding 21
Benign Harmless
Chronic Happens again and again; does not end
Cardiac Heart
Edema Swelling; build up of fluid
Fatigue Tired
Screening Test
Intake What you eat or drink
Generic Not a brand name
Adverse events Side effects
Consider Using This One
Instead of Using This Word
Improve Patient Understanding
Rosa is 55 y.o. Hispanic female with a history of Type 1 DM who goes to clinic with complaint of recurrent fainting spells. Provider draws blood and reviews her meds (insulin, ACE inhibitor, atorvastatin); patient has hyperlipidemia and hypoglycemia. Doctor tells nurse he is frustrated with his non-compliant patient.
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Doctor should ask if Rosa needs a Spanish-language interpreter.
Does the patient understand her medication and diet regimen?
Summary
On-stage or off-stage? Body language communicates a lot. Does patient understand their health and treatment? Have you tailored your message to the individual?
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Acknowledgements
Murtuza Ali, MD Richard DiCarlo, MD Rebecca Frey, PhD Stacey Holman, MD Richard Tejedor, MD Quality, Risk and Safety Department, Interim LSU Hospital. Hospital Training and Development Department, Interim LSU
Hospital.
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