Cultural Competency in Health

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Cultural Competency in Health
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About cultural competency

• What is it?
• Why do we need it?
• What does it do?
• Who is responsible?

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What is cultural competency?

• Behaviours, attitudes and policies that
  enable systems, organisations, professions
  and individuals to work effectively in
  cross-cultural situations

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What is cultural competency?

• improves health and wellbeing by integrating
  culture into delivery of health services
• focuses on capacity of health systems
• more than awareness of difference
• everyones responsibility - not special
  interest groups
• its not new !!good health policy services
  meet consumers needs

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Why do we need cultural competency in health?

• Everyone has a right to health care that meets
  their needs
• Australias diversity is increasing
• Health system not always responsive
• Health inequalities experienced by many groups
• Health services, managers and practitioners are
  accountable for meeting needs of all consumers
• World-wide pressure to improve
• Bangkok Charter 2005, WHO World Health Report
  2006

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Benefits

• Improves equity access for all groups
• Good business practice
• More effective service for health consumers and
  carers
• Better use of health resources

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A culturally competent health system

• Acknowledges benefits of diversity
• Achieves best, most appropriate care for each
  consumer
• Ensures self-determination for consumers and
  communities
• Holds governments, health organisations and
  managers accountable for meeting needs of the
  communities they serve

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Whos responsible?

• Governments all levels
• Policy decision-makers all agencies / all
  levels of government (not just health!)
• Managers CEOs, finance, operational managers
  of health related services
• Professions professional bodies and their
  members
• Workers practitioners in health related
  organisations
• Individuals Everyone can learn and contribute

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A guide to improving cultural competency

• New NHMRC guide
• Aim
• Target audience

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NHMRC Guide Cultural competency in health
a guide for policy, partnerships and
participation

• National focus
• Complements existing work
• Generic approach
• Applies to wide range of groups not specialised
  
• Provides model 4 domains for action
• systemic, organisational, professional
  individual
• Focus on healthier living environments, obesity
  overweight
• Recognises gaps, identifies next steps
• Based on research, consultation feedback
• Prepared by experts /researchers in public health

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Aim of Guide

• Support development of health care services that
  meet needs of culturally linguistically diverse
  communities

Target audience

• High level policy decision-makers
• Impact on-the-ground health services
• Anyone interested in health related policy

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Outcomes

• Stimulate broader discussion
• Ownership of issues
• Begin nationally supported, sustained change
• Provide ideas for next steps

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Increasing cultural competency

• Principles
• Four Dimensional Model
• Developing Competency

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Systems, organisations, professions can

• Adopt principles that underpin cultural
  competency in health
• Take action on infrastructure human resources
  that support cultural competency
• Set standards establish specific competencies
  at system, organisation, professional and
  individual level

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Principles for cultural competency

• Engaging consumers communities and sustaining
  reciprocal relationships
• Leadership and accountability for sustained
  change
• Building on strengths know the community, know
  what works
• A shared responsibility creating partnerships
  and sustainability

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Principle 1

• Engaging consumers communities and sustaining
  reciprocal relationships
• Promotion of healthier living and environments is
  a reciprocal relationship
• CALD background communities and health services
  engage, learn exchange at all stages of health
  care research, development and delivery

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Principle 2

• Leadership and accountability for sustained
  change
• Begins at highest levels of systems,
  organisations and professions
• Continues to individual development and practice

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Principle 3

• Building on strengths know the community, know
  what works
• Population health approach
• Use data, information on diverse communities
• Acknowledge CALD experience successful practice
• Understand risk factors protective behaviours

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Principle 4

• A shared responsibility creating partnerships
  and sustainability
• Partnerships between health and human
  services, education and research sectors
• Find systematic and long-term approaches

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The Model

• Four dimensions for action

Source Research and consultation report
commissioned for NHMRC project
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systemic
organisational
professional
individual
Action at Systemic Level

• Fosters culturally competent behaviour through
• Effective policies and procedures
• Mechanisms for monitoring
• Sufficient resources
• Policies that support involvement of culturally
  diverse communities in health matters

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systemic
organisational
professional
individual
Action at Organisational Level

• Cultural competency is valued, integral to core
  business, supported and evaluated
• Skills and resources to support diverse clients
  are in place
• Management committed to diversity management
• e.g. training for staff, cultural and linguistic
  diversity in staffing

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systemic
organisational
professional
individual
Action at Professional Level

• Makes cultural competency important part of
  education professional development
• Professions develop cultural competence standards
  
• Guidance provided for working lives of individuals

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Action at Individual Level

• Individuals develop optimum knowledge, attitudes,
  behaviours re cultural competence
• Individual health professionals are supported to
  work with diverse communities
• Individuals develop relevant, appropriate,
  sustainable health promotion programs

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Develop competencies

• Competency knowledge, conviction, capacity for
  action
• Systems, organisations, professional groups
  individuals can develop cultural competencies in
  specific areas

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Specific competencies

• Policy / Evaluation
• e.g. a policy framework that directs supports
  cultural competency across health system
• Budgeting resources
• e.g. high priority areas are specifically
  budgeted for staff training, interpreter
  language skills
• Consumer participation
• e.g. reps of diverse communities are included at
  all stages of service development delivery

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Specific competencies

• Management
• e.g. performance agreements hold managers
  accountable
• Education/skills
• e.g. professions consider cultural / linguistic
  diversity in communication health practice
• Self-reflection
• e.g. individuals understand potential impact of
  cultural linguistic diversity on clients,
  adapt practice to meet cross-cultural requirements

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Competence knowledge conviction capacity
for action
Organisation profession support individual
system
organisation
profession
individual
Individual applies knowledge, conviction,
capacity for action to inform organisation,
profession system
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Practical approaches

• Case study scenarios
• Next steps
• Resources, contacts more info

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Case Study Scenario 1 Media campaign

• Research shows poor nutrition and low fitness
  affect some CALD background groups more than
  others
• How would cultural competency principles guide a
  media campaign to promote healthy eating and
  improve fitness?

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Culturally competent approaches

• Use research
• identify issues key groups
• Partnerships
• work with relevant community leaders, share
  knowledge
• Community engagement
• get communities involved from planning onward
• use consumer advisory group, focus groups
• Methodology
• select media outlets used by the CALD background
  group/s you want to reach
• Evaluate
• before after data to assess impact

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Case Study 2 Community group fitness

• A Muslim community leader notices low physical
  activity / reduced fitness among Muslim women in
  her local area
• What culturally competent strategies would help
  find a solution?

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Culturally competent strategies .

• Community involvement
• Muslim women initiate action, identify solutions
• Reciprocity
• Culturally appropriate community consultation,
  informal discussion, discuss barriers within
  community with local authorities
• Sustainability
• Identify culturally appropriate solutions that
  have ongoing support, e.g. women-only exercise
  classes, appropriate venues
• Think about wider factors e.g. child care,
  transport etc.
• Share success
• Evaluate document outcomes, share learning with
  other cultural groups

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Next Steps

• Suggestions for projects action at all levels
• Individual
• Organisational
• Professional
• Systemic

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Next steps for individuals

• Access toolkits or other material to develop
  self-awareness competencies
• Take part in cross-disciplinary forums to share
  information skills, promote support awareness
  
• Look for opportunities to introduce or improve
  cultural competence discuss with colleagues

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Next steps for organisations

• Participate in partnership forums with govts to
  apply the Model locally
• Budget strategies mobilise resources,
  prioritise cultural competence
• Management competencies and performance measures
• HR strategies
• recruitment, succession planning, education
• Context-specific competencies for your
  organisation, its community health workers

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Next steps professional groups

• Demonstrate leadership
• raise profile of cultural competency, recommend
  strategies for professional practice
• Participate in partnership forums with govts /
  other agencies on applying the model
• Reflect principles of cultural competency in
  ethical other professional conduct codes
• Develop policies and context-specific
  competencies for specific health professional
  group
• Promote information to members

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Next steps across systems

• A specific resource for Aboriginal and Torres
  Strait Islander Peoples
• National collaboration on framework for
  culturally competent health practice
• Address gaps in research, information and
  evidence base
• Promote best practice diversity organisations

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How to find out more

• Institute for Health and Diversity
  www.vu.edu.au/diversity
• Cultural Competency for Healthy Living a guide
  for policy, partnerships and participation -
  www.nhmrc.gov.au
• Multicultural Mental Health Australia
  www.mmha.org.au
• Centre for Culture, Ethnicity and Health
  www.ceh.org.au

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Cultural Competency in Health Care.
Whos responsible?
Everybody