1 Strategies and Challenges to Integrate Cultural Competence for Providers and Organisations – The...
-
Upload
kieran-provost -
Category
Documents
-
view
215 -
download
0
Transcript of 1 Strategies and Challenges to Integrate Cultural Competence for Providers and Organisations – The...
1
Strategies and Challenges to Integrate Cultural Competence for Providers and Organisations –
The British Case
Carol Baxter
Head of Equality & DiversityNHS Employers, UK
2
Contents
• An historical perspective
• From the margins to the mainstream
• The emergence of a policy agenda
• A paradigm shift from goodwill to competence
• Joining up the agenda
• Close
3
An Historical Perspective
• Response rate: 76%
• Number of schools: 176
_____________________________________
• Pre-dominance of a cultural model
• Theory / Practice dichotomy
• Teacher preparation
• The role and position of BME staff
Survey of Schools of Nursing, 1993
4
Survey of Schools of Nursing, 1993RESPONSES NO. OF
INSTITUTIONS%
Culture and health 87 93.3
Specific client groups 64 61.5
Racism and discrimination 30 28.8
Communication skills 24 23.0
Racial inequalities in health 22 21.1
Practical hospital care 15 14.4
Demography / Migration 14 13.5
Care in the Community 12 11.5
Patterns of illness 8 7.7
No. of institutions replying to this question 104
Table 1. Subject areas reported by nurse teachers to be covered in teaching on race equality
5
Survey of Schools of Nursing, 1993WORDS WHICH TOGETHER REFLECT A CULTURAL PERSPECTIVE
TOTAL FOR ALL DOCUMENTS
WORDS WHICH TOGETHER REFLECT AN ANTI-RACIST PERSPECTIVE
TOTAL FOR ALL DOCUMENTS
Culture / Cultural 91 Racism 12
Special needs 88 Prejudice 10
Ethnic 50 Multiracial 8
Customs 16 Black 4
Spiritual / Religious 16 Racial 4
Multicultural 13 Discrimination 4
Immigrants 12 Stereotypes 3
Habits / Practices 10 Inequalities 3
Taboos 5 Colour 2
Rituals 4 White 1
TOTAL 305 TOTAL 51
Table 2. Content analysis: Implied meaning in documents – word frequency
6
Challenging racism and racial stereotypes - when using material which gives cultural information the following questions should first be asked:
• Who has been involved in compiling the information? Is it written by someone from the community being addressed?• Is the material dealing with the culture of:
− an entire society?− a particular social class or group?− a particular area of the country?− a small localised group?
• Is it clear what sections of the population the information refers to?• Does the material simply describe patterns of behaviour?
− are the patterns described in a way that makes them seem absurd or bizarre?
adapted from Mares, Henley & Baxter (1985)
Guidelines for Evaluating Information on Cultural Norms
7
− does it suggest possible explanations? − does it discuss the underlying reasons for unfamiliar patterns of
behaviour?− is it clear whether the patterns described are ideal or actual norms?
• Does the author make value judgements about the cultural patterns described? eg: does the author’s attitude strike you as positive, neutral or negative?• Is culture seen as a fixed state or a dynamic phenomenon? Is this aspect discussed or ignored?• Does the information analyse the situation of minority cultural groups in Britain purely in terms of culture and cultural differences? Does it make any reference to important economic and social factors (eg: unemployment and racial discrimination)?• What specific new insight have you gained from the information? Has it increased your understanding of the culture described, or created further questions in your mind about aspects you were not previously aware of?
Guidelines for Evaluating Information on Cultural Norms
8
which generates misinformation and
ignorance about these groups of
people
which become socially sanctioned attitudes, beliefs,
feelings and assumptions
which become the justification for
further mistreatment
Systematic mistreatment of
people of colour and third world people
Racism is one consequence of a self-perpetuating imbalance in economic, political and social power
Racism hurts all of us, whether or not we are members of the targeted group
Adapted from Ricky Sherouer-Marcuse, Unlearning Racism Workshops, 6501 Dana, Oakland CA 94609, USA
Racism
9
• Racism is part of the culture within British society and individuals within it have been socialised from childhood into this• Racism encompasses not only our prejudice but also the power held by white society to translate its prejudices into practices that initiate and perpetuate injustice• Both black and white people are hurt by racism but in different ways. In the process of becoming aware of our own racism the pain of that hurt must be made conscious• Racism Awareness training is concerned with enabling individuals to explore how racism is part of themselves, the organisations in which they work and in society as a whole• Individuals are required by the teacher to take responsibility for their own learning. • The teacher thus acts primarily as a facilitator who helps to build a group sense of trust; has an understanding that guilt can block change; and is willing to confront racism and help individuals to make choices about future assumptions and behaviours.
Basic Premise and Principles of Racism Awareness Training
10
• The teacher therefore requires a deep knowledge and understanding of how racism operates, as well as skills as a groups facilitator and sensitivity to group process and individual emotions• Racism Awareness does not take place in one-off short workshops. It is part of a broader programme of organisational development towards equality of opportunities in which the overall aim is to confront and change institutional structures and procedures• The ultimate value of Racism Awareness training lies in its generation of both individual and group commitment to action for changing racist practices and achieving justice. This is achieved by overcoming emotional blocks that can undermine other initiatives such as Equal Opportunity Programmes or antiracist confrontations
Basic Premise and Principles of Racism Awareness Training
11
EXAMPLE: MULTIRACIAL MULTICULTURALCAUSES OF INEQUALITIES
Largely due to racism Largely due to cultural differences
FOCUS OF TRAINING AND DEVELOPMENT
• Specific issues arising from black / white relations• Perception of BME cultures contributing to inequality and disadvantage
Lifestyle of various cultural groups
2 PERSPECTIVES:
“Multiracial” vs “Multicultural”?
12
From Margins to MainstreamLANGUAGE OF OPPRESSION RESPONSES
• Discrimination• Prejudice• Exclusion• Power• Marginalisation
• Anti-oppressive practices• Anti-racism• Anti-sexism• Anti…
LANGUAGE OF INCLUSION RESPONSES
• Engagement• Consultation• Involvement
• Rights and responsibilities• Genuine choices• Valuing diversity
13
Competency:
“The behaviours that employees must have, or must acquire, to input into a situation in order to achieve high levels of performance”
- CIPD
Building Cultural Competence Within the Organisation
14
“Cultural Competence”:
Cultural Awareness:
Cultural Knowledge:
Cultural Sensitivity:
Recognition that others might be different from you
Understanding of specific cultural needs
Knowing that cultural differences as well as similarities, exist, without assigning values eg. better or worse, right or wrong etc
Understanding Organisational Competence
15
• There is such an entity as cultural competence – which can be acquired
• It is possible to describe and to provide training to improve the cultural competence of healthcare professionals which will improve the competence of the organisation
• The employment of ethnic minority healthcare staff (particularly nurses) will improve organisational competence
Cultural Competence - Assumptions
16
Attitudes / Values:
• Stereotypes
• Prejudice
• Personal racism
• Institutional racism
Knowledge:
• Demographic and population issues
• Inequalities in health
• Specific illnesses
• Concepts of health and illness
Race Equality in Healthcare and Education, Baxter, 1997
Building Cultural Competence Within the Organisation
17
Skills:• Communication across cultural and language barriers
• Practical hospital care – physical and spiritual
• Care in the community
• Specific client groups
Approaches:
• Change management
• Policies and strategies
• Building networks
• Sharing experiences, good practice and ideas
Building Cultural Competence Within the Organisation
Race Equality in Healthcare and Education, Baxter, 1997
18
• Sex
• Ethnicity
• Disability
• Age
• Sexual Orientation
• Religion and Belief
• Human Rights
The Emergence of a Policy Agenda
19
Sex / Gender
Race / Ethnicity
Disability
Age
Sexual Orientation
Religion and Belief
Human Rights
1970s 1980s 1990s 2000s
employment
goods, facilities, servicesboth
EPA SDA
RRA RR(A)A
EA
DDA DDA
EE(A)R
EE(SO)R
EE(RB)R
HRA
EA(SO)R
EA(RB)R
GRA
Equality Legislation: Quickening Pace
20
Gender
Race
Disability
Age
Sexual Orientation
Religion and Belief
Human Rights
EMPL SERV GENERAL DUTY: SPECIFIC DUTIES:
Equality Impact Assmts etc
Gender Equality Duty
Race Equality Duty
Disability Equality Duty
Race Equality Scheme
Disability Equality Scheme
Gender Equality Scheme
Equality Impact Assmts etcEquality Impact Assmts etc
√√ √√√√
√√
√√√√
√√
√√
√√
√√
√√
√√
√√
2009?
Equality Legislation: Equality Duties
21
From Goodwill to Competence
Promote equality and value diversity
Act in ways that support equality and value diversity
Develop a culture that promotes equality & diversity
Support equality and value diversity
NHS KNOWLEDGE AND SKILLS FRAMEWORK CORE DIMENSION 6 Equality & Diversity
Core
2
3
4
1
= This is a key aspect of all jobs that everyone does. It underpins all dimensions in the NHS KSF
LEVELS:
22
Act in ways that support equality and value diversity
KSF CORE DIMENSION 6 Equality & Diversity
1
Indicators:The worker: a) acts in accordance with legislation, policies, procedures and good practiceb) treats everyone with whom s/he comes into contact with dignity and respectc) acknowledges others’ different perspectivesd) recognises that people are different and makes sure they do not discriminate against other peoplee) recognises and reports behaviour that undermines equality and diversity
Examples of application: a) around: age, racial group, disability , gender, human rights, mental health etc
b) – e) may include:• what they do or say• what they do not do or say• when interacting with colleagues• when interacting with service users• when working with the public• when working with visitors to the organisation
23
KSF CORE DIMENSION 6 Equality & Diversity
2
Indicators:The worker: a) recognises the importance of people’s rights and acts in accordance with legislation, policies and proceduresb) Acts in ways that:• acknowledge and recognise people’s expressed beliefs, preferences and choices• respect diversity• value people as individualsc) takes account of own behaviour and its effect on othersd) identifies and takes action when our own or others’ behaviour undermines equality and diversity
Examples of application:a) around: age, racial group, disability, gender, human rights, mental health etcb) might relate to:• food and drink• how they like to be addressed and spoken to• personal care• privacy and dignity• the information they are given• the support they would like• their faith or beliefd) would include:• recognising when equality and diversity is not being promoted and doing something about it• recognising when someone is being discriminated against and doing something about it
Support equality and value diversity
24
KSF CORE DIMENSION 6 Equality & Diversity
3
Indicators:The worker: a) interprets equality, diversity and rights in accordance with legislation, policies and procedures and relevant standardsb) evaluates the extent to which legislation is applied in the culture and environment of own sphere of activityc) identifies patterns of discrimination and takes action to overcome discrimination and promote diversity and equality of opportunityd) enables others to promote equality and diversity and a non-discriminatory culturee) supports people who need assistance in exercising their rights
Examples of application:a) around: age, racial group, disability, gender, human rights, mental health etcb) might relate to:• communication with different people• health, safety and security / risk management• quality systems standards and guidelines• the allocation of resources• the availability of services• the development of services c) might relate to:• the learning and development offered to different people• the recruitment, selection and promotion of staff
Promote equality and value diversity
25
KSF CORE DIMENSION 6 Equality & Diversity
3
Indicators:The worker: d) enables others to promote equality and diversity and a non-discriminatory culturee) supports people who need assistance in exercising their rights
Examples of application:d) might include:• acting as a role model• being aware of the wellbeing of all members of the work team and supporting them appropriately• enabling others to reflect on their behaviour• identifying training and development needse) might relate to:• advocacy• enabling people to make the best use of their abilities• intervening when someone else is discriminating against someone on a one-off basis or routinely• making arrangements for support • representing people’s views
Promote equality and value diversity
26
KSF CORE DIMENSION 6 Equality & Diversity
4
Indicators:The worker: a) interprets legislation to inform individuals’ rights and responsibilitiesb) actively promotes equality and diversityc) identifies and highlights methods and processes to resolve complaints as a consequence of unfair and discriminatory practiced) supports those whose rights have been compromised consistent with legislation policies and procedures and good and best practice
Examples of application:a) and d) around: age, racial group, disability, gender, human rights, mental health etcb) would include:• acting as a mentor to people from diverse groups• acting as a role model• actively working in partnership with diverse groups• developing and supporting own team in relation to equality and diversity• ensuring that development opportunities are available to all staff• ensuring the fair recruitment and selection of staff
Develop a culture that promotes equality and diversity
27
KSF CORE DIMENSION 6 Equality & Diversity
4
Indicators:The worker: e) actively challenges individual and organisational discriminationf) evaluates the effectiveness of equality and diversity policies and procedures within the service / agency and contributes to the development of good and best practice
Examples of application:b) would include:• focusing resources to deliver equitable outcomes• involving the local population in the development of services• listening to the experiences and views of different groups and acting on them• modelling good practice• promoting an open and fair culture throughout the organisation• promoting equality and diversity during partnership working
Develop a culture that promotes equality and diversity
28
NHS Leadership Qualities Framework
29
Joining up the Agenda
“An environment where all staff feel valued and enjoy a fair and equitable quality of working life, and where different backgrounds, perspectives, knowledge and experiences are welcomed and the benefits that this diversity can bring are actively sought and embraced.”
“A service which continuously seeks to improve the quality of healthcare provided to an increasing diversity of patients and clients, through nurturing, supporting and developing its staff.”
Vision for the NHS
30
Cultural Awareness
Policies
Procedures
Standards
Behaviours
BY / OF INDIVIDUALS SYSTEMATIZED WITHIN AN ORGANISATION
QualityOf
Service
CULTURE
STRATEGY
POLICIES & PROCEDURES
CLIMATE SYSTEMS
STRUCTURECultural Sensitivity
Cultural Knowledge
Making cultural competence effective
31
LINK TO HUMAN RIGHTS
DOMAIN AND STANDARD HOW TO MEASURE
eg:
THE RIGHT NOT TO BE DISCRIMINATED AGAINST IN RELATION TO ANY OF THE RIGHTS
Leadership and Governance Healthcare organisationdemonstrates culturallyCompetent leadership andgovernance
Leadership • Being representative of its community • Individual and collective knowledge • Non-discriminatory decision-making and attention to vulnerable groups • Individual and collective responsibility for the organisation’s performance in meeting the needs of minority and vulnerable groups
RIGHT TO LIFE Commissioning and ProcurementHealth care organisations will applyHuman Rights principles in procuringgoods and services
Commissioning• Involvement and participation of minority and vulnerable groups in the commissioning process • The use of up-to-date and reliable population data in the commissioning process
The Regulators: UK NHS Healthcare Commission –Draft Strategic Cultural Competence Framework
32
CLOSE
33
GlossaryEA - Equality Act, 2006EA(RB)R - Equality Act (Religion or Belief) Regulations, 2007EA(SO)R - Equality Act (Sexual Orientation) Regulations, 2007 DDA - Disability Discrimination Act, 1995
- Disability Discrimination Act, 2005DED - Disability Equality DutyDES - Disability Equality SchemeEE(A)R - Equality in Employment (Age) Regulations, 2006EE(RB)R - Equality in Employment (Religion and Belief) Regulations, 2003EE(SO)R - Equality in Employment (Sexual Orientation) Regulations, 2003EPA - Equal Pay Act, 1970GED - Gender Equality DutyGES - Gender Equality SchemeGRA - Gender Recognition Act, 2004HRA - Human Rights Act, 1998RED - Race Equality DutyRES - Race Equality SchemeRRA - Race Relations Act, 1976RR(A)A - Race Relations (Amendment) Act, 2000SDA - Sex Discrimination Act, 1975SES - Single Equality Scheme