HMAHealthManagement.com

ADA Annual Diabetes Practice Update

Jeffrey Ring, Ph.D.

November 2, 2018

Cultural Agility

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Axolotl – Julio Cortazar

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Disclosure

• Speaker for Merck Pharmaceuticals

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Objectives

By the conclusion of this presentation, participants will:

• Deepen your understanding of culturally and linguistically responsive health care: definition and rationale

• Deepen self-reflection on implicit bias and microaggressions

• Consider next steps in enhancing your own cultural agility

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Rev. Dr. Martin Luther King, Jr.

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

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• “I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Maya Angelou

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The American Diabetes Association is committed to embracing and drawing from the unique voices, experiences and perspectives of our staff, volunteers and partner organizations in all that we do

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Culturally Responsive Health Care

• Providing care consistent with the patient’s world view

• Addressing patient’s cultural and linguistic needs

• Patient-centered care

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UNEQUAL TREATMENT, 2002Institute of Medicine

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Patient Centered Care Culturally Responsive Care

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Group Brainstorm: Rationale Culturally Responsive Health Care

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Culturally Responsive Health Care: Rationale

• Patient Satisfaction• Practice Building• Practitioner Satisfaction• Avoid Malpractice/Medical Errors/Informed

Consent • Enhanced Treatment Adherence/Improved

Outcomes/ Lower Readmission Rates• Social Justice• AAMC/ACGME• Health Disparities• US HHS required educ. topic for hospitals • Federal CLAS Standards

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Costs of Disparities

• The Joint Center for Political and Economic Studies estimates racial and ethnic disparities to have cost this nation $1.24 trillion between 2003 and 2006: $229.4 billion for direct medical care expenditures associated with health disparities and another $1 trillion for the indirect costs of disparities.

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Imagery Exercise

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Stereotypes: Take Home Messages

• Unavoidable

• Can contribute to health disparities

• More likely under stress and limited info

• Requires conscious effort

• Don’t beat yourself up

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Category (group)

+Generalization

Stereotype (label)

+ Judgment

Prejudice (attitude)

+ Action

Discrimination (behavior)

+ Power

Oppression/ “Isms”(process, system)

S. Harrell, Ph.D.

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Implicit Bias

Implicit bias, also know as implicit social cognition refers to the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner.

Leuke and Gibson (2014) Mindfulness reduces implicit age and race bias

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Implicit Bias

https://implicit.harvard.edu/implicit

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Microagressions

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• “Brief and commonplace daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory or negative racial slights and insults toward people of color” Derald Sue, Ph.D.

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Unconscious Bias, Microaggressions and Personal

Experience

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Exploring Health InequitiesHealth of the United States

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“Statistics are people with the tears wiped away.” Irving Selikoff

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Causes of Disparities

• Society Factors

• Health Institutional Factors

• Patient Factors

• Practitioner Factors

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Practitioner Factors

• Bias and stereotypes

• Reaction to time pressure

• Cultural competence

• Language/skill working with interpreters

• General medical knowledge/skill

• Skill in reflection

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CLAS STANDARDS(Culturally and Linguistically Appropriate Services)

• Published by OMH in 2000

• Enhanced Standards published in 2013

• Emphasize opportunities to address disparities at every point of contact along health care services continuum

• Emphasis on health care organizations

• Legal consequences

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CLAS Principal Standard

“Provide effective, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practice, preferred languages, health literacy and other communication needs.”

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CLAS: Governance, Leadership, Workforce

• Policy, practices and allocated resources towards CLAS promotion

• Recruit and support culturally and linguistically diverse governance/ workforce

• Educate governance, leadership and workforce in culturally and linguistically appropriate policies on an ongoing basis

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How to Proceed?

• Clinic Self-Assessment

• Language Assistance

• Data and Disparities

• Identify Resources

• Cultural Medicine Training

– Awareness/Attitudes

– Knowledge

– Skills

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How to Proceed?

• Team-Based Care

• Population Health Management

• Patient Engagement and Activation

• Motivational Interviewing

• Shared Decision Making

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Lisa Cooper, M.D.

• Respect the humanity of the people in front of you, regardless of whether you like them or agree with what they are saying.

• Empathize — imagine yourself in the patient’s shoes. • Listen more, and talk less. • Ask yourself what assumptions you may be making

and whether they are based on facts about this particular person.

• Talk with patients about their personal lives, not just their medical problems.

• Engage patients in problem-solving and decision-making by asking what they think about their condition and the care plan.

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Dr. Cooper, RELATE

• https://www.bloomberg.com/amp/view/articles/2018-08-28/doctors-can-fight-implicit-bias-against-african-american-patients?__twitter_impression=true

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Mindfulness

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Shoulders by Naomi Shihab Nye

A man crosses the street in the rain,

Stepping gently, looking two times north and south,

Because his son is asleep on his shoulder.

No car must splash him.

No car drive too near to his shadow.

This man carries the world’s most sensitive cargo but he’s not marked.

Nowhere does his jacket say FRAGILE, HANDLE WITH CARE.

His ear fills up with breathing.

He hears the hum of a boy’s dream

deep inside him.

We’re not going to be able to live in this world if were not willing to do what he’s doing

with one another.

The road will only be wide. The rain will never stop falling.

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Commitment to Act

Based on our work together today, please list at least two things you intend to do better, anew, or enhanced in patient care and/or resident teaching?

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Jeffrey Ring, Ph.D.

jring@healthmanagement.com

Follow Me @ring4jeff