Professionalism and Culture in Healthcare

Professionalism, Culture, and Cultural Awareness in Healthcare

• Healthcare professionalism encompasses patient welfare, patient autonomy, and social justice. These principles guide healthcare decisions and practices.
• Defining culture involves understanding variations in beliefs, values, and behaviours across different groups.
• Organisational culture is the shared way healthcare organizations think, feel, and behave.
• Cultural awareness is recognizing differences in attitudes and values between individuals and groups, particularly those from different countries or backgrounds.

Organizational Culture

• Healthcare organizations are made up of various subcultures, which can either drive or hinder initiatives for quality improvement.
• Research indicates a correlation between strong organizational cultures and good quality of care.
• Cultural factors play a significant role in healthcare scandals, and a nuanced understanding of cultural dynamics is needed to prevent and address them.
• Simple diagnoses and prescriptions regarding culture are insufficient for effectively addressing complex issues.

Three Levels of Organizational Culture

• Visible aspects of organizational culture encompass service distribution, physical layouts of facilities, established care pathways, staff roles, and systems (e.g. dress codes and rituals).
• Shared understandings include beliefs and values underpinning visible practices, including views on patient needs and dignity.
• Deeper shared assumptions include the unspoken and unexamined underpinnings of daily practice, for example how hierarchy is valued.

400-1200 Excess Deaths

• The Mid Staffordshire NHS Foundation Hospital experienced 400 to 1200 excess deaths.
• Poor care and high mortality were documented from 2005 to 2009 in the report by Dr Robert Francis.
• There were various examples of poor care and compassion in the hospital.

A Negative Culture

• Cutbacks in staffing and services contributed to financial surpluses for the hospital.
• Poor leadership, pressure on staff, and a culture of fear and tolerance contributed to deficiencies in care in the hospital

Cultural Awareness

• Cultural awareness involves an individual's understanding of differences between themselves and people from other countries or backgrounds, especially differing attitudes and values.

The Wong-Baker FACES Pain Rating Scale

• It uses faces to help patients rate their pain.
• The scale ranges from "no pain" to "worst possible pain".
• It is available in various languages.

Different Cultural Views on Death

• Some cultures, particularly Buddhist Southeast Asian cultures, value the natural cycle of life, karma, reincarnation, and view death as part of life.
• Aggressive treatment might be perceived as interfering with the natural process of death.
• Patients and families may view advance directives positively in these cultures.

Assisted Decision-Making Capacity Act (2015)

• This Act aims to maximize individual capacity for decision-making.
• It supports individuals who face challenges by providing tiered support systems.
• The act emphasizes the right to self-determination.

Capacity

• The 2015 Capacity Act established a four-stage test for mental capacity, considering understanding relevant information, retaining said information, weighing up the information, and being able to communicate one's decision.

Advance Healthcare Directive (Act 2015)

• Advance Healthcare Directives allow individuals to pre-plan for future healthcare decisions, expressing their wishes and preferences concerning treatment.
• AHDS must be followed, where applicable, regardless of capacity.

Health Equity (or Inequity)

• Poorer populations experience worse health outcomes than wealthier populations.
• Differences exist in life expectancy between high and low-income countries.
• Gap between poorer and richer subgroups for illnesses (e.g. cancer) is widening.

Social Determinants of Health

• Social determinants of health are non-medical conditions that impact health and well-being.
• These factors involve income, education, unemployment, working conditions, food security, housing, and environment, etc.

Racism and Health

• Racism/racial discrimination is associated with poorer physical and mental health.
• Indigenous cultures are negatively impacted by colonization, with social systems perpetuating disparities.
• Racism can be interpersonal or systemic and impacts health through reduced access to resources.

Indigenous Health and Wellbeing

• The Australian Burden of Disease Study shows Indigenous Australians experience significant premature mortality.
• Leading causes of illness and death include mental health issues, injury, cardiovascular disease, cancer, and musculoskeletal issues.
• Indigenous health problems are significantly greater than other populations.

Cultural Safety in Healthcare

• Cultural safety, from the New Zealand definition, involves effective care practices determined by the patient or family, aiming to not diminish, demean or disempower cultural identities.
• It emphasises client-centered culturally safe health care delivered by care providers who understand the values and practices of the client’s culture.

Cultural Differences

• Collective decision-making is prevalent in many cultures.
• Cultural values regarding autonomy and individual rights often clash with collective decision-making.
• Treatment dilemmas arise when a health care provider prioritizes individual decision-making.

Cultural Awareness Model

• Cultural awareness is described as a reflective process for practitioners to understand their own cultural background and how it impacts communication.
• Cultural backgrounds include knowledge of values, beliefs, biases, and assumptions.
• Cultural awareness is vital for understanding how cultural differences can affect communication and interactions.

Cross-cultural Communication

• Cross-cultural/intercultural communication is the study of how verbal and nonverbal communication happens in diverse cultural settings.
• Cultural norms, communication styles, language differences, and nonverbal communication methods can vary significantly impacting communication.
• Misunderstandings can occur due to assumptions, differing language skills nonverbal communication interpretation, cultural stereotypes and high anxiety caused by unfamiliarity with the culture.

Cultural Competency

• Cultural competency allows healthcare providers to deliver individualized care that takes into account cultural considerations.
• It involves the process of cultural desire, awareness, knowledge, skill, collaboration and encounter.
• Cultural competency enables culturally sensitive healthcare that avoids stereotyping.

Discrimination

• Direct discrimination occurs when treating someone less favourably due to a protected characteristic.
• Indirect discrimination occurs if a practice, criteria or policy, although seemingly neutral, negatively impacts a certain group, putting them at a disadvantage.
• Discrimination stemming from disability often involves unfavourable treatment based on disability-related factors.

Cultural Safety

• Cultural safety emphasizes the importance of healthcare providers acknowledging and respecting the cultural identities and needs of clients.
• It requires health practitioners to reflect on their own cultural values and how they affect their behaviors. This process ensures clients are treated with respect and safety.
• A method called ACCESS helps in assessing and improving cultural safety skills.

GMC Ethnic Bias

• Doctors from marginalized ethnic groups face twice the referral ratio to the GMC for fitness-to-practice concerns compared to white doctors.
• Exam pass rates show disparities between White and Black and minority ethnic (BME) UK graduates, with overseas graduates displaying even greater disparity.

GMC “Fair to refer” Report 2019

• The report found that ethnic minority doctors and international medical graduates face higher referral rates.
• There are issues with adequate induction, feedback, support, and opportunities for continuous learning.

NMC 'Ambitious for Change' Research

• The research emphasized the significant variation in experience and outcomes across different ethnic groups in NMC procedures.
• Black and ethnic minority nurses experience higher referral ratios for fit-to-practice proceedings.
• Variations in outcomes across ethnicity are highlighted.

Irish Traveller Health Inequality

• Traveller communities experience significant health inequalities, including lower life expectancy for women and men.
• Infant mortality rates are significantly higher.
• There are increased rates of deaths from respiratory, cardiovascular diseases, and suicides.

Learning Objectives

• Learners will gain a comprehensive knowledge and understanding of culture and organizational culture in healthcare settings.
• This includes diversity and discrimination, culturally safe and sensitive practice including methods (ABCD, RESPECT, ACCESS) impacts on healthcare outcomes, and impacts on topics like medical insurance, indemnity, and regulation.