Achieving Cultural Safety in Health Services. through Understanding and Responding to Underlying Cultural Factors

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1 Achieving Cultural Safety in Health Services through Understanding and Responding to Underlying Cultural Factors

3 Meno-Ya-Win» Health» Wellness» Wellbeing» Wholeness Our care is based on recognizing the relationship of physical, emotional, mental and spiritual aspects of all people

Lake Pickle Lake Winnipeg Hudson Savant Lake Four

4 Meno-Ya-Win Service Area Twenty Eight First Nation Communities 21,475 people Area = 385,000 sq km Red Lake Pickle Lake Winnipeg Hudson Savant Lake Four Southern Communities 5,500 people Close to Sioux Lookout

5 Ill SLMHC Catchment Area Population Physician 80% 28 FN communities 21,456 Clinic or Hospital 5% SL FN residents 1,295 15% SL non-fn residents 4,041 Diagnostic/ treatment Source: 2001 Census Discharge Home Care

6 Ill SLMHC Catchment Area Population Nursing Outpost - Triage - Call to MD Send to MD Scheduled MD Visit 15% SL non-fn residents 4,041 5% SL FN residents 1,295 NIHB screens/books Escort? 80% 28 FN communities 21,456 Flight south/airport kiosk/ground transport Source: 2001 Census HOSTEL, etc. X 130/day Clinic or Hospital Culture/Language Diagnostic/treatment Discharge ALC HOSTEL, etc. X 130 Flight north Home LTC Home Care (rarely available locally)

7 DIMENSIONS of PATIENT SAFETY Developing a culture of safety Adverse Events Infection Control Inform educate - communicate Worklife Cross-cultural patient safety

8 : WHY IS THIS AN ISSUE FOR MENO YA WIN? Patient care is sometimes compromised because of failure to understand cultural implications and issues. Four Party Agreement principles and commitments. Interpretation challenges. Problematic discharges to communities. 3 incidents involving mishandling of fetal remains. Sam McKay letter re family members. Unexpected death of Mishkeegogamang First Nation member in October

9 3 Miscarriages resulted in pathology exams at our regional lab Following local practice, the specimens were returned to the families for burial. Where is my Baby? P.O.C.!

10 An old man died in hospital Not unexpectedly. except to the family They had not understood the explanation of his condition but didn t want to show disrespect to the doctor

11 The common thread on these and many other issues, in reality, adverse events, is cultural diversity.

12 : WHAT IS CROSS-CULTURAL PATIENT SAFETY? Definition: Cross-cultural patient safety occurs through building a culturally-integrated organization developing culturally-congruent staff requiring and suppoprting culturally competent practice and the effective delivery of health care services across barriers to understanding and identifying patient or client needs and by surmounting obstacles to implementing prescribed remedial or supportive actions. There are numerous impediments and other cross-cultural issues that arise from diversity in service and provider populations. Taken from Achieving Cultural Safety in Health Services: Understanding and Responding to the Underlying Cultural Factors. Walker and Cromarty, Sioux Lookout Meno-Ya-Win Health Centre working paper. 2006

13 ANALYTICAL FRAMEWORK In our practice these impediments include Language Culture Practice Context Systems Genetics Racism/Discrimination Power History Politicization and other issues that arise from diversity in service and provider populations.

14 These cross-cultural issues apply to any diverse population in care whether indigenous, assimilated or migrant.

15 100.0% Language Characterisitics of the Aboriginal Identity Population 80.0% 60.0% Note: The Sioux Lookout Meno-Ya- Win Health Centre catchment population uses 3 distinct language families and 19 or 20 separate dialects in addition to English and some French. 40.0% 20.0% Aboriginal Language Fluency 0.0% Dryden Parry Sound Kenora District Sioux Lookout Sandy Lake Mishkeegogamang Deer Lake Lansdowne House Fort Severn Webequie Poplar Hill SLMHC Catchment Area Source: 2001 Census

16 100.0% Language Characterisitics of the Aboriginal Identity Population 80.0% 60.0% Note: The Sioux Lookout Meno-Ya- Win Health Centre catchment population uses 3 distinct language families and 19 or 20 separate dialects in addition to English and some French. 40.0% 20.0% Aboriginal Language Fluency Speak only English 0.0% Dryden Parry Sound Kenora District Sioux Lookout Sandy Lake Mishkeegogamang Deer Lake Lansdowne House Fort Severn Webequie Poplar Hill SLMHC Catchment Area Source: 2001 Census

17 Linguistic Competence Supports LEP clients to ensure understanding of and by providers Recognizes that language and culture are interconnected Language reflects culture while shaping it at the same time Culture shapes our thinking, which in turn shapes our language

18 This powerful interrelationship affects all human interactions; Linguistic competence involves more than just the ability to speak and understand another language; It involves the knowledge of the cultural orientation that helps create meaning from language.

19 What do you really know about medical conditions, diagnoses, treatment processes, drug regimens, technology, or other clinical encounters? What about languages which have no words to describe medical conditions, diagnoses, treatment processes, drug regimens, technology, or other clinical encounters? How do you deal with access and navigation challenges in a foreign environment?

21 What does it mean to be medically literate?

22 The real need is for not just linguistic interpreters, but for cultural interpreters!

24 Program or Practice differences You re killing my people with your food. Chief Donny Morris Kitchenuhmaykoosib Inninuwug First Nation

25 Context or Structural differences

26 Systemic differences 4 southern Communit ies 7,359 people 28 First Nation Communitie s 22,135 people Area = 385,000 km 2

Genetic differences Prevalence of Diabetes, as an example 250 Rates of CAD Admissions 1980-1996: MYW First Nation Communities compared to

6% The illness burden in our northern communities is extremely high.

27 Genetic differences Prevalence of Diabetes, as an example 250 Rates of CAD Admissions : MYW First Nation Communities compared to Northern Ontario and All of Ontario 30% + 16% Winnipeg Red Lake Hudson Pickle Lake Savant Lake % The illness burden in our northern communities is extremely high. In many instances it exceeds virtually all other areas in Canada, not just Ontario, and in some cases ranks close to highest in the world! 6% Native Communities Northern Ontario Ontario

28 Racism/Discrimination

29 Power, History and Politicization of Health

31 What is known about cultural barriers to safe patient care? Access to care, quality of care and clinical safety are all impacted by cultural issues. Numerous approaches to describing cultural barriers to patient safety have been developed. These taxonomies do not provide a useful set of tools for defining ing the nature of the problem and consequently do not establish a sound base for problem-solving.

32 . What does the SLMHC study add? A simple, validated analytical framework for defining the root cause(s) of culturally embedded patient safety issues is provided.

34 . What does the SLMHC study add? Reinforcement for the position that while cultural competency may be defined by the service provider, cultural safety is defined by the client.

35 Meno-Ya-Win is Ontario s first First Nations Hospital

36 . What does the SLMHC study add? A beginning point for developing input, assessment and outcome indicators is provided.

37 Barrier Potential SLMHC Performance Indicators Magnitude Input/Activity Outcome Average interpreter time per client allocated to assist clients to understand clinical terminology or to navigate the system 1. Medical Literacy Proportion of clients seeking assistance to understand clinical terminology or to navigate the system 2. Linguistics Proportion of clients receiving language interpretation assistance in clinical transactions 3. Cultural Differences Proportion of reported incidents with the root cause identified as cultural difference Average interpreter time per client allocated to assist clients or providers to communicate Average interpreter time per client allocated to assist clients or providers identify and understand cultural differences Proportion of staff completing cultural competency training Polarity and rate of change in reported incidents identifying medical literacy as a root cause Polarity and rate of change in reported diagnostic, treatment or compliance incidents resulting from failure to communicate Polarity and rate of change in reported diagnostic, treatment or compliance incidents resulting from failure to communicate Proportion of clients accessing one or more elements of the SLMHC traditional healing, medicines, foods and patient supports program Mapping Cross-Cultural Patient Safety: Identifying Barriers and Developing Performance Indicators Walker, St. Pierre-Hansen, Cromarty, Kelly and Minty, 2009

38 . What does the SLMHC study add? Establishes an agenda of adjusting clinical patient safety and other risk management programming to incorporate cross-cultural barriers into reporting, measurement, evaluation, prevention and prospective programming

39 SLMHC Complaints Review Process Complaint Investigation Determination of Material Facts Determination of Root Causes Review Cultural Issues Consult with Elders and/or First Nations Health Advisor Change in Practice, Policy, etc. Implementation Education Redirection Communication with Patient, Family, Leaders, Community Evaluation Further Adjustments

40 Change Behavior and Mindsets Practice Standards and Guidelines Performance monitoring Best Practices Collaborate in the creation and sharing of knowledge Becoming a Center of Excellence in delivering First Nations health services Partnerships

41 WHAT ARE OUR CANADIAN RESPONSES? many good things happening but generally in isolated pockets need for a policy context need for a Charter need for standards of practice need for a regional/provincial/ national dialogue

42 WHAT ARE OUR CANADIAN RESPONSES? Access Quality Cost Safety Cross-Cultural Patient Safety

43 Kinanakomininawah Meegwetch Thank you

Goal #1: Mastery of Clinical Knowledge with Integration of Basic Sciences

Goal #1: Mastery of Clinical Knowledge with Integration of Basic Sciences Objective #1: To demonstrate comprehension of core basic science knowledge 1.1a) demonstrate knowledge of the basic principles