Cultural Safety
ASHNA Presentation
February 14, 2017
Vision: Alaska Native people are the
healthiest people in the world
Our Mission: Providing the highest quality health services in partnership with our
people and the Alaska Tribal Health System
Patient and Family Centered
Organizations are continually
recognized as demonstrating the best
operating system for health care
delivery.
Objective
∗ To share how cultural safety and alignment of engagement
strategies can improve patient safety and quality of care
Discussion points:
- Diversity of Native communities
- Patient and family centered care
- Cultural Competency
- Health literacy
Diversity of Native Communities
The Challenges
∗ Alaska Native & American Indian
people experience higher rates of
poor health outcomes then any
other ethnic group in the U.S.
Focus Area:
∗ Diversity of culture between and
within individuals and communities
∗ Language
∗ Availability of health care services
∗ Geographic isolation
∗ Recruitment/retention of health
care providers
∗ Health literacy
Project Period SMART
Objective:
Strategy:
Annual SMART
Objective:
Project Period
Outcome
Measure (Data
Source):
Potential
Number of
People reached
Collaborating
Organization(s)/Grou
p(s)
Community
Sector(s)
Reached
Activities to meet
objective
Milestone/Prod
Person
Responsible (who ucts
will do the work)
Annual Outcome
Measure (Data Source)
Q1
Due Date
Q2
Q3
Q
4
Nurse Leader and Patient
Perspective
Nurse Leader Rounding and HCAHPS Patients Perspective Results
Feb 1, 2016- Jan 31, 2017
100%
99%
97%
96%
98%
97%
95%
90%
85.9%
85%
82%
81.3%
80.6%
80%
75%
72.6%
71.4%
70%
65%
86.9%
63.6%
76.2%
87.2%
76.5%
74.1%
60%
62.5%
55%
50%
Nurse explain
Doctor explain
Pain well controlled
Nurse Leader Rounding (n=1032)
Staff courteous and
respectful. (HCAHPS
Nurse)
HCAHPS (n=[540-683]
Staff courteous and
respectful. (HCAHPS
Doctor)
national avg (bedsize 100-300)
Cleanliness
Engagement
Patient and Family-Centered Care
A continuous quality improvement approach that focuses on the quality of care
for two aspects of health care delivery:
∗ Consistency in care processes
∗ Trust in patient and staff interactions
∗ Flexibility of care through evidence-informed decision-making that
promote mutually beneficial relationships through:
∗ Respect and dignity
∗ Information sharing
∗ Collaboration
∗ Communication
Institute for Patient and Family Centered Care, 2013
Health Literacy
∗ “ability to obtain, process, and understand health
information and use that information to make
appropriate decisions about one’s health and medical
care.”
∗ Institute of Medicine, Committee on Health Literacy, 2004
Health literacy and the role of culture
The Largest Study Conducted to Date
on Health Literacy Found That…
33% Were unable to read basic health care materials
42% Could not comprehend directions for taking
medication on an empty stomach
26% Were unable to understand information on an
appointment slip
86% Did not understand the rights and responsibilities
section of a Medicaid application
60% Did not understand a standard informed consent
Source: Williams MV, Parker RM, Baker DW, et al. Inadequate Functional Health Literacy Among Patients
at Two Public Hospitals. JAMA 1995 Dec 6; 274(21):1,677–82
Culture and our cultural lens
∗ Learned and shared behaviors of a community of
interacting human beings (Useem, J., & Useem, R., 1963)
∗ Culture describes the group, not the individuals in it
∗ Cultures are dynamic
∗ People often belong to more than one culture
∗ Some cultural groups have more power and authority
History of Cultural Safety
∗ New Zealand 1989- Concept began during a nursing
education leadership discussion in concern to
recruitment and retention issues of Maori nurses
∗ Aims to improve the delivery of respectful and
responsive services for Indigenous people
Engagement challenge
The impact of system transference
∗ Past experience with a system influences current
feelings and reactions
∗ Positive history results in more trust and optimism
∗ Negative history results in more distrust and pessimism
Acesconnection.com
The Golden Rule
Do unto others as you would have them do unto you
Surface culture visible: 10% of the Cultural Iceberg
Cultural
Awareness
•Acceptance
Cultural
Sensitivity
•Respecting
differences
•Neutral
communication
Cultural
Knowledge
•Familiarize
with selected
cultural
characteristics,
history, values,
beliefs
The Platinum Rule
Do unto others as they want done unto them
∗ Deep culture difficult to see: 90% of Cultural Iceberg
Cultural
Competence
•Applying
knowledge to
create a safe
environment
Cultural Humility
•Self-reflection
•Willingness to
see power
differences and
privilege
Cultural Safety
•Stresses
importance of
relationships,
power shift to
patient
•They decide
what is safe
and what is not
Maslow’s Hierarchy of Needs
www.pursuit-of-happiness.org
Connection to community
18
Best Practices, for who?
∗ Applying best practices to Alaska Native cultures can
create a barrier to healthcare access, incongruent
with culture
∗ Consider relationship-based care options that involve
family and community
∗ “Pima Pride” study with unstructured culture and
history had more positive outcomes on every biological
parameter measured (Narayan et al, Diabet Med
1998;15:66-72)
Engagement tips to help create a
safe healing environment
∗ There is no ‘right’ or ‘best’ way. You can learn a lot by
reflecting on your experiences and watching others
∗ Be aware of non-verbal communication and meaning
∗ Be willing to adjust your speed, tone, volume, pauses
∗ Be willing to share your story and listen to theirs
∗ Be mindful of the importance of community
Cultural Safety
∗ An environment that is safe for people; where there is
no assault, challenge or denial of their identity, of
who they are and what they need. It is about shared
respect, shared meaning, shared knowledge and
experience, of learning, living and working together
with dignity and truly listening.
Health Quality Forum, 2012
Thank you.
Questions
Contact:
Sadie Anderson, RN MSN
Peggy Porter, RN MBA
Karla Weise, RN MPH