Cultural Competence

in Healthcare Oleh : Arief Alamsyah

Have you ever heard this words ?

 “Masuk angin”
 “Sangkal putung”
 “Tarak/pantang”
 “Suntik kanan kiri”
 “KB itu haram”
 “Dukun bayi”
 “Kesambet”
 ..............................
Culture
 A system of thoughts & behaviors shared by a
group of people
 Our cultural backgrounds have tremendous
impact on our lives
Culture may include all or a subset of following characteristics :

 Ethnicity
 Language
 Religion and spiritual beliefs
 Gender
 Socio-economic class
 Age
 Sexual orientation
 Geographic origin
 Education
 Etc...
Cultures includes more than just etnicity
What are the health problems related to this
picture ?
 Allergy
 Infection
 Scars
 Hepatitis B and C
 etc

Cultural differences affect patients’ attitudes about medical care

and their ability to understand, manage, and
cope with the course of an illness, the meaning of a diagnosis, and
the consequences of his/her behavior.
Tahnik
 According to Islam, a
chewed date, honey
or something sweet
may be rubbed into
an infant’s palate
(Tahnik)
 What are the health
problems related to
this picture ?
 .......................
 .......................
In Class Activity

 List 5 things that make you a special (unique)

individual :

 ....................
 ....................
 ....................
 ....................
 ....................
 Unique individuals need
Patient Centeredness and Cultural
Competence

Patient Centeredness :
“Physician tries to enter the patient’s world,
to see the illness through the patient’s
eyes.”
(McWhinney-The father of family medicine in Saha et.al, 2008)
Five Dimensions of Patient Centeredness
(Mead and Bower, 2000)

 Adopting to biopsychosocial perspective

 Understanding the patient as a person in his
or her own right, not merely as body with an
illness
 Sharing power and responsibility between
doctor and patient
 Building a therapeutic alliance (healing
relationship)
 Understanding the doctor as a person, not
merely as a skilled technician
Cultural Competence Continum
(Goode,2004; Association of Medical Colleges,2005)
The Cultural Competence
Continuum
There are six points along the cultural
proficiency continuum that indicate unique
ways of perceiving and responding to
differences.
 Cultural Destructiveness
 Cultural In-capacity
 Cultural Blindness
 Cultural Pre-Competence
 Cultural Competence
 Cultural Proficiency
Cultural Destructiveness

“See the difference; stomp it

out.”
Using one’s power to eliminate the culture of
another.

Examples
 Genocide or Ethnocide
 Avoid certain beliefs
Cultural Incapacity

“See the difference; make it wrong.” – Silent

discrimination
Believing in the superiority of one’s own culture
and behaving in ways that disempowering
another’s culture.

Examples
 Disproportionate allocation of resources to certain
groups
 Lowered expectations
Cultural Blindness
“See the difference; act like you
don’t.”
Acting as if cultural differences do not matter or as
if there are not differences among/between
cultures
Examples
 “I don’t see color. We are all the same.”
Cultural Pre-Competence

“See the difference;

. respond to it
inappropriately.”

Examples
 Frustation because of the patient’s style in
communication
Cultural Competence

“See the difference; understand the

difference that difference makes.”
Cultural competence in health care describes the ability of
systems and health care professionals to provide high quality
care to patients with diverse values, beliefs and behaviors,
including tailoring delivery to meet patients social, cultural
and linguistic needs.

(Commonwealth Fund, Cultural Competence in Health Care

Report, 2010)
Examples
“You are you. I am me. But together, we are we.”

“It is important to look at someone else’s perspective and try to

understand it.”
Cultural Proficiency
“See the difference; respond positively.
Engage and adapt.”
Esteem culture; knowing how to learn about
organizational culture; interacting effectively in a
variety of cultural groups.
Examples
 Interdependence
 Personal change and transformation
 Alliance for groups other than one’s own
Cultural Competence/Proficiency in
healthcare practice (Saha et.al,2008)

Within Healthcare
Organizations:
Ability of the organization to meet
needs of diverse groups of patients

Within Interpersonal interactions :

Ability of a provider to bridge cultural
differences to build an effective
relationship with a patient
Within Healtcare Organizations
 Diverse workforce reflecting patient
population
 Healthcare facilities convenient and attentive
to community
 Language assistance available for patients
with limited “bahasa Indonesia” proficiency
 Ongoing staff training regarding delivery of
culturally and lingustically appropriate
services
Within Interpersonal Interactions
 Explore and respect patients
beliefs, values, meaning of illness,
preferences and needs
 Builds rapport and trust
 Finds common ground
 Aware of own biases/assumptions
 Knowledgeable of different
cultures
 Aware of health disparities and
discriminationaffecting minority
grouups
 Effectively uses interpreter
services when needed
Cross Cultural Communication Model

 BATHE Model
 BELIEF Model
 RESPOND Model
 ESFT Model
 ETHNIC Model
 LEARN Model
 SPACE Model
SPACE Model- Basic of Social Intelligence
Situational
(Goleman, 2007)
Awareness
 the ability to read situations and to interpret the behaviors of people in those situations, in
terms of their possible intentions, emotional states, and proclivity to interact;
 Presence
 it’s a whole range of verbal and nonverbal patterns, one’s appearance, posture, voice
quality, subtle movements
 Authenticity
 To be honest when we do not know a particular things and need to refer to
specialist/expert
 Clarity
 the ability to explain ourselves, illuminate ideas, pass data clearly and accurately, and
articulate our views and proposed course of action, enables us to get others to cooperate
with us
 Emphaty - Respect
 a shared feeling . In this connotation we will consider empathy a state of ‘connectedness’
with another person, which creates the basis for positive interaction and cooperation.
LEARN Model for Cross Cultural
Communication (Berlin and Fowke,1983)
 Listen
 Listen with empathy and understanding to the patient's
perception of the problem
 Explain
 Explain your perceptions of the problem
 Acknowledge
 Acknowledge and discuss the differences and
similarities
 Recommendation
 Recommend treatment
 Negotiate
 Negotiate agreement
Some cultural characteristics in Indonesia that related to
doctor-patient communication
(Claramita et.al, 2013)

 The strong nonverbal ettiquette of

politeness
 The use of traditional
medicine/traditional healer
 The strong family support system
 The strong religiousity/spirituality
 Hirarchical culture from spiritual
guru/traditional leader (“Ulama/kyai, kepala
suku”)
Overlap between patient centeredness and cultural competence (Saha et.al, 2008)
Barrier of cultural competence :
Stereotyping

Stereotypes are assumed
characteristics based on a large group of
individuals whose beliefs, habits, and actions
are similar .
 Education can help us overcome stereotypes.
Tanpa saudara kita etnis Cina, Indonesia
tak pernah Juara All England
Elias Pical (Maluku) – Petinju Legendaris
Indonesia
Anak Papua tidak BODOH bahkan
Juara “First step to nobel Prize”
 Respect Others....

Let’s make the better world...thank you