Quantitative and Qualitative Findings and Implications of an Intercultural Sensitivity Assessment Among Employees at a Large Health System

Tuesday, November 10, 2009: 2:45 PM Jarret R. Patton, MD , Department of Pediatrics, Lehigh Valley Health Network, Allentown, PA Jay Baglia, PhD , Department of Family Medicine, Lehigh Valley Health Network, Allentown, PA Lynn M. Deitrick, RN, PhD , Department of Community Health, Health Studies and Education, Lehigh Valley Health Network, Allentown, PA Anthony Nerino, MA , Department of Community Health, Health Studies and Education, Lehigh Valley Health Network, Allentown, PA Eric J. Gertner, MD, MPH , Department of Medicine, Lehigh Valley Health Network, Allentown, PA Judith N. Sabino, MPH , Cultural Awareness, Lehigh Valley Health Network, Allentown, PA MaryKay Grim, BS , Human Resources, Lehigh Valley Health Network, Allentown, PA Debbie Salas-Lopez, MD, MPH , Department of Medicine, Lehigh Valley Health Network, Allentown, PABackground: As our nation welcomes people from many cultures, it is essential that healthcare providers understand the cultural background of their patients. In response to this diversity, community hospitals are systematically strengthening and improving services to address the cultural needs of their multi-cultural patient populations. As part of a multi-faceted, system-wide cultural awareness initiative, our health network conducted a baseline intercultural sensitivity assessment of its employees. Research Objectives: To establish measures of intercultural sensitivity among employees through the use of a validated instrument. Population: 9,000+ physicians, nurses, technicians and non-clinical employees of a large health network in mid-Eastern Pennsylvania. Methods: All employees were invited to complete the IRB-reviewed, web-based Intercultural Sensitivity Scale (Chen and Starosta 2000). The ICS scale measures attitudes about interacting with people from different cultural backgrounds. The five sub-scales include: 1) interaction engagement, 2) respect for cultural differences, 3) interaction confidence, 4) interaction enjoyment, and 5) interaction attentiveness. Three open-ended questions asked how the network could enhance cultural sensitivity. Two other questions asked for learning preferences (i.e., e-learning, Grand Rounds) and topic information (i.e. diet, religious practices). Demographic information (i.e., age, position, years of service hospital) was also acquired. Results and Conclusions: A 35% (n=3446) response rate was achieved. Characteristics of the respondent sample were highly similar across age, length of employment, racial and ethnic status, gender and proportions of staff positions. With regard to two of the five sub-scales, the survey revealed relative strength in interaction enjoyment while respect for cultural differences exposed an interesting bi-modal distribution – with many staff achieving perfect scores in this area and another large contingent scoring well below the mean. Baseline measures informed educational interventions, assessed training needs, enabled evaluation of interventions, and revealed individual and/or institutional factors that impeded or enhanced responses to patient experiences of healthcare disparities. Initial findings suggest general staff preferences for diversity workshops and cultural fact sheets as the preferred mode of instruction. Employees requested information about religion, attitudes about death and dying, and attitudes about health care institutions relevant to cultures represented in our local community. Practice Implications: Baseline results are used to direct network initiatives (i.e. creating health information repository, ensuring language-appropriate services, and strengthening educational programs) and to measure intervention outcomes. Along with obtaining uniform racial/ethnic patient data, this information is essential in comprehensive organizational change regarding culturally-appropriate service delivery and will ensure the delivery of equitable health care. Learning Objectives: 1. Explain how quantitative and qualitative results inform system-wide planning related to cultural competency. 2. List the key findings from this assessment 3. Describe a research methodology to measure the intercultural sensitivity of a health care organization employee population. Keywords:Cultural Competency, Hospitals Presenting author\u27s disclosure statement: Qualified on the content I am responsible for because: I am co-chair of Lehigh Valley Health Network\u27s Cultural Awareness Initiative. The abstract describes a baseline assessment that was part of this initiative. Any relevant financial relationships? No I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation

Mad Men as health communication: health-related themes in the hit AMC television series.

As a popular contemporary text, the appeal of cable television\u27s Mad Men (AMC) lies in its capacity to highlight the differences between 1960s sensibilities and 21st-century assumptions. Viewers can enjoy a sense of superiority by recognizing the folly of the beliefs and actions of the characters with the benefit of historic hindsight, as well as noting the evolution of technology, philosophy, and human rights. Health-related scenes and themes in the series are a particularly interesting focus for analysis. We employ Burke\u27s four master tropes as an analytical lens and argue that the dominant dramatic technique of irony, particularly in the form that we call strategic anachronism-derived from an audience\u27s enjoyment of historical hindsight-highlights the racism, sexism, homophobia, and overall conservatism of the early 1960s while simultaneously serving to obfuscate the ways in which we still have much to critique in the delivery of contemporary health care and other body politics

Transforming emergency medicine through narrative: qualitative action research at a community hospital.

Emergency departments struggle daily to save lives in an environment characterized by staff shortages, limited resources, and an expanding patient population. This qualitative action research study focused on the nature of communication in an urban emergency room (ER) and the organizing practices employed by staff to cope with these environmental changes, highlighting disconnects between current practices and traditional models of emergent care. A narrative description of the ER culture served as an impetus for practical improvements at this site, providing staff with both a unique perspective and a useful tool for improving their emergency care practices

Generating developmentally appropriate competency assessment at a family medicine residency.

BACKGROUND AND OBJECTIVES: Ten years after the Accreditation Council for Graduate Medical Education\u27s (ACGME) mandate that residency programs evaluate learners\u27 competency, research is needed to guide efforts to meet this challenge. During an innovative residency redesign, the authors developed a process to effectively measure competence. This particular family medicine residency admits six residents per class year and is sponsored by an academic community hospital. Our objective was to generate developmentally appropriate observable behaviors that assess competencies. METHODS: Eight steps guided the development of this assessment system: (1) Generate residency-specific competencies, (2) Define residency-specific competencies, (3) Identify principles of assessment, (4) Compose and analyze narratives of excellence within each competency, (5) Distill standard statements from narratives and organize into Dreyfus levels of competence, (6) Derive observable behaviors from standard statements to directly correlate behaviors and competency levels, (7) Design assessment tools (based on observable behaviors) for six residency learning sites, and (8) Translate assessment tools for ACGME competencies. RESULTS: The results of this process include an assessment system that (1) features six tools used with strategic frequency throughout the academic year and (2) generates global assessment of residents\u27 performance in both ACGME and residency-specific competencies. CONCLUSIONS: Narrative reflection was an effective method to tie observable behaviors to competencies. The process was time intensive; however, greater efficiency and enthusiasm is expected in the use of these assessment tools, with greater confidence in the program\u27s capacity to assess training outcomes. Future research should include comparison of these tools with those of other programs