RACMA THE ROYAL AUSTRALASIAN COLLEGE OF MEDICAL ADMINISTRATORS

Transcription

1 Cultural Competence for Medical Administrators in Australia and New Zealand RACMA Cultural Competence Position Paper SCOPE The Royal Australasian College of Medical Administrators (RACMA) and its members are uniquely able to influence and facilitate Cultural Competence at a national, state, regional, organisational and departmental level. Cultural Competence for Medical Administrators in Australia and New Zealand is the second position paper to be published in a series of statements pertaining to the issue of Cultural Competence. RACMA is committed to improving the health status of all in our care by educating and supporting our Candidates, Fellows, Associate Fellows and Affiliates to provide health care environments that are culturally appropriate, sensitive and inclusive. The College facilitates this by delivering Cultural Competence education through our Fellowship Training and Continuing Education Programs, involving stakeholder representatives on relevant committees, and encouraging diversity and inclusivity within each Candidate intake. Context Acknowledges that the term Cultural Competence includes consideration, respect and accommodation of a range of population groups whose diversity may encompass age, gender, language, spiritual and secular beliefs, ethnicity, sexual orientation and lifestyle. Acknowledges that Culturally and Linguistically Diverse (CALD) communities may view health and illness differently from each other and that these perspectives may be interconnected to the land, environment, family, spirituality, history, physical body, community, relationships and the law. Acknowledges that populations will continue to become increasingly diverse and multicultural. Understands that recognition and acceptance of cultural differences is imperative to the safe and effective management of health care systems and patient needs. Acknowledges that the issues and historical context of indigenous peoples are different from those experienced by non-indigenous peoples, and commits to the elimination of inequality of health status of indigenous peoples in constituent countries. Acknowledges the unique place that Māori occupy in New Zealand society as the tāngata whenua and the statutory significance of the Crown s Treaty of Waitangi relationship with Māori. Acknowledges that multicultural diversity is reflected in the health workforce that Fellows of the College may be responsible for leading and managing. Fellows must ensure that the specific needs and strengths of members of their workforce who affiliate with any cultural or ethnic minority are recognised, supported and valued. Acknowledges that as diversity develops within the College membership, Fellows of the College will need to apply Cultural Competence principles to interactions with Fellows and Candidates and others within the College.

2 Systemic Application Commits to introducing a cultural impact assessment to the creation or revision of relevant College policy and procedures. Within this assessment, the impact on Indigenous peoples requires specific consideration. Commits to making explicit its awareness of cultural implications in its communications, relationships, joint partnership arrangements within its membership and with other medical colleges, government officials, universities and non-government organisations, and to the promotion of cultural awareness within these organisations. Commits to researching options to secure consumer involvement and participation in College policy, business and curricula development and to following up appropriate options with actions. Acknowledges that this is a constantly evolving area and commits sufficient resources to enable the College to stay abreast of developments, publications, studies, policies and projects that will influence relevance and accuracy of the College s educational programs and position statements, and revise them accordingly. College Operations Is committed to providing basic training in cultural competence and its relevance to the leadership and management of health services, to RACMA Board members, Committee Office Holders and College staff. Is committed to affirmative action in recruitment of members of currently under-represented cultural minority groups such as Maori, Aboriginal and Torres Strait Islanders into the College, as Fellows, Associates, Affiliates and equally importantly, as staff members and advisors. Affirmative action includes additional support for these Candidates during their training. Auspices a Cultural Competence Working Party comprised of Fellows, Candidates and Indigenous community representatives to advise the Curriculum Steering Committee regarding educational and policy developments. Prioritises the development and delivery of a suite of Cultural Competence resource materials for use in the Fellowship Training Program and Continuing Education Program, available to all College members. Is committed to ensuring Candidates demonstrate an appropriate level of Cultural Competence before Fellowship is granted, as well as meeting the particular legislative requirements of each country. Appropriate in New Zealand includes understanding and being able to speak about the duties of health care providers to fulfil their Treaty obligations. Professional Recognises the disparity in access and utilisation of health services experienced by Indigenous people and the need for medical administrators to lead the reduction in such inequalities through advocacy and the professional practice of medical administration. Will develop specific standards for medical administrators to comply with existing professional standards (e.g. Medical Council of New Zealand (MCNZ), Australian Medical Council (AMC)) applying to curriculum and learning objectives, assessment and monitoring processes. Is committed to the full integration of Cultural Competence into its curricula for Fellowship training, and continuing education and assessment for practising Fellows. Page 2

3 Is committed to developing a specific guideline/resource to support continuous skill development with respect to the application of Cultural Competence in the workplace. (Bank of case studies, published papers, key policy documents) Individual Fosters the continuous professional development and learning of associated skills in the management of change throughout its membership. Commits to the provision of continuing support and education with respect to Cultural Competence, health disparity, inequalities and overall performance of the health system. Supports RACMA members to recognise disparity with respect to the access and utilisation of health services experienced by culturally and linguistically diverse (CALD) populations with a particular emphasis on rural, low socioeconomic and high needs communities/regions. Supports RACMA members to raise issues constructively in the public domain when appropriate. BACKGROUND The Concept of Culture Culture includes the beliefs, behaviours, objects and other characteristics common to the members of a particular group or society. Through cultural practices, people and groups define themselves, continually evaluating their place within wider society. Cultural diversity is not restricted to ethnicity, but also encompasses age, gender, spiritual and secular beliefs, sexual orientation, lifestyle and perceived social status. Culture is expressed through a variety of behaviours including language, customs and mores, values and rules, tools and technology, group and familial structures, and institutions. The term institution refers to clusters of rules and cultural meanings associated with specific social activities. Common institutions are the family, education, religion, work and health care. Definitions of Cultural Competence There are several definitions of cultural competence, including: 1. Behaviours, attitudes, and policies that enable systems, organisations, professions, and individuals, to work effectively in cross-cultural situations 1 Cultural competence requires an awareness of cultural diversity and the ability to function effectively, and respectfully, when working with and treating people of different cultural backgrounds. Cultural competence means a doctor has the attitudes, skills and knowledge to achieve this. 2 Cultural Competence is the ability to interact effectively with all people who possess cultures and belief systems different to your own. 3 Page 3

4 Why is Cultural Competence important in Australasia? The Commonwealth Government defines cultural identity as the right of all Australians, within carefully defined limits, to express and share their individual cultural heritage, including their language and religion. 4 Both Australia and New Zealand populations comprise a combination of Indigenous peoples and centuries of immigrants: convict, settler and post-settlement. Particularly in the twentieth century, this continues to challenge each country to define its national identity, and to question what it means to be an Australian or a New Zealander. While cultural assimilation and the melting pot used to be the prevailing concepts underpinning immigration, in recent decades, this has changed to models of multiculturalism and the salad bowl where different ethnic and cultural groups reside side by side, maintaining their beliefs and practices while living in a new society. Particularly from the late 1970s, such concepts have integrated into all sectors of Australasian society, reflecting the high level of culturally and linguistically diverse populations resident in each country. Everyone has a right to health care, and health service providers, managers and practitioners are increasingly accountable for meeting the needs of diverse populations. Accordingly, the health care system needs to be flexible and responsive. However, extensive research demonstrates that health policies, procedures and practitioners do not always cater adequately for this diversity. Barriers - both apparent and perceived - include disparities in accessing health services, unsuitable services, and inequalities in resource allocation. A lack of community input into health decision-making can also adversely impact on a population or sub-population. (Refer to RACMA Position statement on Indigenous Health). In New Zealand, prioritising the improvement of Māori health and reducing population inequities is embedded in legislation and government policy and strategy, beginning with the Treaty of Waitangi (1840). Additionally, the New Zealand Health Practitioners Competence Assurance Act 2003 (HPCAA) requires health professional registration authorities (such as the New Zealand Medical Council) to ensure registered health professionals adhere to set standards for clinical competence, cultural competence and ethical behaviour. Accordingly, The Medical Council of New Zealand requires medical colleges to embed the learning and maintenance of cultural competence into training program curricula, and medical practitioners must meet and maintain cultural competence in clinical practice. By contrast, in Australia there is currently no legislation that mandates cultural competence in health contexts. However, the National Health and Medical Research Council Guideline, Cultural Competency in health: a guide for policy, partnerships and participation, presents four principles for cultural competence, including: 1. Engaging consumers and communities and sustaining reciprocal relationships. 2. Leadership and accountability for sustained change. 3. Building on strengths know the community and know what works. 4. A shared responsibility creating partnerships and sustainability. 5 Page 4

5 This guide also outlines a model for action which suggests that actions to improve and strengthen cultural competence can occur across four domains encompassing systems, organisations, professionals and individuals. These concepts are presented diagrammatically below: Source: Research and consultation report commissioned for NHMRC project. The table below provides examples of actions at each of these levels that help support and facilitate cultural competence: Table 1: Actions to Facilitate Cultural Competence Systemic Organisational Professional Individual Effective polices & procedures Monitoring mechanisms Sufficient resources available Involvement of diverse communities in policy development Support is provided for professionals to work with diverse communities Develops and sustains an organisational culture that values cultural competence Cultural competency is valued, integral to core business, supported and evaluated Skills & resources to support diverse clients is available Management is committed to diversity management Support to professionals Cultural competency is part of education & professional development Professions develop cultural competence standards Guidance provided for working lives of individuals Individuals develop awareness and knowledge, of cultural attitudes, behaviour Individuals develop relevant communication and promotion tools & resources Page 5

6 Why is Cultural Competence important in health services management and leadership? Health system leaders and managers play a key role in building the capacity of the health system and determining how services are organised, funded and evaluated. Improving the quality and appropriateness of health care services, reducing inequalities and optimising health outcomes by deciding how resources are allocated and utilised, are central to the roles and responsibilities of medical administrators. Ensuring equity of access includes communication with the communities concerned to ensure services are adequate, and monitoring primary care referrals to secondary services. A medical manager must lead and influence at every level (systemic, organisational, professional, and individual) 6 in order to institute change and drive quality improvement in cultural competence. Medical managers establish organisational priorities, direct financial allocations and lead change from their positions of authority and influence. Therefore they are well positioned to advocate and institute change, and to engender an organisational culture which caters for and does not unintentionally discriminate against ethnic and cultural minority groups. Additionally, governance, management and leadership of the current health workforce and training of the future workforce, requires a medical leader and administrator to understand how cultural biases impact on decision making, management practices and individual behaviours in the workplace. This insight must then be reflected in service planning. While respect for different cultures must be embedded in health care settings, medical managers must also be able to advise practitioners when patients may seek unethical practices or refuse to take medical advice due to their cultural beliefs or practices. An organisation that gains skills in Cultural Competence increases its ability to provide quality care for everyone in its catchment population. References 1. National Health and Medical Research Council, Cultural Competency in Health: a guide for policy partnerships and participation, December Retrieved 6th March 2013 from 2. Medical Council of New Zealand. Cultural Competence and Patient Centred Care. 3. New South Wales Department of Health, Cultural Competence, May Retrieved 6th March 2013 from 4. Department of Immigration, National Agenda for a Multicultural Australia, Retrieved 6 th March 2013 from 5. National Health Medical Research Council, Cultural Competency in health: A guide for policy, partnerships and participation. Retrieved 6 th March 2013 from 6. The Royal Australasian College of Medical Administrators, Medical Leadership and Management Competency Framework, Authors: RACMA Cultural Competence Working Party, Dr Bernard Street, Sue Jansen and Juliet Buchanan. Page 6