Progress in Setting Standards for Cultural Competence in

Aotearoa/NZ

Dr David Jansen MBChB, MRNZCGP, BHB, BA (Māori ), Dip Tchg

Dr Peter Jansen MBChB, FRNZCGP, Cert Clin Tchg

Dr Kira Bacal MD, PhD, MPH, FACEP

HPCA Act 2003HPCA Act 2003

• Health Practitioners Competence Assurance Act 2003

• Has effect from 2004, based on earlier legislation – medical practitioners

• to protect the health and safety of members of the public by providing for mechanisms to ensure that health practitioners are competent and fit to practise their professions

Registration AuthoritiesRegistration Authorities

• Registration Authority to set standards – clinical competency– cultural competency– ethical behaviour

• Fifteen Ras under original legislation– Medical, Dental, Pharmacy, Nursing, Midwifery,

Chiropractic, Dieticians, MedRadTech, MedLabTech, Physio, Optom, OT, Osteopathic, Psych

• Scopes of practice, titles are protected

Progress this farProgress this far

• Some RAs have published a statement on cultural competency

• Mauri Ora Associates work– MCNZ: Statement on Cultural Competence– MCNZ: Best Health Outcomes for Maori: Practice Implications– MCNZ: Best Health Outcomes for Pacific Peoples: Practice

Implication– ACC: Guidelines on Maori Cultural Competencies for Providers– RNZCGP: Cultural Competence. Advice for GPs to create and

maintain culturally competent general practices in NZ

Progress this farProgress this far

• Dental, Physio, cultural competence statements based on MCNZ

• Pharmacy, Nursing have developed own standards

Progress this farProgress this far

• Medical Laboratory Science Board– Maori name – Te Poari Matai Oranga– Med Lab Technicians – phlebotomy, cryotech,

mortuary technicians– Code of Competency and Standards 2006– No recertification programmes exist yet– No accredited programmes yet

• Drug and Alcohol Counsellors• Medical Herbal Therapists

Branch Advisory BodiesBranch Advisory Bodies

• RNZCGP

• AFPHM – now NZ Council of Public Health Medicine

• RANZCP

• Others have no statements or resources.

RNZCGPRNZCGP

• Practice based– Focus on equal health outcomes, relationship

with community, all staff

• Behaviour based– Collect correct ethnicity, pronounciation,

involve family

• Competence with Maori, and with multiple cultures, Pacific, Asian…

AFPHM / NZCPHMAFPHM / NZCPHM

Identified 12 Cultural competencies:• 7 Universal cultural competencies • 3 Te Tiriti o Waitangi and Māori health • competencies • 2 Ethnic minority health competencies

Need mechanism for assessing and approving cultural competency educational activities and performance measures when cultural competence standards and recertification framework reviewed (2008)

Next StepsNext Steps

• Cultural competence curricula– Multiple options: communications, professionalism,

standalone

• Accredited training– In-house or accredited external providers

• Common shared foundation programme– Introductory, on-line, universal, amenable to further

specialist staircased programmes

• Require comprehensive approach– All doctors – registrars to CPD/recert

Branch Advisory BodiesBranch Advisory Bodies

Māori Health DisparitiesMāori Health Disparities

• Disparities in access and outcomes:– preventive services, – primary care services, – hospital services– mental health, – injury services, – home help, – income support, – complaints and compensation for medical

error, etc etc

SummarySummary

• Maori have the greatest levels of health inequality in New Zealand, with measures of mortality and morbidity showing significant gaps compared to non-Maori even after controlling for deprivation.

• Research in New Zealand shows large disparities in a large number of levels (access, outcome etc), in a large number of health areas (cancer, diabetes) and in a large number of services (GP, ACC).

Research shows…Research shows…

– Promotes a better exchange of information**

– Improves decision making*– Builds trust**±

– Improves medical outcomes**

– Avoids medical errors**– Increases compliance with

treatment plans* ^^– Improves patient

monitoring of physiological values (such as blood sugar, BP)***

– Enhances patient and provider satisfaction^

– Brings patient expectations into line with reality**

– Reduces patient anxiety**– Increases behavioral

change to healthier lifestyles^^

– Improves patient understanding***

– Enhances patient recall of information***

•National Breast Cancer Centre and National Cancer Control Initiative. 2003. Clinical practice guidelines for the psychosocial care of adults with cancer. National Breast Cancer Centre, Camperdown,NSW; ^ Devine & Westlake, Oncol Nurs Forum, 1995 ;22:1369-81; ** Saxton &

Finkelstein, Phys News Dig, Nov 2003; Beck et al, J Am Bd FP 2002, 15(1):25-38; DiMatteo R in Gochman DS’ Handbook of health behaviour research II, New York: Plenum Press, 1997, ***Lussier & Richard, Can FP 2004, 50:43-8

•±Pacific Health Research Centre 2003

Effective communication between patients and providers:

Issues for IdentityIssues for Identity