4.1 Responsiveness to diversity
Being responsive to diversity means understanding that each individual is unique and recognising their individual differences. There are many dimensions to diversity, which include not only ways of being, but also ways of thinking and believing.
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The practice is knowledgeable about the diverse groups within its enrolled populations (for example transgender, refugees, etc) and plans and provides for their health care needs.
Some examples of diversity in populations are:
- Sexual orientation
Identifying diverse groups using practice data and pursuing equitable outcomes
New Zealand has a highly diverse population including a variety of different cultural groups. In planning for care it is helpful to capture patient information and data as this could influence the services you provide and how you provide them, as well as the training and skills the team may require delivering these.
The practice team can often determine a patient’s cultural connections by asking their ethnicity, hobbies, profession and other aspects of their life. Practice teams can also directly ask if there are any elements the practice needs to be aware of that are important to the patient (e.g. religious beliefs may influence end-of-life care plans). In this way the practice can create a culturally safe environment. When collecting information from patients, you must comply with the Health Information Privacy Code 2020.
Audits run on your practice data can be used to implement initiatives to embrace diversity, inclusion and equity which can be included in the Quality plan (criterion 8.2)
Some examples of improvement initiatives may include:
- Posters and leaflets in other languages (these may be available through the DHB).
- Evening or weekend clinics .
- Involving patients (for example, on an advisory panel, or by focus group or surveys) and using their feedback to come up with ideas.
- Providing kaiāwhina support for Māori patients and whānau in response to Māori patient requests for cultural and spiritual assistance and pastoral care.
Cultural safety and cultural competence
The Medical Council of New Zealand (MCNZ) has published work on cultural safety which is vitally important to promoting health equity; this can be explored further on their website.
Their definition is: “Cultural safety focuses on the patient and provides space for patients to be involved in decision-making about their own care and contribute to the achievement of positive health outcomes and experiences.”
It's important to realise simply knowing the information is insufficient. To achieve cultural competence, and for patients to experience cultural safety within the practice, general practice teams must integrate their knowledge into specific practices and policies that are applied to appropriate settings.
Developing an understanding of cultural competence will allow the practice to:
- Build strong relationships with patients.
- Find out more about the patient and their condition in order to make a more informed diagnosis.
- More effectively explain the diagnosis, treatment and what the planned follow-up will be by using a patient-centric approach to the consultation.
- Provide an environment within the general practice setting that is not inconsistent with the values, language, norms and practices of their patients.
- Understand each patient’s own environment and make recommendations that are more realistic and likely to succeed.
- Significantly affect numerous patient outcomes, including emotional health, symptom resolution, function, physiologic measures (e.g. blood pressure and blood sugar level) and pain control.
- Increase doctor and patient satisfaction.
- Enhance continuity of care.
- Avoid unintentional offence.
Training and continuous professional development
Cultural competency and diversity training along with ongoing professional development will help team members deliver culturally safe care and be responsive to the cultural needs of patients. When deciding which training may best suit your team, consider the enrolled population groups within the practice, such as an underrepresented ethnicity, migrants, refugees, religious groups, those with disabilities or impairments and those who identify as gender diverse. If a team member has previously completed cultural diversity training, it is expected there is a continuation of professional development activities in this area. At times a practice may design their own training to reflect the needs of their diverse groups. This could be delivered by an inhouse trainer.
Links to resources
MauriOra Foundation Course in Cultural Competency
Courses for working with CALD patients
LearnOnline - Learning Resources for Health Practitioners - search for ‘Cultural Competency’
HQSC: Learning and education modules on understanding bias in health care
Mauriora Health Education Research
The Professional Association for Transgender Health Aotearoa (PATHA)
Guidelines for gender reaffirming healthcare
Inclusivity for transgender people
Learning cloud: Disability Awareness – Working with People with Disabilities
Health Practitioners Competence Assurance Act 2003
Ministry of Health: Refugee health care: a handbook for health professionals; 2012
MCNZ: Statement on cultural competence
MCNZ: Best health outcomes for Māori
MCNZ: Best health outcomes for Māori: Practice Implications
Ministry of Health: Ethnicity data protocols for the health and disability sector
The Code of Health and Disability Services Consumers’ Rights 1996
New Zealand Society of Translators and Interpreters (NZSTI)
Auckland Regional Public Health Service: Refugee Health
The Office of Ethnic Communities: Language Line
Department of Internal Affairs: Translation Service
New Zealand Relay service