Cultural Humility and Bridging the Power Imbalance

Anil Jain, Liz Leaver The Nightingale Centre & Genesis Prevention Centre

Barriers Resulting in Health Inequalities

•  Lack of supportive and inclusive environment •  Lack of support for patients to develop their

confidence and capacity to engage effectively. •  Low level of literacy •  English not spoken or read by all; limited

translation/interpreter services. •  Lack of Cross Cultural Communication •  Privilege gap between patients and HCP

Our initiatives at the Nightingale Centre •  Addressing Health Inequalities National

Conference in 2010 •  Focus groups with patients and HCPs since

2011 •  Asian Breast Cancer Support Group launch in

Oct 2011; Two meetings each year with active participation of patients and HCPs.

•  Cross Cultural Communication Training since 2011

•  Patient to Patient Support Initiative (PaPSI) since 2015 with meetings bimonthly

Cultural Humility Model –  The provider relinquishes the role of expert and

becomes a humble student –  Recognises the need of life-long self reflection and

critique –  Aware of personal beliefs and not letting them come

in the way. –  Redress power imbalance by using patient focussed

care –  Mutual respect and partnership with patients –  Develop and maintain mutually respectful dynamic

partnership based on mutual trust –  Values patients agenda, beliefs, concerns and

practices etc.

Summary: Four A’s of Cultural Humility •  Attitude of openness •  Appreciation and acceptance of differences •  Awareness of own cultural values •  Adapt practice to fit the cultural contexts of the

client, family and community •  ‘CH enhances patients care by weaving an

attitude of learning about their cultural differences’

•  Anderson Juraez et al. (2006). Bridging the gap: A curriculum to teach

residents cultural humility. Fam Med 38(2), p.98.

Cultural Humility: People, Principles & Practices:

*Lifelong learning & critical self-reflection *Recognise and challenge power imbalances for respectful partnerships *Institutional accountability

Questions for you to consider

•  What are your own cultural values and beliefs? •  Are you aware of your personal biases and

assumptions about people who have different values to you and how do you deal with it?

•  What are the biggest barriers to challenging the power imbalance between patients and healthcare professionals?

•  If you could make one change to the patient/healthcare encounter in your trust/organisation what would this be? (In what ways do you think this would change the organisation?)

‘We celebrate the diversity in our country, get

strength from the cultures and the races that go to make up the Britain today’

Acknowledgements:

Asian Breast Cancer Support Group Patiient to Patient Support Initiative (PaPSI) Numerous patients and carers including: Dr P Dube, Mrs H Dube,, Rekha Mehra, Shazia Hamid, Dr Annela Saleem, Jo Taylor Indian Senior Citizen Centre, Jain Samaj

All Radiologists, Radiographers, Surgical, Nursing and Office colleagues at the Nightingale Centre Felicity Goodey, Chair UHSM Attila Vegh CEO UHSM Late Paul Goggins MP Wythenshawe/Sale East Communication Directorate UHSM Genesis; Genesis Volunteers; South Asian Health Foundation Numerous Guest speakers; Medical Students Saima Rashid Nikki Hoffman Dr Gill Reddick Julie Lawton Dr Basma Issa Catherine Zaide Crosse Mr Mehboob Mirza Shaheeda Sheikh Dr Chris Gillespie Mr Lester Barr Mr James Harvey Mrs Anjali Ahluwalia Stephanie Carney Chris Evans Val Reece Alix Hartley Claire Mercer Cathy Hill Shaheeda Shaikh Prof Nusrat Hussain Fatima and Shaheen Dr Raghu Pabbineedi Shaheena Anjum Dr Anil Gumber Shahnaz Ali, OBE Dr Kailash Chand Dr JS Bamrah BMA Colleagues Professor Rajan Madhok

Cross Cultural Communication Skills Training Dr Chris Gillespie Dr Gill Reddick Mr Lester Barr Val Reece Saima Rashid Julie Lawton Cathy Hill Alix Hartley Basma Issa Dr Raghu Pabbineedi Liz Leaver Prof Nusrat Hussain Paul Deemer Dr Anneela Saleem Jo Taylor Numerous patients and carers including: Drs Dube, Rekha Mehra, Shazia Hamid Indian Senior Citizen Centre Jain Samaj Fatima and Shaheen Genesis Volunteers Medical Students All Radiologists, Radiographers, Surgical, Nursing and Office colleagues at the Nightingale Centre Felicity Goodey, Chair UHSM Attila Vegh CEO UHSM Late Paul Goggins MP Wythenshawe/Sale East Communication Directorate UHSM Genesis South Asian Health Foundation

FUNDING North West SHA/ NHS England Greater Manchester Prevent Breast Cancer

Thank You

www.asianbreastcancersg.org