Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Unit:An Overview of the Culture of Health Care
Lecture:Learning more about the culture of health care
Slide content:Rich Points Behaviors that highlight cultural differences Names differ based on interaction: doctors & others : patient counselors, others: client business office: customer medical library: patron IT department: user Imply assumptions about status, goals, relationship May have negative connotations from a different cultural reference point: chief complaint 8
Slide notes:Important insights into another culture or differences between two cultures are gained when we pay attention to what Agar [ ah - gahr ] calls rich points . Rich points are the behaviors that highlight cultural differences. Consider for example the language used to describe the persons we deal with. A person may be referred to by doctors as patient, by counselors and therapists as client, by the business office as customer," by the medical librarian as patron," and by the IT [ I-T] department as user. We also find health care consumer as another term to describe patients and their families. The differences in language suggest differences in the assumptions about the status of individuals, their goals, their relationship, and so forth. Sometimes terms which may seem neutral in one context or from a particular cultural reference point may be positive or negative when taken from another cultural perspective. An example is the conventional use of the term chief complaint by physicians. To physicians, this is an entirely neutral term which refers to the key symptom(s) or condition(s) that brought the patient to see the doctorthe problem which the patient would like solved. To others, however, the word complaint may connote [ kuh - note] a more negative implication, that the person is complaining or whining. Not long ago a physician was doing a sabbatical in informatics [in- fer -mat- iks ] and worked within the office setting of an informatics [in- fer -mat- iks ] department. This physician used the assumptions and behaviors of his profession in the new role. For example, with pager alerts the physician reaches for the nearest desk phone or uses his mobile phone to immediately place a call. For workers in this particular office setting, this behavior is completely unacceptable since a desk telephone belongs to a given individual and its not okay for anyone to walk up and use the desk phone without first asking. Also, stopping in the middle of a conversation to take or accept a cell phone call is also considered unacceptable. This is a rich point that can give us insight into differences between the cultures across departments within one organization. In a clinical department, most equipment, including telephones, is available to everyone. Picking up the nearest phone, if no one is using it, to make a call is normal behavior. This physicians behavior, based on a clinical departments beliefs and assumptions, resulted in a conflict with the normal beliefs and assumptions of the new office setting. This rich point is an example of a behavior that highlights cultural differences. The cultural difference in this case is the assumption in an office setting that pieces of equipment belong to or are assigned to specific individuals, compared with the assumption in a hospital setting that most pieces of equipment belong to no one in particular and are shared by all. The same difference in assumptions can occur when health information technology, or HIT [H-I-T], implementations in the hospital bring with them office-based assumptions about assignment and ownership. In an office setting, computers are often assigned to specific individuals and owned by them an assumption that may be enforced in the way that each machine is configured for a specific individual. This assumption doesnt translate well into the hospital setting where individuals move from ward to ward, from desk to desk, from computer to computer, and all computers must essentially serve all individuals. Configuration for a specific individual simply breaks down. 8