Sample of Instructional Design work completed in 2008 for Oregon Health & Science University.

1. Cultural Competency Foundations

2. Hardware requirements
Sound card needed
This training module requires
a computer equipped with a
sound card for the video
portion of the training.

3. How to navigate this training module
previous page
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click this button
to go forward
progression meter
this marks how far you are
into the module

4. To raise awareness regarding the need
for cultural competency
To increase curiosity about difference
To encourage personal and professional
development
Goals of this training

5. Learning objectives
Describe what cultural competence
means in healthcare.
Identify elements of your personal
diversity.
Identify situations where the diversity
of others may require you to adapt
your behavior in order to be culturally
sensitive.

6. Cultural competency enables you to
provide patient-centered care and to
ensure safety and quality when serving
diverse communities. Cultural competency
also allows you to be a more effective
member of a culturally diverse work team.
Building your own cultural competence
requires openness and lifelong learning.
The Joint Commission &
cultural competency

7. 1. Culturally competent healthcare at OHSU
2. “Cultural Competency: Just Good Healthcare” video
Resources
3. Serving diverse communities
Content index
Content index
To complete this training you will be guided
through these three modules.

8. Content index
1. Culturally competent healthcare at OHSU
2. “Cultural Competency: Just Good Healthcare” video
Resources
3. Serving diverse communities
Content index
To complete this training you will be guided
through these three modules.

9. Three steps to developing
cultural competence
Start with self-awareness.
Consider how your beliefs and values
influence your behaviors, attitudes,
and practices.

10. Three steps to developing
cultural competence
Next, consider others.
Be curious about difference by
observing and asking questions.
Being curious will help you become
aware of and sensitive to the different
beliefs, values, and practices of others.

11. Three steps to developing
cultural competence
Finally, adjust your behavior.
Work with others and provide
service and care in a way that is
respectful of these differences
and the preferences of others.
If you don’t know, just ask.

12. What is diversity?
Elements of diversity, such as
ethnicity, age, gender, sexual
orientation, work classification,
social class, physical ability,
religion, and many other cultural
differences are an important part
of what makes each person
unique.
Let’s explore some elements of
diversity that you or someone
else may hold important.

13. Personality
This is unique to each individual.

14. These are elements over which
we have little control.

15. We have more
choice about
these elements.

16. Like other elements,
we have some control
over these and they
can change over time.

17. Personality

18. Personality

19. As you can see,
each of us has complex
layers of diversity.
Some things are unique
to us and some we share
with others.
Personality

20. OHSU voices
Click on the right arrow to learn more
about what some of our OHSU
employees have to say about the
difference that cultural competency
makes.

21. “As an interpreter, there are times when it is important to be in the
room with the patient, rather than providing the interpretation
by phone. Many times I have entered a room and I can see the tension
in either the parents or the patient. When I open my mouth and begin
speaking their language, you can just watch people relax, their
shoulders relax. And they begin to open up.
I work mostly with Mexicans and they want to be very polite.
The doctor may ask, ‘Do you have any questions?’ And they are
likely to respond ‘No. Everything is fine.’This shows politeness.
However, by the expression on their face I know they have
questions. I will then say to the patient, ‘You can ask whatever you
want.’ And they would then ask that question and this whole other
thing would be discovered by the doctor - something they hadn’t
been aware of.”
Jaime Pláceres, Spanish Medical Interpreter
OHSUTranslation & Interpreter Services
OHSU voices

22. “As a 14-year nurse at OHSU, I deal with life and death issues.
One patient I remember well. I learned that he was a professional singer
in his homeland of India, a store owner in the States, a husband, a father
of two, a grandfather and a recent Christian convert. It was important to
him to allow God’s control over his life and death. His children did not
share their father’s religious view.
By allowing the individuals to deal with the end-of-life issue in their own
way, it made it easier and more comfortable for both the patient and the
family members.The father, from his Christian perspective, was focused
on preparing for his new life, while his family members were focused on
honoring his present life.”
Amy Guthrie, Instructor
Patient Relations
OHSU voices

23. “Without question, the best part of working at OHSU is
the people. It is a pleasure working with such gifted,
talented, and passionate people who bend over
backwards to get along with everyone.”
John Ma, M.D.
Professor and Chair
Emergency Medicine
OHSU voices

24. “Cultural competence is something that I need to apply
every day. I cannot tell, nor should I judge, by looking at
someone who they are. Once I served a transgendered
woman who was very sick. I could see that she wanted
to be referred to as female and to use her female first
name, though her armband indicated a male name and
sex. Following her wishes, I used her preferred name and
pronouns and asked other providers to do the same. We
did and it worked out well.The patient told us that she
felt very comfortable with us.”
Debbie Dixon-Smith, Registered Nurse
Family Medicine at South Waterfront
OHSU voices

25. Content index
1. Culturally competent healthcare at OHSU
2. “Cultural Competency: Just Good Healthcare” video
Resources
3. Serving diverse communities
Content index
To complete this training you will be guided
through these three modules.

26. Sound check
Please plug in your headphones or make sure that
the speakers are turned on.
Ensure that the volume is comfortable to you and
respectful of the people that may be around you.

27. ( video window )( video goes here )

28. Content index
1. Culturally competent healthcare at OHSU
2. “Cultural Competency: Just Good Healthcare” video
Resources
3. Serving diverse communities
Content index
To complete this training you will be guided
through these three modules.

29. Serving diverse communities

30. In addition to working with people from
different ethnic backgrounds, we also
serve individuals who represent other
culture groups such as:
• Non-native English speakers
• People with disabilities
•Gay, lesbian, bisexual, and
transgendered (GLBT) individuals
Serving diverse communities
Following are some best practices
for serving members of some of
these diverse communities.

31. Speakers with accents come from
many backgrounds, educational
levels, and have various linguistic
abilities.
A foreign accent only tells you
that the person speaks more
than one language.
Serving non-native
English speakers

32. Serving non-native
English speakers
• Listen carefully and slow down.
• Allow pauses between sentences
or after questions.
• Repeat your sentence in different
ways if needed.
• Ask the individual to restate their
understanding in their own words.
• Know when to request an
interpreter.
Best Practices

33. OHSUTranslation &
Interpreter Services
TheTranslation and Interpreter Services Department
operates 24 hours a day, 7 days a week. Orders can be
placed either via the Epic system or by phone.
It is the policy of OHSU to use only qualified healthcare
interpreters. OHSU staff should not ask, suggest, or
encourage that a patient’s friends or family members
interpret for a patient except in urgent situations.
If the patient decides to decline the help of the OHSU
interpreter, he/she has to sign a Medical Interpreter
ServicesWaiver Form. You can get it from the Ozone or
call OHSUTranslation & Interpreter Services.This waiver
form releases OHSU from any legal obligation to provide a
qualified healthcare interpreter and from liability
for any adverse consequences of a non-professional
interpretation.

34. How to use interpreters
more effectively
• Look directly at the patient.
• Use first person “I” statements.
• Make appropriate stops.
• Watch for the body language.
• Ask the patient to repeat back
their understanding.
• Stay in the room until the
communication is complete.
Best Practices

35. Disabilities may or may not be visible. Disabling
conditions can affect physical, sensory (hearing
or vision), cognitive, or mental abilities.
• Let the individual ask for assistance; don’t assume
the need.The best practice is to ask “How may I help you?”
as every person and their disability is unique.
• Remember that this person is an expert concerning
his/her disabilities and abilities and can best direct you
as how you may assist them.
• Address the individual, not the people accompanying
him or her.
• Respect personal space, including wheelchair, assistant
devices, or service dog.
• Ask how you can facilitate communication (braille or large
print, speech reading, writing, sign language, etc.).
Working with individuals with disabilities

36. At OHSU we welcome and serve equally all individuals
regardless of their sexual orientation or gender
identification.
Avoid the assumption that patients or colleagues are
heterosexual. Of every 100 patients that you work with,
up to 10 may be lesbian, gay or bisexual and between one
and 10 may be transgendered.
Treat all patients with respect and protect patient
confidentiality by following HIPPA guidelines. Obtain
patients’ permission before documenting sexual
orientation in the patient records as a matter of sensitivity.
Be aware of your verbal and body language to create a
welcoming atmosphere of care, openness, and non-
judgment.
Working with gay, lesbian, bisexual,
and transgendered (GLBT) populations

37. Oregon law recognizes a registered domestic
partner relationship as equivalent to a
marriage, therefore, registered domestic
partners should be treated the same as
spouses.
Domestic partnership & healthcare
If a patient says they are in a domestic partnership, it is appropriate
to ask if they are registered domestic partners. If the patient is in a
registered domestic partnership, this should be identified in Epic.
There is a field in Demographics Activity to document “registered
domestic partner”, “single” or “married”.

38. At OHSU, we take someone at their
word when they identify themself as
a spouse or domestic partner of a
patient.
We would only require a domestic
partner to provide legal
documentation of registration under
the same circumstance where we
would require a spouse to provide
documentation of legal marriage.
Domestic partnership & healthcare

39. People define families in different
ways.The healthcare team members
must be sensitive to the diversity of
cultures and familial relationships,
particularly when handling consent,
end-of-life decision making, and
patient and family education.
The OHSU Consent Policy and the
policy of Do Not Resuscitate,
Advance Directives, Physician Orders
For Life-SustainingTreatment & End-
Of-Life Decision-Making Process
apply in the end-of-life decision
making.
Honoring family members

40. Closing thoughts
Click on the right arrow to read each of
these closing thoughts about the value
of cultural competency in healthcare
at OHSU.

41. Closing thoughts
“As we work toward expanding and
nourishing our culture of inclusion, here at
OHSU, we give greater meaning to our
commitment to honor the uniqueness of
everyone.”
Steven Scott, Associate Hospital Administrator
Professional Services

42. Closing thoughts
“Working in a diverse environment has
taught me the value of understanding that
we all come from different places and have
different views about how the world works
and that is what makes each one of us
unique.”
Sima Desai, M.D.
Section Chief, Division of Hospital Medicine
Associate Residency Program Director, Internal Medicine

43. “Every employee is responsible to live the
diversity promise at OHSU Healthcare.
Living the diversity promise means
recognizing that people are different and
personally committing to respecting those
differences in every encounter, with every
individual, every time.”
Peter Rapp, ExecutiveVice President and Executive Director,
OHSU Healthcare
Closing thoughts

44. There is a lot to learn and know when
developing cultural competence.
You don’t need to be an expert about all things.
The key is awareness and sensitivity.

45. Acknowledgements
OHSU design team
Arturo Pelayo
Riikka Salonen
KirstenWall
OHSU contributors
Priscilla Andres
Alix Bach
Nikki Bishop
Join Elsenpeter
Sue Orhard
Pamela Pauli
Samia Saad
Steven Scott
Riikka Salonen
AmyVanderbroucke
TammyWade
KirstenWall
DeanWestwood
External resources
Leslie Aguilar
& Linda Stokes
Coastal Productions
Lee Gardenswartz
& Anita Rowe
Joint Commission
Kaiser Permanente

46. CONGRATULATIONS!
You have finished the Cultural Competency Foundations training.

47. Content index
1. Culturally competent healthcare at OHSU
2. “Cultural Competency: Just Good Healthcare” video
Resources
3. Serving diverse communities
Content index
To complete this training you will be guided
through these three modules.

48. Resources to continue
learning about diversity
and cultural competence
are available to you on:
The Learning and Change
Management site for
OHSU Healthcare
http://ozone.ohsu.edu/
healthsystem/dept/
nursingeducation/
Resources

49. OHSU Center for Diversity & Multicultural Affairs (CeDMA)
Serves as a university resource supporting collaboration with the academic units,
hospitals, and other campus and community resources in promoting an
environment that values and nurtures an inclusive environment of diversity
through various resources and programs for students, staff and faculty including
Student Access and the Cultural Competency Lecture Series.
Affirmative Action & Equal Opportunity (AAEO)
A resource for staff, faculty, students, patients, and employment applicants in
their effort to support diversity and prohibit discrimination in all facets of the
University's activities including providing information on reasonable
accommodation requests, diversity recruitment and diversity education.
Internal Resources

50. Chaplaincy Services
Provides spiritual support OHSU staff and patients. Chaplains are available to
provide spiritual guidance, prayer, emotional support and comfort. A prayer/
meditation room is available in Doernbecher Children's Hospital, room 10301.
The Coalition for Health and Affirmation of Sexual Minorities (CHASM)
OHSU's campus-wide organization for lesbian, gay, bisexual, transgender, queer,
and intersex (LGBTQI) students, faculty, and employees and their allies, friends,
and family.
Index ofTranslated Patient Education Material
A list of patient education handouts available in multiple languages including:
English, Russian, Spanish,Vietnamese, Chinese, and Serbo-Croatian.
Internal Resources

51. The Oregon Institute on Disability & Development (OIDD)
Located at the Child Development and Rehabilitation Center, it is one of 67
University Centers for Excellence in Developmental Disabilities, located in
major universities throughout the U.S.
We have a more than 40-year history of working to improve quality of life for
people with disabilities and their families.
We embrace the right of the persons with disabilities to determine the
course of their lives and to live as fully integrated, contributing members of
their communities. Our research and projects are all developed with those
missions in mind, and we welcome your feedback, participation and input.
http://www.ohsu.edu/oidd/index.cfm
Internal Resources

52. Culture CluesTM
http://depts.washington.edu/pfes/CultureClues.htm
This site by the University ofWashington Medical Center includes tip sheets for
clinicians to increase awareness about patients from diverse cultures. End-of-life
care information is also included.
Cross Cultural Health Care Program (CCHCP)
http://www.xculture.org
The CCHCP offers online information, books, videos, and cultural competency
training programs for physicians and interpreters.
Internal Resources

53. Diversity Rx
http://www.diversityrx.org
DiversityRx has information on how to meet the health care needs of
minorities, immigrants, refugees and other populations.The site also
includes interpreter information and models for designing programs.
Ethnomed
http://ethnomed.org
This site contains information about cultural beliefs and medical issues
related to the health care of recent immigrants.The site also has links to
foreign language patient education materials.
External Resources

54. The Joint Commission: Hospitals, Language, and Culture
http://www.jointcommission.org/PatientSafety/HLC/
The Joint Commission views the issue of the provision of culturally and linguistically
appropriate health care services as an important quality and safety issue and a key
element in individual-centered care. It is well recognized that the individual’s i
involvement in care decisions is not only an identified right, but is a necessary source
of accurate assessment and treatment information.
The Joint Commission has been studying these issues through its Hospitals,
Language, and Culture: A Snapshot of the Nation (HLC) study, and HLC staff have
developed several resources that highlightThe Joint Commission standards that
support the provision of care, treatment, and services in a manner that is conducive
to the communication, cultural, language, health literacy, and spiritual/religious
needs of individuals.
External Resources

55. National Center for Cultural Competence (NCCC)
http://www11.georgetown.edu/research/gucchd/nccc
NCCC resources include full-text publications, definitions of cultural and
linguistic competency, tools and processes for self-assessment, and a Spanish
language portal.
Office of Minority Health
http://www.omhrc.gov/templates/browse.aspx?lvl=1&lvlID=3
The OMH’s cultural competency site includes recommendations for national
standards for Culturally and Linguistically Appropriate Services (CLAS).The site
also has statistics, publications, and links to other cultural competency resources.
External Resources

56. Provider’s Guide to Quality and Culture
http://erc.msh.org/mainpage.cfm?file=1.0.htm&module=provider&language=English
This website helps health care organizations provide culturally competent
services to multi-ethnic populations. It includes information on patient-provider
interaction, health disparities, cultural groups, and culturally competent
organizations.
Think Cultural Health
https://www.thinkculturalhealth.org
This site, sponsored by the U.S. Office of Minority Health, offers free online
cultural competency continuing education programs, guides for physicians and
nurses on culturally competent care, and more.
CulturedMed
https://culturedmed.sunyit.edu
External Resources