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Title: Cultural Competency -

Cultural Competency - Key Considerations and
Awareness for an Inclusive VA Workforce
John Fuller, Ed.D. Chief Diversity
Educator Office of Diversity and Inclusion
Learning Objectives
  • At the end of this session, you will have
    gained knowledge of key considerations for
    workforce inclusion through
  • Examining How external and internal factors
    affect you and your employees
  • Identifying Perceptions of Diversity,
    Inclusion, and Culture
  • Recognizing Cultural Competency is a lifelong
  • Discussing Various cultural awareness areas to
    include Generational, Religious and Veteran
  • Considering Cultural competencys relation to
    Patient Centered Care and awareness of Employee
    Self-Determination Theory

To fulfill the mission and vision
  1. A Diverse Workforce Build a diverse,
    high-performing workforce that reflects all
    segments of society.
  2. An Inclusive Workplace Cultivate a flexible,
    collaborative, and inclusive work environment
    that leverages cultural competency and empowers
    all contributors.
  3. Outstanding Public Service Facilitate
    outstanding, culturally competent public service
    and stakeholder relations through effective
    leadership and accountability.

DI Strategic Plan
Equality of Employees
Everyone has the ability to do something amazing
some just do it on a more regular basis.
Managers and Employees Workplace Challenges
Our Customer is Changing
  • There will be more Veterans who
  • Live in Rural Areas
  • Identify as LGBT
  • Have service-connected disabilities
  • Are Hispanic/Women
  • Hold diverse religious beliefs
  • Are from younger generations

All Expect Inclusive Services
From Road Rage to Desk Rage
  • Commuting to work and someone cuts you off,
    accident or weather delays, etc.?
  • Just received a foreclosure notice on your home?
  • Husband, wife, or partner lost their job
  • Listening to constant criticisms of the VA in the
  • Not being allowed to telework if eligible?
  • Thinking about your current boss? or
    co-workers?... Your tremendous workload?....then
    you arrive at work!

  • Personal Problems 62
  • Job overload 60
  • Financial Stress 56
  • Lack of Resources 47
  • Depression/Anxiety 46
  • Issues with co-workers 41
  • Technology Issues 31
  • Care giving Responsibilities 30
  • Issues with supervisors 26
  • Lack of training 23

I just want to do my 8 hours and go home. Help
me make it through the day!
Non-productive Harassing or Incivil Workplace
  • Missing work, taking extended breaks, finishing
    projects late
  • Accepting favors, like missing work without
  • Racial, ethnic, or sexual comments/slurs
  • Engaging in provocative conduct
  • Gossiping about anything
  • Using excessive profanity within your

The Incivility Continuum
  • Negative Behavior
  • Rude comments (hey, nothing personal!)
  • Insensitive actions
  • Unintentional slights
  • Complaining
  • Gossip/rumors
  • Cultural bias
  • Crude jokes
  • Profanity
  • Rolling eyes
  • Verbal Aggression
  • Yelling / loud voice
  • Belittling comments
  • Intimidation / threats
  • Discriminatory comments
  • Cursing at someone
  • Humiliation
  • Physical/Sexual Aggression
  • Assault / Battery
  • Throwing objects
  • Violent outbursts (e.g., hitting the wall)
  • Inappropriate touching
  • Harassment

Humor - A Risky Behavior?
  • Humor can relieve tension and energize
  • teasing and sarcasm, however, are high risk
  • Does this mean that all fun is out of order in
    the workplace?
  • "It was just a joke" is not an excuse.
  • People often have such different perspectives on
    sarcasm, jokes, etc.
  • Remember that only the impact, and not the intent
  • Make certain that your behavior whether in
    person, by phone, text, twitter, Facebook, or via
    email, is welcome.

What Can You Do?
  • Say you do not like it and ask the person to
  • Tell your supervisor
  • If you are a supervisor and witness this, stop
    the behavior immediately.
  • If the conduct is repeated it can become a
    violation and the offender can be advised of
  • Inform employee to keep a log or diary of the
    conduct, including dates, times, witnesses,
    direct quotes, emails, tweets, Facebook postings,
    and any documents or photographs.

Psychological Safety
  • Is it safe to take a risk?
  • The right to express thoughts and opinions freely
    and encourage open expression within a climate of
    civility, sensitivity and mutual respect.
  • Are co-workers comfortable and capable of having
    a discussion with issues, i.e., Immigration,
    Religion, LGBT, Political Elections, Affirmative
    Action, in-house promotions, Tea Party, Unions,
    changes in the workplace, etc., openly and
  • Veterans WILL talk about these subjects!

  • When was the last time you received recognition
    at work for a job well done or gave recognition
    to someone else for a job well done?
  • Does not have to be supervisor to subordinate
  • Encourage encouragement and set the example
  • .

Rapid Demographic Changes1990-2010
  • Only one-third of households now have children
  • Since 1990 more Asians were added (4.3 million)
    to the population than Blacks (3.7 million)
  • About 430,000 Asians arrived in the U.S. in 2010
    representing 36 of all new immigrants that year.
  • Almost one in six Americans are Hispanic (31 of
  • More than doubled since 1990

Rapid Demographic Changes
  • 11 Million people in 2012 on Social Security
    Disability Insurance compared to 4.2 Million in
  • Educational Gap is growing
  • Women make up nearly 60 of college enrollment
  • More women receive graduate and doctorate degrees
  • 5.5 Million 85 years of age in population
  • Doubled since 1990
  • 41 share of births by unmarried women in 2010
  • (up from 26 in 1990)

It is not Quantum Physics butWhat is
In its broadest context, diversity includes all
that makes us unique
race, color, gender, religion, national origin,
age, disability, culture, sexual orientation,
gender identity, parental status, educational
background, socioeconomic status, intellectual
perspective, organizational level, and more.
It is I!
From ODIs Glossary of Terms http//www.diversity.
Nine Dimensions of Difference
Reprinted with permission from Loden Associates.
Secondary Dimensions
  • Characteristics that represent an individuals
    group identity
  • Unlike primary dimensions because of the element
    of choice

Reprinted with permission from Loden Associates.
Whats Inclusion
An Inclusive Workplace allows leaders to leverage
the diverse talents and attributes of the entire
Inclusion A practice that enables the full
participation and contribution of the workforce
in support of the mission of the organization by
eliminating implicit and explicit barriers.
Empowering the full potential of all employees.
What is Culture?
  • Integrated patterns of human behavior that
    include the language, thoughts, communications,
    actions, customs, beliefs, values, and
    institutions of racial, ethnic, religious, or
    social groups.
  • The Joint Commission Advancing Effective
    Communication, Cultural Competence, and Patient-
    and Family-Centered Care A Roadmap for
    Hospitals. Oakbrook Terrace, IL The Joint
    Commission, 2010.

Cultural Competence
  • Cultural Competence refers to a combination of
    knowledge, skills and awareness pertaining to
    cultural differences and different
    interpretations across groups
  • It includes the awareness of and respect for
    differences, without making assumptions that
    everyone from a particular background holds the
    same beliefs and practices.

Joint Commission Expectations
  • Cultural competence requires organizations and
    their personnel to do the following
  • (1) value diversity
  • (2) assess themselves
  • (3) manage the dynamics of difference
  • (4) acquire and institutionalize cultural
    knowledge and
  • (5) adapt to diversity and the cultural contexts
    of individuals and communities served
  • The Joint Commission
    Advancing Effective Communication, Cultural
    Competence, and Patient- and
  • Family-Centered Care
    A Roadmap for Hospitals. Oakbrook Terrace, IL
    The Joint Commission, 2010.

How Does Your Level of Cultural Competency Affect
Veteran Care?
  • Health care providers bring perception,
    traditions, and patters of communications based
    on cultural, racial and ethnic identity to the
    clinician-patient interaction.
  • Cultural issues can influence appropriate
    diagnosis, treatment adherence as well as care
    seeking behavior and maintenance by Veterans
    leading to health care disparities.

VHA Defining Excellence
  • Patient (Veteran) centered
  • Characterized by team care
  • Continuously improving itself and
  • Data driven, evidence based

Data Driven Evidence Based
  • 10 Principles
  • Service quality and value are always defined by
    the Veteran
  • Veteran participation adds value and quality to
    their service experience
  • Everyone must believe that the Veteran matters
    and act that way (Veteran-focused culture)
  • Find, hire, train and retain competent and caring

10 Principles, cont.
  • Veterans expect employees who are not only well
    trained but have good interpersonal skills
  • Veterans expect the service experience to be
  • Avoid making Veterans wait for the service
  • Create the setting (environment) the Veteran
  • Measure all aspects of the service experience -
    what gets measured gets managed - Ask Veterans
    about their experience at the time the service is
    being delivered and
  • Commit to continuous quality improvement, i.e.,
    patient satisfaction surveys, town hall meetings,

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Service Core Values Echo Throughout the VA
  • Army Loyalty, Duty, Respect, Selfless Service,
    Honor, Integrity, Personal Courage
  • Navy and Marine Corps Honor, Courage, Commitment
  • Air Force Integrity, Service Before Self,
  • Coast Guard Honor, Respect, Devotion to Duty
  • VA War Related
    Illness and Injury Study Center (WRIISC) )2011

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Military vs. Civilian Work Culture
  • Military Command Control Operations Model
  • Hierarchical /vertical structure - more exact
    rules of conduct
  • Veterans share a bond in beliefs, traditions,
    values, and the concept of rank and structure
    Not just a job but a way of life
  • Firm, fair and consistent plus always a sense
    of urgency in getting the mission accomplished
  • Far less time spent in meetings
  • The B vs. LM Principle

Civilian vs. Military Work Culture
  • Corporate/Non-military
  • Collaborative Model
  • More implied or "understood" rules of conduct
  • Flexible/ambiguous roles status - variations
    across teams
  • Less defined career progression or lateral
    assignment opportunity

No matter the length of service or era, all
Veterans still have much of their military
culture ingrained in them. However, separating
active duty members and current Veterans of the
VA need to be able to adjust and collaborate.
Language Awareness for CiviliansMilitary
Cultural Competence
  • AIT
  • Tunnel Rat
  • O Dark 30
  • Head
  • MOS
  • ADA
  • In Country
  • Butter Bar
  • Green Zone
  • IED

If you dont know, its okay to ask (or to
Average age of soldiers
World War II 26 Volunteers and Draft
Average age of soldiers
Vietnam 19 Draft and Volunteers
Average age of soldiers
Iraq/Afghanistan 30 All Vounteer
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Some Guidelines Interacting with Veterans
  • It is never OK to ask a Veteran if he or she has
    killed someone in combat or joke about it.
  • When you thank a Veteran for their service it is
  • Dont tell us that wars are a waste of dollars or
    lives or was fought for oil
  • What we may hear in that is that our best friend
    or other brothers and sisters in arms died for
  • Many more of us today have PTSD or TBI.
  • We can be sensitive about our acquired disability
    and that war injuries today are different and
    often not visible.
  • It is not OK to tell someone they dont look

Cultural Implications for Female Veterans
Over 1.8 Million Female Veterans
300,000 Female VA Patients
Women Veterans
  • Struggling to find work Can be choice or
    circumstance, i.e., family, school, disability
    preventing full time work.
  • nearly one out of five women who served in the
    military at home or abroad during the two wars is
    now without a job, according to the new Bureau of
    Labor Statistics report
  • More than 40 of women Veterans surveyed were
    very dissatisfied with the competence level of
    the VA for women-specific or gender-specific
  • Women have had difficulty gaining recognition for
    their combat service.

Women Veterans
  • VA and DoD finds assaults more common study
    shows more happen in war zones and becoming more
    frequent in all locations.
  • Nearly 50 of women sent to Iraq and Afghanistan
    report being sexually harassed.
  • 42 experience PTSD as a result
  • Himmelfarb, N., Yaeger, D., Mintz, J.
    Posttraumatic stress disorder in female veterans
    with military and civilian sexual trauma. Journal
    of Traumatic Stress, 19, 837-846.

Religious/Spiritual Beliefs and Practices
Religion Culture Americans who say they
68 are either Moderately or Very Religious 32
are either not religious or Non Affiliated
How Many Symbols Can You Identify?

Christian Cross Star of David Muslim Crescent Hindu Omkar Shinto Torii

Hindu Lotus Flower Sikh Khanda Toaist Taiji Zoroastrian Faravahar BahaI Nine Pointed Star

Buddhist Dharma Wheel Jainism Wicca Unitarian-Universalism Unification Church
Asian American Religious Beliefs
  • Christian 42
  • Unaffiliated 26
  • Buddhist 14
  • Hindu 10
  • Muslim 4
  • Other Religion 2
  • Sikh 1
  • Pew Forum on Religion Public Life

While the U.S. is generally considered a highly
religious nation, African-Americans are markedly
more religious on a variety of measures than the
U.S. population as a whole, including level of
affiliation with a religion, attendance at
religious services, frequency of prayer and
religions importance in life (79)..nearly 80
Generational Perspectives
  • Whatever your age, the other ages you have are
    still inside of you.
  • Thats what gives you the compassion and patience
    for those who are irritatingly younger (or older)
    than you!
  • The principles other generations used to get
    through life remain relevant yet you may need a
    completely different set of tools in order to
    tackle modern nuances of the current workplace.

What is a Generation?
  • In addition to coincidence of birth year
    grouping, a generation is also defined by common
    tastes, attitudes, and experience.
  • Those times encompass a myriad of circumstances
    economic, social, sociological, and, of course,

Zemke, R. Raines, C., Filipczak, B. (2010)
Generations at work Managing the clash of
Veterans, Boomers, Xers, and Nexters in your
workplace. New YorkAmacon.
Generational Differences
  • Preferred Leadership Approach
  • Communication Style
  • Motivational Buttons
  • How They Interact with Others
  • Preferred Approach to Feedback
  • View toward the VA
  • When generations fail to communicate with each
  • May impact turnover rates, recruitment, hiring,
    training, retention)
  • May impact grievances and complaints
  • May impact perceptions of fairness equity

Department of Veterans Affairs by Generations
Source ODI Workforce Analysis Team, May 2011
April 2011
Department of Veterans Affairs by Generations
Source ODI Workforce Analysis Team
2 SES Millennial
Current Working Generations
  • Veterans or Traditionalists (1900-1945)
  • Baby Boomers (1946-1964)
  • Generation X (1965-1980)
  • Generation Next or Millennials (1981-1999)

Veterans or TraditionalistsBorn 1900 - 1945
Veterans or Traditionalists 1900-1945
  • Also known as the Greatest Generation
  • Defining events Great Depression, New Deal,
    World War II, Korean War remembers life before
    TV and fireside chats with FDR.
  • Faith in institutions loyal patriotic and
    actually did ball room dancing.
  • Save for a rainy day, Waste not, want not
  • Remembers cars with running boards.
  • Influential people Ella Fitzgerald, Charles
    Lindberg, Franklin Delano Roosevelt

Baby BoomersBorn 1946 to 1964
Baby Boomers 1946-1964
  • Defining events television, Vietnam, womens and
    human rights movements, wanted to join the Mickey
    Mouse Club saw every episode of Leave it to
  • Optimistic and competitive prosperous
  • Promise of good education opportunities their
    parents didnt have used a typewriter to write
    term papers
  • Influential people Martin Luther King, John F.
    Kennedy, Richard Nixon, Beaver Cleaver
  • Now dealing with difficult life decisions retire
    or not to retire?

Generation X Born 1960-1980
Generation Xers Born 1965-1980
  • Defining events Challenger explosion, fall of
    Berlin Wall, fall of Soviet Union, personal
    computer, played Asteroids on an Atari,
    Schoolhouse Rock, and cell phones comfortable
    with smart phones.
  • Skepticism institutions called into question,
    rise of single parents and both parents working
    of Gen X (latchkey kids), record player is
    antique, Ipod is a given environmentally
  • Now in middle and upper management waiting for
    those old folks to get out of the way
  • Leading people Monica Lewinsky, O.J. Simpson,
    Supermodels, Michael Jordan, Dilbert

MillennialsBorn 1981 -1999
Millennials Born 1981-1999
  • Also known as Echo Boom, Generation Y, Baby
  • Defining events Oklahoma City bombing, Columbine
    High School massacre, death of Princess Diana,
    Lewinsky scandal, smart phones live on social
    networks with texting as major communication
  • Realistic optimistic yet cautious
    multiculturalism, believe in group consciousness
    and collaboration
  • Personal Safety is a workplace concern
    appreciate diversity deeply worried about
    future and employment
  • Influential people Barney, Backstreet Boys,
    Venus and Serena Williams, Tinky Winky

What Generation?
Training and Development Journal November, 1970
  • Seeking challenge
  • Looking for meaningful work
  • Chance to prove themselves and show they can
    perform well
  • Enjoys contact with people
  • Desire to be in a position of responsibility
  • Resents being looked at as though they have no
  • Tends to be more job mobile
  • Less respectful of authority

When We are FocusedWe See with Clarity
  • Each person has a different perspective
  • The brain filters reality through experience,
    beliefs, education and imprints a new reality.

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Recruiting Strategies
  • Specify the need for skills to work effectively
    in a diverse environment in the job, for example
    "demonstrated ability to work effectively in a
    diverse work environment."
  • Make sure that good faith efforts are made to
    recruit a diverse applicant pool.
  • Focus on the job requirements in the interview,
    and assess experience but also consider
  • transferable skills and demonstrated
    competencies, such as analytical, organizational,
    communication, coordination.

Considerations Before Interviewing
  • Prior experience has not necessarily meant
    effectiveness or success on the job.
  • Know your own cultural biases assess yourself.
  • What stereotypes do you have of people from
    different groups and how well they may perform on
    the job?
  • What communication styles do you prefer?
  • Sometimes what we consider to be appropriate or
    desirable qualities in a candidate may reflect
    more about our personal preferences than
  • about the skills needed to perform the job.

Fairness Best Practices
  • Many people think that "fairness" means "treating
    everyone the same.
  • How well does treating everyone the same work
    for a diverse staff?
  • While distributing emails to all staff is
    "treating everyone the same," this approach may
    not communicate essential information to
  • A staff member who missed out on essential
    information might feel that the communication
    process was "unfair.
  • A process that takes account of the diverse
    levels of English language and reading
    proficiency among employees.

A Managers Three Best Practices
  • Fully recognize and understand the employees
  • An employees unique perspective is the truth
    from which that employee operates.
  • Effective managers develop a deep understanding
    of employees perspectives.
  • Communicate to the point of Over Communication
  • Information helps employees understand their
    work and make wise choices.
  • Controlling/judgmental communication blocks
    engaging dialogue.
  • Generate opportunities for choice Examine

How Can Managers Support Internal Motivation?
  • Leaders cant create internal motivation in their
    employees. They can support internal motivation
    by creating conditions that allow employees to
    satisfy their own needs for competence,
    relatedness, and autonomy.
  • Leaders should recognize that they are not solely
    responsible for thinking of a solution but
    arriving at one.

Employee Self Determination
  • The need to feel valued as knowledgeable,
    skilled, and experienced.
  • People have a powerful need to hone and
    demonstrate skills, whether technical,
    interpersonal, or leadership.

  • The need to collaborate with others.
  • Most employees actually want to work with others.
  • Studies show this internal need is powerful
  • Working effectively with others improves business
    results through a melding of views and

  • The need to exercise self-regulation, within
    guidelines, to achieve business goals.
  • No one has total freedom in the workplace because
    everyone must contribute to shared results.
    Still, people crave autonomy, or freedom to shape
    their work to support. the work of others.

Consequences of Status Quo
  • Ignoring cultural issues costs time, money, and
  • Some of the consequences can include
  • unhealthy tensions between people of differing
    gender, race, ethnicity, age, abilities or
    generations, etc.
  • loss of productivity because of increased
  • inability to attract and retain talented people
    of all kinds EEO complaints and other actions.

  • Internal and external factors influencing
    workplace respect and productivity
  • Diversity should be broadly defined
  • Inclusion is about valuing all employees
  • Cultural Competency is a continuous process
  • Evidence based Patient Centered Care
  • Religious dynamics, unique Veteran culture, and
    workplace generations
  • Managers best practices facilitating employee
    self determination

Department of Veterans AffairsOffice of
Diversity and Inclusion
  • John Fuller, Ed.D.
  • Chief Diversity Educator
  • Office of Diversity and Inclusion
  • 202-491-5969

Honor, Courage, Commitment Semper Fi