Trends & issues in executive management for health care administrators

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Week 1

Trends & Issues in Executive Level Management for Health care Administrators

Cultural Competence and the Workforce of the Future

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As a current or future health care administration leader, what is your role in fostering cultural competence for your health care organization? What is your role in creating the workforce of the future that reflects the changing demographics of the United States?

Communication, leadership, practice, and education require components of cultural competence in order to navigate these areas and relate to others around us. As it relates to health care delivery, cultural competence impacts the degree to which health care organizations and their workforces impart effective health care, health services, and positive health outcomes for their patient populations.

The United States is becoming more diverse, and the workforce of the future in health care needs to reflect the demographics of the patients that health care organizations serve. Currently, health professions do not generally reflect the diversity of the country; this is to the detriment of patient care and health care outcomes. As a current or future health care executive, you will be responsible for ensuring that your health care organization is reflective of the patient population in your workforce.

1. This week, you examine cultural competence in patient experiences for health care administration practice. You explore the health care executive’s role in fostering cultural competence in health care organizations. You also reflect on strategies health care administration leaders may implement for creating a more diverse health care workforce.

Learning Objectives

Students will:

· Analyze cultural competence for health care administration practice

· Analyze health care executive leadership’s role in relation to cultural competence

· Evaluate how health care organizations’ workforces mirror population diversity

· Evaluate strategies on creating a more diverse health care workforce

Learning Resources

This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media player below.

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

American Association of Colleges of Nursing. (2015). Fact sheet: Enhancing diversity in the nursing workforce. Retrieved from http://www.aacn.nche.edu/media-relations/diversityFS

Association of American Medical Colleges. (2015). Facts and figures data series. Retrieved from https://www.aamc.org/initiatives/diversity/179816/facts_and_figures.html

Delphin-Rittmon, M., Andres-Hyman, R., Flanagan, E. H., & Davidson, L. (2013). Seven essential strategies for promoting and sustaining systemic cultural competence. Psychiatric Quarterly, 84(1), 53-64.

Dotson, E., Nuru-Jeter, A., & Brooks-Williams, D. (2012). Setting the stage for a business case for leadership diversity in healthcare: History, research, and leverage. Journal of Healthcare Management, 57(1), 35-44; discussion 45-6.

Wilson-Stronks, A., Mutha, S., & Swedish, J. R. (2010). From the perspective of CEOs: What motivates hospitals to embrace cultural competence? Journal of Healthcare Management, 55(5), 339-352.

Required Media

The Medicine Box Project (Producer). (2011). Crossing cultures: Using the LEARN model [DVD]. Minneapolis, MN: Author. Note: The approximate length of this piece is 13 minutes.

The Video Transcript

Crossing Cultures: Using the LEARN Model

Program Transcript

DR. WALKER: Not only is it a privilege to be able to provide health care in a

multicultural society, but it’s fun. I meet people from all over the world. I see

diseases that I think are fascinating.

[INAUDIBLE]

Good morning.

I keep coming back to the fact that we really are a nation of immigrants. From the

Ukraine, from Russia, from Vietnam from Laos, from Cambodia, Oromo

community, the Korean community, the Somali community, the Hmong

community, that is our patient population of the present. And that number of nonEnglish speaking patients may even increase in future.

MALE SPEAKER: Hello.

DR. WALKER: Compassion, respect, cultural humility, I think those are the things

that drive me and probably drive most providers in health care.

MALE SPEAKER:

Hey, Martin. How are you?

MALE SPEAKER: How are you?

MALE SPEAKER: Good, good good. Do you want to come over here?

DR. WALKER: I think cross cultural health care is providing high-quality care and

service to people whose cultures are different from one’s own. It’s about

someone whose life experience, cultural experience, is different from your own

and your ability to learn from that patient, learn about that patient, and then use

that learned model to negotiate.

When we think about how to approach someone who’s different from us, there

are a couple fundamental

things.

One is to not assume anything about someone,

obviously, based on the way they look or their cultural identity or even what

country they’re from. So the fundamental principle is that we have these sets of

generalizations that we think might be true.

But to assume that it might be a theory– and then the most important thing is to

ask the patient. So the challenge becomes, how can I know all of those things

about every patient from every culture? And of course, the answer is that you

can’t. But there is the good news there is a framework for thinking about the

cross-cultural encounter that is called the LEARN model.

So it stands for five things. It’s listen. So the first thing to do is listen to the patient

and ask those questions. What do you think is causing your problem? What harm
might be causing you? What are your goals for me today in trying to help you?

So listening carefully.

The E in that LEARN model is to explain your perception of the problem. So my

perception, for example, of your asthma as a Western doctor is that asthma can

be triggered by things in your environment like dust or smoke and explain my

thoughts about what might be causing the problem.

And then the A in LEARN is to acknowledge that there might be some

differences. So my patient believes that her asthma is caused by being a bad

person not setting up the shrine for her ancestor. And I believe it’s caused by

environmental factors. And so to just acknowledge that those differences are

there and not necessarily say it’s one or the other. It might be both, for example.

We know that asthma can be worse if you’re feeling stress or anxiety. And so it

might make sense from the patient’s perspective the her asthma’s worse

because she’s stressed, because the ancestor altar is not set up.

The R in the LEARN model is recommend. And one of the things that we have to

do when we’re talking with patients, obviously, is to be comfortable with our

biomedical model and make recommendations about treatment of cancer or

about treatment of asthma, for example.

So in the context of recommending to patients, we have to then negotiate. So

how can we work together to make your asthma better, which is my goal as a

doctor. And it probably is my patient’s goal, because she’d like to feel better.

So one of the wonderful ways to do that, of course, is to, if it’s comfortable, that

difference that the patient’s describing to you, to not say, well, I don’t think it’s

because you haven’t set up the altar to your ancestor, but to negotiate and say,

well, why don’t you set up the altar to your ancestor? Try to get that done in the

next week or so.

And, also, I’ll give you these medicines that may help your asthma. So that

concept of negotiating and not saying, well, it has to be my way, or I’ll no longer

be your physician. Or, I’m uncomfortable treating you. But in the context of not

compromising what we believe is good medical care to negotiate with a patient.

So, again, that’s the LEARN model. It’s something you can use in every cross-cultural encounter with patients. And it’s a delightful question to ask, particularly,

what is it, do you think, that’s causing your problem?

MALE SPEAKER: [NON ENGLISH

SPEECH]

MALE SPEAKER: You know, historically, when you used to have trouble

breathing before you came to America, why do you think you had trouble? Was it

because of smoking? Or was it something in your environment? Do you

remember? MALE SPEAKER: [NON ENGLISH SPEECH]

MALE SPEAKER: Well, I’m not exactly sure. But back home, there is a lot of

things. And the number one, and on the farm, work on the farm. Secondly, there

is the dust and the blowing. I don’t exactly k

now.

But the doctors back home told

me that I had asthma. But I’m not sure from what I caught this asthma.

MALE SPEAKER: [NON ENGLISH SPEECH]

MALE SPEAKER: [INAUDIBLE]

MALE SPEAKER: OK.

I’m just going to check your belly. Sometimes, with

Bilharzia [INAUDIBLE]. There may be– your test was positive, and we gave a

treatment. But sometimes, you may have blood in the urine that is part of the

same infection. And if we do see any blood in the urine or we do see the eggs of

the parasite in there, we may need to give you treatment again for Bilharzia.

So, in other words, sometimes we need to re-treat the patients, especially if you

do have symptoms. Because it would be very abnormal for you at this age to

have a urinary tract infection. But some of the symptoms that you maybe

complaining down here may be part of the Bilharzia disease.

MALE SPEAKER: Now you’re taking one purple tablet in the morning and one

purple tablet in the evening.

FEMALE SPEAKER: [NON ENGLISH SPEECH]

But I now have a chill every night.

MALE SPEAKER: OK. One of the things I’d like to do is I’d like to try to switch

you back now to one tablet a day, rather than two.

FEMALE SPEAKER: [NON ENGLISH SPEECH]

MALE SPEAKER: I don’t think the chill you’re having at night is from the

medicines, though.

FEMALE SPEAKER: [NON ENGLISH SPEECH]

MALE SPEAKER: OK. Have you tried coining or anything of that sort?

FEMALE SPEAKER: [NON ENGLISH SPEECH]
FEMALE SPEAKER: [NON ENGLISH SPEECH]

FEMALE SPEAKER: Yes, I do.

MALE SPEAKER: Yeah? Does the coining help?

FEMALE SPEAKER: [NON ENGLISH SPEECH]

FEMALE SPEAKER: When I get a coin, I feel better. In Cambodia, we don’t have

the medicine, you know? When we get sick, we make in coin.

MALE SPEAKER: Can you describe to me or tell me how you coin?

FEMALE SPEAKER: [NON ENGLISH SPEECH]

FEMALE SPEAKER: And then when I coin it, it will get red right away. But now I

don’t–

FEMALE SPEAKER: [NON ENGLISH SPEECH]

FEMALE SPEAKER: And see that it doesn’t show.

FEMALE SPEAKER: [NON ENGLISH SPEECH]

FEMALE SPEAKER: And also, when my body feel hot, then my bone, my body is

not getting ache-y.

DR. WALKER: We actually have a very good dental clinic right down the street

that I’ll recommend to you.

MALE SPEAKER: [NON ENGLISH SPEECH]

DR. WALKER: They didn’t say anything? OK. All right. So what I would propose

is that today I just check your heart and lungs and then do all the blood tests for

an annual exam and then have you come back for a complete women’s check-up

another day, like in the next few weeks.

MALE SPEAKER: [NON ENGLISH SPEECH]

DR. WALKER: And then I would like to do an EKG and an echocardiogram of

your heart, because I looked back at the records from [INAUDIBLE]. And I want

to follow up on a couple things.

MALE SPEAKER: [NON ENGLISH SPEECH]

DR. WALKER: So today we can do the blood tests. And we can do the EKG,

where they just put the little monitor on your chest. And then we’ll schedule the

ultrasound on your heart another day.

MALE SPEAKER: [NON ENGLISH SPEECH] DR. WALKER: Are you a new one?

FEMALE SPEAKER: [NON ENGLISH SPEECH]

DR. WALKER: So Joseph, tell me about why you do not want the shot.

FEMALE SPEAKER: He will not do

it.

DR. WALKER: Why?

FEMALE SPEAKER: He will not.

JOSEPH: I wanted the shot.

FEMALE SPEAKER: [NON ENGLISH SPEECH] I don’t do it. [NON-ENGLISH

SPEECH]

DR. WALKER: So, but tell me why.

FEMALE SPEAKER: [NON ENGLISH SPEECH]

MALE SPEAKER: Don’t make it problem, you know. Just get the shot, and put it

in. [INAUDIBLE]

DR. WALKER: But you have watched your wife for many years. What do you

think? It’s not so bad, huh, injecting medication? It’s terrible?

FEMALE SPEAKER: I have problem. I have [INAUDIBLE]. And this is the same.

[INAUDIBLE]

DR. WALKER: The problem, I think, Maria is because, Joseph, you have other

problems. I agree with Dr. Hamadi. And let me explain why. The medicine that he

suggested you stop, one of them you should stop if your kidneys are not working

absolutely normally.

The other one, he said stop because of diarrhea. So because of that, we cannot

use many of the other diabetes medicine. So the shot that Dr. Hamadi is

suggesting is safer and better. I mean, one thing to think about, Joseph, is– did

he tell you this shot is very good, because you can lose weight with it? Did he tell

you that?

Why don’t you try the medicine for two or three weeks, the shot?

MALE SPEAKER: OK. DR. WALKER: See Hamadi. And then you can decide yes or no. OK? Think

about it for just a few weeks. It’s not so bad.

FEMALE SPEAKER: [NON ENGLISH SPEECH]
MALE SPEAKER: OK.

DR. WALKER: OK. Are their particular patients that were more of a challenge for

you? And, if so, why? Was it that their cultural values were different from yours?

These general concepts about cultural competence in health care are not just

applicable to the immigrant or refugee, that, in fact, we cross many cultures in

health care every day.

We cross the culture of the female provider and the male patient or vice versa.

We cross the culture of the wealthier physician and a poor patient. We cross

cultures of health literacy. So to dispel the myth that it’s about your skin color or

even about your country of origin, it’s about the milieu in which we grow up, the

cultural experience that we have. So it applies to every single clinical and we

know that we have with a patient.

The Medicine Box Project (Producer). (2009). If we knew their stories [DVD]. Minneapolis, MN: Author.

Note: The approximate length of this media piece is 19 minutes.

The Video Transcript

If We Knew Their Stories

Program Transcript

[MUSIC PLAYING]

DR. MEB RASHID: Hopefully you will give them a sense of inclusion. So these

are some pictures I’ve taken. This one was in 1983 when I was in Ecuador. And

so that little guy is probably about 23 years old right now.

DR. PATRICIA WALKER: Did you ask about his story about how he came to the

US?

MALE SPEAKER: I didn’t, I didn’t.

DR. PATRICIA WALKER: OK.

MALE SPEAKER: Yeah, Michelle is in here.

FEMALE SPEAKER: OK, I’ve got his chart on your desk.

MALE SPEAKER: OK.
[MUSIC PLAYING]

DR. ELIZABETH BARNETT: What really strikes you when you take care of these

patients is the stories that patients will tell. And if you relax yourself and just ask

people to tell you the story of how they got here, you will hear some amazing

things.

DR. MEB RASHID: They tell these stories, it’s phenomenal. Its heroic what

people have actually lived through and how they managed to move ahead from

this.

DR ANNA BANERJI: When I talk to refugees and I see what they’ve been

through, it makes my life– it gives me humility. And makes me realize how lucky

we are to live here.

DR. ELIZABETH BARNETT: I think the most amazing story I heard was a

woman who was fleeing her village in Liberia after all the men in the village were

killed. She met up with some other men and they moved to another village where

they saw nothing but burned houses and dead bodies, but they heard the cry of a

child. And they went and rescued a child who had actually been shot in the

shoulder.

ROBERT CARLSON: He’s a Vietnamese gentleman a man who fought in

Vietnam War and actually was imprisoned in a Vietnamese reeducation camp for a number of years. And this gentleman he has bilateral below the knee

amputation. So, he’s confined to a wheelchair.

DR. ELIZABETH BARNETT: She strapped this child on her back and they fled

because they thought the soldiers weren’t far behind. She carried this child. She

said from time to time she’d ask the men she was with to check and make sure

the child was still alive.

And she carried this child to the border over many days and eventually got to a

UN hospital or camp setting. Where she was pulled aside, because the child was

very ill by then and taken to the hospital. She nursed this child back to good

health. And eventually they gained refugee status and came to Boston.

ROBERT CARLSON: He periodically has complaints of phantom leg pain. He still

feels he has legs. And it’s always frustrating to me, because there’s only so much

I can do to help him with his pain. And I’ve known this gentleman now since– at

least for eight years. Every time he comes in this gentleman has the most

incredibly optimistic outlook on life. He’s been very successful here in the United

States. He’s raised children. He’s very proud of them. He owns a house.

DR. ELIZABETH BARNETT: And this was an amazing journey she’s taken with

this child. And I told her I thought they’d saved each other’s lives. Because I’m

not sure she would have gotten here without the child. Several years later she’s

now successful. The child is in school, doing well.

ROBERT CARLSON: I think The thing that was most amazing to me is

everything that he’s been through, is that that glimmer was still in his eye and that

optimism was still there. And I think it’s a very common symbol that we see in all

our refugee patients. That in spite of all the horror, all the torture, all the

miserable stories of rape and killings and famine and economic hardship,

everything else, they maintain this optimism and this ability and this desire to

succeed that is much stronger than I see in the general population.

DR. WILLIAM STAUFFER: She doesn’t. She denies any significant past clinical

history. Grandmother states that she’s had a female circumcision when

questioned. What other questions do you have?

Refugees are particularly rewarding to work with, because for the most part,

they’re survivors, but they’re also very vulnerable. So they’re people who’ve been

through incredible things and they survived.

She immigrated from Kenya after two years in a refugee camp. And before that,

she had come directly from Somalia. Both her parents had been killed during the

Somali conflict.

I choose also work in this population, not because it’s necessarily a normal thing

for me to do. I also think it’s very rewarding population to work in, because you do get those people that you get to meet you’d never meet anywhere else. Who

have had experiences that you can’t imagine happening.

DR. MEB RASHID: I think we are uniquely placed as a point of access for people

to start discussing what’s happened in the past and some of they’re issues are

confronting when they’ve arrived here. The knee, we’ve got the x-ray results.

MALE SPEAKER:

[SPEAKING ANOTHER LANGUAGE]

And what it shows is that the right knee joint where the bullet had gone in, there

is a severe deformity. So it’s changed quite dramatically.

MALE SPEAKER: [SPEAKING ANOTHER LANGUAGE]

DR. MEB RASHID: First time we spoke she was actually very reticent about

speaking to details about what had gone on. So I know when it happened and I

know it was a gun shot wound, but I really don’t know much about the particulars

as yet.

And in a lot of ways, I guess you could argue, it doesn’t make a huge difference.

As long her mental health seems stable. And it actually seems quite good when

we assessed her the first time. That, I think that story will unravel with time. And

we haven’t really pushed on.

We know that she has the injury to her knee. It looks like she might require

surgery or a knee replacement because of the damage. We also that after the

gun shot wound it actually took two years to get care. So the first time that she

was assessed and eventually operated on was about two years after the original

injury. Which is just horrific to think of.

So yeah, outside of that, again, I think like with so many of our patients see

stories will unravel with time. And we take what pieces that give us. And

sometimes push a little bit more and it’s important or relevant and sometimes

hold back until people feel comfortable sharing with us.

FEMALE SPEAKER: [SPEAKING ANOTHER LANGUAGE]

DR. WILLIAM STAUFFER: Well, I think all people, including Americans have a

very difficult time truly empathizing with other people.

DR ANNA BANERJI: A lot of people don’t realize what the refugees have gone

through, where they’re coming from. Often they’re coming from places where

there’s war, a breakdown in public health infrastructure, a place where they’re

being persecuted for whatever religious or ethnicity. These are people who’ve

been traumatized. They live in often very, very poor conditions.

DR. WILLIAM STAUFFER: And I have to say that knowing what these people

have been through, you can see why they’re the minority who’ve actually

survived or who have gotten to where they’ve gotten to. Most people haven’t

made it this far. There is an amazing resilience in some of these people.

DR. PATRICIA WALKER: [SPEAKING ANOTHER LANGUAGE] 92. And did you

come through, how they did you escape? Did you come through Cambodia or by

boat from Vietnam or what happened?

FEMALE SPEAKER: [SPEAKING ANOTHER LANGUAGE]

DR. PATRICIA WALKER: We have so much major depression and post

traumatic stress disorder in a lot of our patients. In fact there was a recent study

published that showed that even two decades after the killing fields in Cambodia,

that many Cambodians have major depression and post traumatic stress

disorder. So, even though they’ve been here for years they’re still struggling with

it.

When people have minor car accidents in the snow in Minnesota their PTSD

symptoms can flare. And we see people who come in and are really afraid when

someone slams the door, there’s a loud noise. A lot of people have triggers

where they’ll have these old terrible memories from their time as a refugee, that

could actually be triggered even after an event like September 11 and anything

they see on TV that’s traumatic about a war.

[SPEAKING ANOTHER LANGUAGE]

And I know many Cambodian people suffered a lot who were born in South

Vietnam and then during the war had to escape to Cambodia.

FEMALE SPEAKER: [SPEAKING ANOTHER LANGUAGE]

DR. PATRICIA WALKER: Did you lose family members during the killing fields,

the Pol Pot time?

FEMALE SPEAKER: [SPEAKING ANOTHER LANGUAGE]
MALE SPEAKER: [SPEAKING ANOTHER LANGUAGE]

FEMALE SPEAKER: Missing a lot, and my cousin, about five families were

missing. All gone.

DR. PATRICIA WALKER: So dozens of people then. Five families.

FEMALE SPEAKER: Five families. When we say the word “pot bouch,” you know

like they’re “missing,” we use the word “missing” because we didn’t see their

bodies, or like genocide. “Pot bouch.” DR. PATRICIA WALKER: Pot Bouch.

MALE SPEAKER: [SPEAKING ANOTHER LANGUAGE]

FEMALE SPEAKER: And there’s three families left. Only one person per family

left. Only females left.

DR. PATRICIA WALKER: And, Boo, during the killing fields where were you in

Cambodia?

FEMALE SPEAKER: [SPEAKING ANOTHER LANGUAGE]

DR. WILLIAM STAUFFER: When you see people who’ve lost everything. I had

one woman who acquired HIV while she was in a refugee camp in Togo. She

was raped multiple times a day for well over a year.

DR. MEB RASHID: You know, we hear a lot of stories about sexual violence. We

hear lot of stories about family break downs.

DR. WILLIAM STAUFFER: She’d acquired her HIV through being raped. When

she presented, she presented almost in a coma. And then shortly after that went

into coma. She had three infections in her brain. Which we treated, and she

actually recovered.

And you’ve never met a person who’s, in a sense, more joyous. Or you go and

see her and she’s just amazing person. She made it through this, and she has

this attitude about life, that she continues to live life. And she’s partially paralyzed

now.

DR. MEB RASHID: I remember one woman who is here with her three children

and we were taking her family history she mentioned she had three other kids.

When I inquired, she came for a place where she had to leave very quickly in the

middle of the night. And she basically scoop and ran. And to this day, she doesn’t

know where her other three children are.

DR. WILLIAM STAUFFER: She Talks about how lucky she has to be alive. She

has this amazing, again, resilience. Where I think most people, I think of other

people in similar situations, and I think well over 99% of people would have died

in those situations or would have chosen not to go on.

DR. MEB RASHID: I’ve got one patient of mine who was sharing his stories

about leaving a country and how difficult it had been. In transit they were

attacked and he watched family members die in front of them in the water.

And he was in tears as he was telling the story. And he’d been here quite a long time, and I had known for a couple years before he’d shared his particular tale.

And I close to tears and he was in tears. And at one point he stopped and he

said, “you know, what really bothers me is I can’t contribute more to this country.”

DR. CARLOS FRANCO: I feel, in my experience, that they sometimes avoid the

medical system, because it’s a complicated system. And two, they don’t have

insurance, or they don’t have somebody that will spend the time talking about the

history, their culture, and what they’ve gone through, which is very, very

significant.

He’s in two? OK.

Hey, Martin. How are you?

MARTIN: How are you?

DR. CARLOS FRANCO: Good, good. You want to go over here?

How long have you had this pain?

MARTIN: I think it’s a couple of months.

DR. CARLOS FRANCO: A couple months. So the last time I saw you was a few

months ago and you were doing OK.

MARTIN: Yeah, the last time you saw me.

DR. CARLOS FRANCO: We gave you that treatment and you did feel better.

MARTIN: Yeah.

DR. CARLOS FRANCO: So now this seems to be a new problem?

MARTIN: Yeah.

DR. CARLOS FRANCO: This is one of the scars from when you fever when you

were a kid?

MARTIN: Yeah, right.

DR. CARLOS FRANCO: When I ask him specifically about these medical issues

back at home, I do feel like we make a connection. Because in a way, he is

sharing about the way they were treated in their communities in Sudan. And it’s a

way to develop rapport with them. So I use it just to let them know that I care

about what happened when they were kids. And in a way they don’t come with a

chart of their illnesses. So getting a good history on them and sometimes looking at the scars. I think the

scars tell you a story when there were kids. Some of them, there’s guys that I’ve

seen on their bodies are scars from bullets. And actually there’s a couple guys

there we’ve seen here in a clinic, that they do have bullets in their system that we

can actually see on x-rays. And that’s obviously the result of the violence that

took place back in Sudan. Back during the war.

MARTIN: So the time I left the country, it was not the decision that I had made. I

was just forced out by the war when I was really a little boy.

So the time I left Sudan, I went to Ethiopia, and on my way to Ethiopia a lot of my

friends have lost their lives, through wild animals, some people might have

drowned if we can find a river, and other people died of thirst, hunger, and a lot of

things.

The government was really following us because they know that is where there

are a good number of people. And what the Sudan government expects always

is to cause damage to people, to kill people. So, whenever they know that the

refugees are there, they used to bomb those places. So we were moved from

Nairoos. And if they come to Nairoos they will kill us, so then we fled to Kenya.

MALE SPEAKER: Do you remember times when you felt like your life was very

much in danger? That you might die?

MARTIN: Yeah, especially like the time I– on my way sometimes maybe you

don’t know what are you going to eat? How are you going to survive? You just

give up the life, and work like that, and if you survive tomorrow you don’t know

about next tomorrow, you don’t know about next. It’s just only God’s will that I’m

alive today. Because we have lost a lot of people, even the people who are older

than me, others who were really very littler than me, and I do, as do some of my

friends, then I also die.

DR. MEB RASHID: And to think about how people move on, and not without their

scars, but can somehow seem to plod forward and take care of their families and

adjust to new lives everyday, it really, I think, a lesson for all of us.

DR ANNA BANERJI: I think that a lot of people have the idea that these refugees

or refugee claimants, people coming here that they have the illegal documents,

that they’ve crossed borders illegally.

And a lot of people don’t realize if this was a movie, the person who actually

came here would be a hero, like Harrison Ford. He escaped these people that

we’re trying to kill him. They escaped this firing squad, they escaped all kinds of

obstacles to arrive here.

ROBERT CARLSON: I think that’s something that’s really underestimated, is the

power to succeed and the power to overcome. And these people that have just

had tremendous hardships and overcome it.

DR ANNA BANERJI: That’s survival. That’s how you get to a place like this. And

so I think that we’re very quick to label these people as bad people, but if it was

any of us facing those dire circumstances, what would we do to escape?

Discussion Part 1 (2 pages)

Cultural Competence and the Workforce of the Future

As a current or future health care administration leader, you might engage in certain cultural competence initiatives for your health care organization. In what ways would fostering increased efforts for cultural competence in a health care organization impact health care delivery? In what ways might cultural competence efforts enhance the patient experience in your health care organization?

1. For this Discussion, review the resources for this week and reflect on the efforts aimed at increasing cultural competence in health care. Consider how you, as a current or future health care administration leader, might promote efforts to ensure your health care organization provides culturally-competent care.

By Day 3

2. Post an explanation of your role in ensuring that your health care organization or one with which you are familiar provides culturally-competent care. Be specific and provide examples.

By Day 5

Continue the Discussion and respond to one of your colleagues’ initial posts analyzing his or her explanation of his or her role in an organization’s provision of culturally-competent care. What suggestions would you offer your colleague to enhance the organization’s provision of culturally-competent care?

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 1 Discussion 1 Rubric

Post by Day 3 and Respond by Day 5

To participate in this Discussion:

Week 1 Discussion 1

Discussion Part 2(2 pages)

Health Care Workforce of the Future

Research shows that the current health care workforce does not match the diversity of the nation (AAMC, 2015). As the population continues to become more diverse, health care executives will be responsible for the diversity of the workforce in health care organizations.

1. For this Discussion, reflect on how health care executives might implement strategies to enhance workforce diversity in health care organizations.

By Day 4

2. Post an explanation of how the workforce of the future in health care organizations should mirror the diversity of the national population. Then, explain how this might be accomplished in your health care organization or one with which you are familiar. Be specific and provide examples.

By Day 6

Continue the Discussion and post a response to one of your colleagues’ initial posts responding to his or her suggestions regarding creating a more diverse health care workforce.

Submission and Grading Information
Grading Criteria
To access your rubric:

Week 1 Discussion 2

Rubric

Post by Day 4 and Respond by Day 6

To participate in this Discussion:
Week 1 Discussion 2

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