Cultural System

Culture was mentioned in two contexts: The need to develop a culture of patient centred collaborative care and the need to be sensitive to the culture of our constituents (often remote, rural and First Nations).

Culture of patient centred collaborative care

Although the participants in this study were all proponents of patient centred collaborative care, one could argue that the prevailing set of shared attitudes, values, goals and practices has not yet embraced this model of care. What is being proposed then is a cultural shift so that IPC becomes the norm.

One of the limitations of this study was that only proponents of IPE and IPC were interviewed. Prior to implementing a strategy for IPE and IPC there should be an opportunity to give voice to groups and individuals who may be reluctant to a shift towards collaborative care. Airing any concerns will either decrease the perceived threat or in fact modify whatever is being proposed to mutual benefit. One participant expressed these thoughts this way:

It was previously mentioned in the sections on technology and organizational structure that the younger generation may be the ones more apt to embrace those aspects of IPC (although one participant thought strong advocates can also be found amongst experienced practitioners who have better basis for comparison; see willingness to collaborate section). If willingness to do referrals to other health professionals is a characteristic of an IPC culture shift, then a focus on the younger learners appears to be paying dividends:

Culture of constituents

A sensitivity to the culture of one's patients is wrapped up in those core ingredients of collaborative patient centred care of trust, mutual respect and communication. Some of the participants had been involved in cross cultural training and it appeared to be well received and applicable to their work:

Food is part of one's culture and the importance (beyond just the cultural sensitivity) and struggles to serve traditional Aboriginal foods were discussed by a couple of the focus groups:

In addition to cross cultural training and allowing traditional foods to be served it was noted that the interpreters (Sioux Lookout) and Native liaison worker (Maternity Centre) are important for cultural support.

Return to the IPC Model

Culture change is something that doesn't come very quickly obviously. I would say the people you see around this table is a minority and not the majority, but you have a sufficient amount of health care providers who are interested in collaborative care and you have much more of the population that are seeking it. I don't think this small group can saturate the demand of the population who actually would like this kind of care and asks for this kind of care. That is a bit of barrier plus wish list. I wish it would happen. The barrier is so multifaceted it is sometimes hard to pinpoint it. The culture change I guess can be summed up that if there is a will there is a way and that goes for the care provider, that goes for the decision makers, that goes for the politicians and the Ministries.

Close

…the challenges with those particular programs was also giving credit to the culture that existed before and so I know that [XXX] worked diligently to address those issues around the divestment piece and what that does to people in terms of feeling valued and feeling recognized and feeling appreciated. So I think we also need to take a look at those broader influences and it is not just in the workplace, I mean this is a stressful life that we live and peoples lives are under tremendous stress and you know the economy in the area, employment and families kind of breaking down because folks are leaving to get work. I mean there are so many challenges that we see that people do bring those pieces of their life to the workplace by virtue of the fact they are human beings, so I think we also need to take a look at those issues that will help enhance self esteem, help people deal with the stressors of life, so that the workplace feels like a place where they are recognized and valued, where they are seen as doing a good job…that whole strength based model in terms of managing situations so they don't see IPC as a means of scrutiny or looking over their shoulder or somebody else criticizing their work. I think it is a huge piece in why sometimes this breaks down and people are reluctant to move forward.

Close

I just wanted to say along that line, you started early just learning about that culture of collaboration, one of the things that they have done here, is that they are educating medical students and residents and boy has that had an impact far beyond what I thought, because now these medical students, and you guys might speak better to it, by learning early as opposed to maybe getting jaded later on from people who had been in the funding system for a little longer, they are referring more. [XXX] can you speak to that more? [XXX]: Well they are referring period.

Close

I just like education in general because there is so much we don't know and going to this [cross cultural training] it has open my eyes so much and I started to look at things differently. For example, there are three [cultures] for the Aboriginals and they all have their own traditions and ways of doing things and we should be open to that. But then it is not just our aboriginal population; we have a lot of Italians, we actually have Lebanese up here. I saw a Muslim woman give birth a couple weeks ago, and you know the Muslim lady didn't want anyone to see her so we had to cover her with a blanket and we must respect those things.

Close

When you look at the social services there are many, many patients who find it very difficult to survive when they come out of their circle of certainty, their safety parameters and they find it very strange to come to a hospital and they find it very strange to eat different foods. Like the other day she [a nurse] came running up to us and she said you guys get us some traditional foods, my patients are having the runs. ….

They come in from the north and they don't eat pasta and we shove it down them and then they all get the runs…we are just making them sick.

To be honest it is pathetic. It is beyond that. We think of let food be thy medicine. Anyway I just pray that our new hospital can really get a handle on that and the food. It is really bad.

We are going to have two different kitchens [in the new hospital].

But the problem is I want it all to be one kitchen with one healthy good food, traditional and non-traditional, not one kitchen that serves up garbage.

This is going to be uninspected when we bring meat in from the north and uninspected can't be in the same place as the inspected so...

Yes. Hopefully people can grab it. Gosh that would be so great

And it works. If you have a patient with wounds, they need the protein and they need the food to heal. I had a patient and he said he could only eat plain traditional foods and he was not eating and so then he is not healing medically. And I am trying to find, you know we are calling around trying to find food or something so he can eat, cause he is saying I don't eat this kind of stuff. It was macaroni and cheese.

Close