Diversity Dialogues: A Model to Increase Comfort with Discussion of Religious Cultural Differences in Healthcare Settings
Anne Emmerich, M.D., Associate Director, Department of Psychiatry Center for Diversity, Massachusetts General Hospital
Ngoc Vu, Connecticut College
Estee Sharon PsyD, Massachusetts General Hospital
Barbara Siftar, Massachusetts General Hospital
Nhi-Ha Trinh M.D., Massachusetts General Hosptial
Studies show a majority of patients want healthcare providers to discuss spirituality and religion with them. Patients often ask providers about their spiritual beliefs. Most healthcare providers feel unprepared when these questions arise despite a 2005 survey that showed a majority of U.S. physicians believe in God and attend religious services. The percentage of physicians claiming an underrepresented religious affiliation (Hindu, Jewish, Muslim, Buddhist) exceeds the percentage of non-physician U.S. residents who claim these affiliations. In America in the 21st century religious differences remain a source of confusion and anxiety for many.
As professionals we care for people who differ from us in many ways. We are often confronted with experiences with cultural themes, some of which we may be uncomfortable discussing. Studies show that implicit bias on both the patient and provider side of decision making conversations can impact patient compliance and healthcare outcomes. Increasing demands on providers due to electronic medical record keeping and compliance measures increase even further the risk of providers and patients feeling distant from each other, causing disenchantment and the potential for erroneous assumptions on both sides.
The current paper proposes a Diversity Dialogue model for increasing comfort with discussion of religious or spiritual differences in healthcare settings. Our department developed a 3-hour Diversity Dialogue as a way for staff members of all specialties to have opportunities to discuss cultural themes and strengthen the skill sets needed to provide effective care for patients. Between 2012 and 2016, twelve Diversity Dialogues were held, approximately 25 participants per Dialogue. Participants included medical students, residents, administrative support staff, nurses, psychologists and physicians. Settings included a university mental health clinic, a medical school, and 3 large departments in an academic teaching hospital (pathology, neurology, psychiatry).
Using a combination of small and large group discussion, participants were encouraged to share vignettes from their own lives focusing on cultural factors that led them to be the people they are, in whatever way they define the term “culture” for themselves. Additionally they were asked to share vignettes of clinical encounters in which they felt a cultural difference had been a factor. Many participants spontaneously mentioned religion or spirituality both when sharing about their own cultural heritage and when discussing clinical encounters they felt challenged by.
This Diversity Dialogue program has been well received in our hospital, with each department requesting additional Dialogues after experiencing the first one. The current paper will discuss factors that contribute to successful Dialogues including pre-dialogue work with site leaders, commitment of department leadership, and time management. Inclusion of didactic material in Dialogues is addressed. Facilitators have concluded that didactic material about implicit bias, microaggression and microaffirmation is well received and a majority of participants indicated they were not previously familiar with these concepts. Potential problems that can occur in conducting a Diversity Dialogue program and how to reduce this risk are discussed. A recent literature search of diversity trainings in healthcare settings and how the proposed model differs from these is also presented.
Ngoc Vu, Connecticut College
Estee Sharon PsyD, Massachusetts General Hospital
Barbara Siftar, Massachusetts General Hospital
Nhi-Ha Trinh M.D., Massachusetts General Hosptial
Studies show a majority of patients want healthcare providers to discuss spirituality and religion with them. Patients often ask providers about their spiritual beliefs. Most healthcare providers feel unprepared when these questions arise despite a 2005 survey that showed a majority of U.S. physicians believe in God and attend religious services. The percentage of physicians claiming an underrepresented religious affiliation (Hindu, Jewish, Muslim, Buddhist) exceeds the percentage of non-physician U.S. residents who claim these affiliations. In America in the 21st century religious differences remain a source of confusion and anxiety for many.
As professionals we care for people who differ from us in many ways. We are often confronted with experiences with cultural themes, some of which we may be uncomfortable discussing. Studies show that implicit bias on both the patient and provider side of decision making conversations can impact patient compliance and healthcare outcomes. Increasing demands on providers due to electronic medical record keeping and compliance measures increase even further the risk of providers and patients feeling distant from each other, causing disenchantment and the potential for erroneous assumptions on both sides.
The current paper proposes a Diversity Dialogue model for increasing comfort with discussion of religious or spiritual differences in healthcare settings. Our department developed a 3-hour Diversity Dialogue as a way for staff members of all specialties to have opportunities to discuss cultural themes and strengthen the skill sets needed to provide effective care for patients. Between 2012 and 2016, twelve Diversity Dialogues were held, approximately 25 participants per Dialogue. Participants included medical students, residents, administrative support staff, nurses, psychologists and physicians. Settings included a university mental health clinic, a medical school, and 3 large departments in an academic teaching hospital (pathology, neurology, psychiatry).
Using a combination of small and large group discussion, participants were encouraged to share vignettes from their own lives focusing on cultural factors that led them to be the people they are, in whatever way they define the term “culture” for themselves. Additionally they were asked to share vignettes of clinical encounters in which they felt a cultural difference had been a factor. Many participants spontaneously mentioned religion or spirituality both when sharing about their own cultural heritage and when discussing clinical encounters they felt challenged by.
This Diversity Dialogue program has been well received in our hospital, with each department requesting additional Dialogues after experiencing the first one. The current paper will discuss factors that contribute to successful Dialogues including pre-dialogue work with site leaders, commitment of department leadership, and time management. Inclusion of didactic material in Dialogues is addressed. Facilitators have concluded that didactic material about implicit bias, microaggression and microaffirmation is well received and a majority of participants indicated they were not previously familiar with these concepts. Potential problems that can occur in conducting a Diversity Dialogue program and how to reduce this risk are discussed. A recent literature search of diversity trainings in healthcare settings and how the proposed model differs from these is also presented.