That’s how we’ve always done it.

In a perfect world, race, ethnicity and culture would have no negative effect on the medical care we receive. The effect is due to historical heritage more than skin color. What is meant by this statement?

Historical heritage is another way of saying “That’s how we’ve always done it.”

A family’s real heritage involves where they came from, what languages and customs and beliefs they hold. Historical heritage is an assumption made about a person because of socio-economic trait that leads to a generalization about a person because they belong to a specific, pre-determined, group of people that also share that trait.  A person’s real heritage may be very different from a perceived historical heritage, but the result of this type of stereotyping is precisely what happened to Henrietta Lacks and her descendants. The medical profession had always treated poor, black people with about the same level of concern as they had for laboratory mice. Uneducated people didn’t ever need to consulted about their health care because doctors assumed that they could not even understand their diseases. Even if Henrietta had been white, any number of other factors could have contributed to what happened to her and her family.

Ethics

The ethical aspect of how Henrietta Lacks and then her family were treated are numerous. There are examples throughout the book that illustrate a complete absence of ethics when compared to health care today.  The two most egregious examples show the utter disregard that was shown the Lacks family.

“Like many doctors of his era, TeLinde often used patients from the public wards for research, usually without their knowledge. Many scientists believed that since patients were treated for free in the public wards, it was fair to use them as research subjects as a form of payment. And as Howard Jones once wrote, “Hopkins, with its large indigent black population, had no dearth of clinical material.” 1 (29-30)

The assumption that a patient under their care deserved no compensation for being the subject of research, by today’s standards, is questionable.  However, the fact that many doctors didn’t even communicate to the patient that they were being used in research experiments illustrates what little regard they had for their “free” patients as humans.

 “What do you mean, ‘everybody else’?!” Bobbette snapped. “What supplier? Who’s got cells from my mother-in-law?” It was like a nightmare. She’d read in the paper about the syphilis study at Tuskegee, which had just been stopped by the government after forty years, and now here was Gardenia’s brother-in-law, saying Hopkins had part of Henrietta alive and scientists everywhere were doing research on her and the family had no idea. 1 (180)

This paragraph illustrates both the lack of ethics and the “historical heritage” applied to Henrietta’s family regarding HeLa cells.  Unauthorized, uncompensated and uncommunicated research had been going long before Henrietta, and despite limited change in attitudes on the subject, her family found out that it was still going on and affecting their family directly.

Health Literacy

Henrietta and her family honestly didn’t have a great deal of health literacy, and due to their historical heritage, they were not likely at all to obtain any.

There’s no indication that Henrietta questioned him; like most patients in the 1950s, she deferred to anything her doctors said. This was a time when “benevolent deception” was a common practice—doctors often withheld even the most fundamental information from their patients, sometimes not giving them any diagnosis at all. They believed it was best not to confuse or upset patients with frightening terms they might not understand, like cancer. 1 (63)

In this example, heath literacy would remain stagnant for two reasons: Henrietta wouldn’t have been likely to ask many questions, and her doctor wouldn’t have been likely to volunteer information.  This also shows that historical heritage can sometimes even impact a person’s view of themselves.  Not questioning your doctor during this era was not necessarily even a black patient or white patient issue, it was just how it was, for everybody.

Communication

The communication style used will often depend on the assumed level of understanding of the individual being communicated with.  In the case of the doctors communicating with Henrietta and her family, only as much information as was needed was given.  In the example below, the doctors kept the message simple and repetitive, to the point of pestering. At certain point they may have seen an opening in which Day’s cousin could help their cause.  It was at that point that it was shared that the research might help his family.  They only referred to the procedure as “tests” – only as much information as they needed to share in order to accomplish their uncommunicated goals.

The way Day remembers it, someone from Hopkins called to tell him Henrietta had died, and to ask permission for an autopsy, and Day said no. A few hours later, when Day went to Hopkins with a cousin to see Henrietta’s body and sign some papers, the doctors asked again about the autopsy. They said they wanted to run tests that might help his children someday. Day’s cousin said it wouldn’t hurt, so eventually Day agreed and signed an autopsy permission form. 1 (89-90)

Health disparities

The passage below is a striking example of how historical heritage caused Elsie to not only spend her life in an institution, but to die there.  All of the other aspects, communication, ethics and literacy played into what happened to Elsie, when the family was told about her and how she was treated while institutionalized.

Soon after Elsie’s death, a new warden took over at Crownsville and began releasing hundreds of patients who’d been institutionalized unnecessarily. The Washington Post article quoted him saying, “The worst thing you can do to a sick person is close the door and forget about him.” When I read that line out loud, Deborah whispered, “We didn’t forget about her. My mother died … nobody told me she was here. I would have got her out.” 1 (276)

One of the aspects of this book that I found the most interesting was that throughout the story, the Lacks and Lee families never were compensated and never shared in any of the glory or thanks for what Henrietta contributed to science and medicine.  The CNN news story referenced here discusses answers two questions raised by the story of Henrietta Lacks.  Not only did the families eventually get a say in the future distribution of HeLa cells and what kind of research could be performed with them, they also helped reform genetic research ethics and an end (hopefully) to the kind of unethical use of any kind of test results from medical procedures or research.

This quote from the CNN article displays what is now a common framework when dealing with privacy and permission to use research in the medical field.

"What happened with Henrietta Lacks is beyond-the-pale horrible, and we don't want that to happen again," said Dr. Robert Klitzman, director of the Masters of Bioethics Program at Columbia University and author of "Am I My Genes?: Confronting Fate and Family Secrets in the Age of Genetic Testing." 2

"We owe it to people to give them a choice: 'Do you want to do this research even if it is a potential risk to your privacy?'" 2

References

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1.	Skloot R. The immortal life of Henrietta Lacks. New York: Crown Publishing Group; 2010.
2.	Smith S. Family finally has say on HeLa cells' destiny - CNN.com. CNN Health. August 11, 2013. Available at: http://www.cnn.com/2013/08/07/health/henrietta-lacks-genetic-destiny/. Accessed January 29, 2017.

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Cross Cultural Communication Training

Cross Cultural Communication Training - Intro

I really do not have the background or experience in any sort of healthcare workplace, so I am going to complete this competency based on what I have seen in the corporate banking world and what I have learned while working on the other competencies in this course.  Some of my experience is also rooted in 24 years of military service.  I have found that some of the skills/knowledge I gained there are useful in the civilian world, but some are not.  In fact, some needed to be unlearned in order to re-learn leadership and communication styles more appropriate to cubicles than ships and combat zones.

My organization, a very large international bank, suffers from poor communication across different cultures.  Large organizations with top-down management sometimes also get saddled with very top-down communications that are often directed at different, diverse groups, but are provided in a single senior/subordinate manner. I will create this training with my co-workers as an audience, not necessarily just Enterprise Information Technology, where I work, but the bank and all its employees.

The topic of this training is very broadly “Cross-cultural communication.”  The reason that formal training like this is so appropriate to my workplace is the many cultures that all work together to serve the financial needs of

clients that are even more diverse than our own teams.  An anecdotal reason I know that the topic is important to the executives and senior leaders in my organization is that we repeat annual training on several areas of diversity and inclusion.  Unfortunately, I have not noticed the training varies much year to year, so this is my attempt at creating something a little different. I understand that it takes an organization time to develop broad skills in cultural competency, and formal training is just one element of the continuous cycle of feedback and improvement.

The world continues to get smaller. Not in a physical sense, but in terms of the global economy and the interconnected nature of business. You work for a company with offices and banks in over 25 countries which means there are Team members from many cultures and backgrounds, as well as the customers we server.

One of the primary tenets of our Vision and Values is "Diversity and social inclusion" which means that we "ensure everyone feels respected with equal access to resources, services, and opportunities to succeed." 2

Cultural competency is important not only because it is good for business, but it is also good for our team members.  Watch below as Michelle Lee explains how diversity leadership drives employee engagement.

It takes consistent individual practice and the support of a culturally competent organization to continue to develop and maintain individual cultural competence. 1

Learning Objectives

1. Define Culture and its effect on communication
2. Better communicate with a cross-cultural audience
3. Have additional tools to improve communication in cross-cultural relationships.

Each of the above objectives will be covered in a separate post, so to see the entire series, use the label "comp1" to see just these training posts.

In the next post, you will be learning what the term culture means when applied to workplace communication.  In the third post of this series, you will learn some key points to remember when communicating with a cross-cultural audience.  In the last post, we will discuss some tools or skills that not only help improve your communication, but will also lead to better cross-cultural relationships.

But first, here is an example of the wrong way!

Things to consider:

What might he have done prior to this trip to prevent what happened?

Why do you think she reacted the way she did?

Write down a few thoughts, we'll attempt to answer these questions in the next post.

Next

Cross Cultural Communication Training - Part III

Better communication with cross-cultural audiences

So, to review the last post, we were discussing how to improve our own awareness.  In business like in life, you can't just fly through on auto-pilot.  Being aware is a skill that will lead to understanding when you are in a situation in which you need to learn about a culture to have effective communication.

Watch this short clip from Little Pilot and try to pick out the actual things to be aware of as you learn.

Many people in the banking industry are aware of what is meant by a dashboard.  In terms of business it isn't as simple as a dashboard in your automobile that tells you a few things about the engine, how fast you are going and how many miles you've driven.  In business, its a starting point, an overview of things you should know and be aware of.  It is a tool to help you dig deeper.

What are three aspects of a culture that the video suggests you be aware of in order to understand a culture that you are doing business with?

1. Deal Oriented vs Relationship oriented
2. Direct communication vs Indirect communication
3. Egalitarian or hierarchical leadership

Consider how these things might influence your communication style.  In the next post we will discuss how these and other skills can contribute to not only improving your cross-cultural awareness, but also your relationships with customers and co-workers from different cultures.

Next

Cross Cultural Communication Training - Part IV

Improving cross-cultural relationships

The best way to show you how different cultures can clash and cause personal conflicts that can have lasting effects on business relationships is to start with an example of it going very badly.

Watch this video of a short business meeting between two people that are not only from different cultures, but have managed to cultivate some negative attitudes about the other's culture.

While this is a somewhat humorous presentation of the stress different cultural values can put on a relationship, you can see that although these two people probably have a great deal in common, their approach to business is very different because of their culture.

Both characters, in their thoughts to themselves asked "Why?" questions about the other's approach to business.  Very simply put, the answer is their culture.  Had either taken the time to understand one another's values about "getting down to business" or punctuality, this encounter could have been a lot less tense.

So what can be done to learn about a culture, especially one that you will be interacting with during a typical business day?  Watch this video below and consider what the speaker suggests, and even what she did to learn about the Chinese culture.

For the final post in this series, we will summarize what was presented in the previous posts, but before that, jot down a few of the tools Valerie Hoeks provides in the video you just watched.  We'll discuss them in the wrap-up.

Next

Cross Cultural Communication Training - Part II

Review

Welcome back!  So after watching that video of the two stick figures, you should be able to see the importance of cultural competency and how forms of communication can mean very different things in different cultures.

What do you think the stick figure man could have done prior to the business trip?  For one thing, attending some cultural training specific to the country might have helped avoid this situation.  It demonstrates pretty well that while some things are considered harmless in one culture, other cultures may react to it quite differently.

Why do you think the female stick figure reacted the way she did?  Its possible that in her culture there is not as much separation between business life and personal life; or his behavior crossed a very distinct line in her culture.  The only way to know is to be prepared!

What is culture?

Define Culture and its effect on communication

So what is culture? That really depends on who you ask.  Here are a few definitions. 3

• Culture refers to the cumulative deposit of knowledge, experience, beliefs, values, attitudes, meanings, hierarchies, religion, notions of time, roles, spatial relations, concepts of the universe, and material objects and possessions acquired by a group of people in the course of generations through individual and group striving.
• Culture is the systems of knowledge shared by a relatively large group of people.
• Culture is communication, communication is culture.
• Culture in its broadest sense is cultivated behavior; that is the totality of a person's learned, accumulated experience which is socially transmitted, or more briefly, behavior through social learning.
• A culture is a way of life of a group of people--the behaviors, beliefs, values, and symbols that they accept, generally without thinking about them, and that are passed along by communication and imitation from one generation to the next.

So what is the common thread? Beliefs and behaviors are both mentioned often.  And the highlighted item in the third bullet perfectly describes the purpose of this training. Verbal, written, nob-verbal communication elements help us to define and understand a culture.

Watch the movie below to understand what culture is and how it can interfere with communication and what you can do to avoid some of the issues you might experience.

Does this clip help you understand what was going on in the stick figure scenario from the first post?  Consider that the male stick figure's culture has a more distinct line between business and personal communication, where the female's culture takes a more holistic approach.  It's easy to see how different cultures could perceive the same behavior differently than intended, leading to conflict.

The first tool, as with almost any new thing you learn or try to get better at is awareness.  Think about this question: How can you train yourself to be more aware of the different cultures you work with?  How does one become more aware of being aware?  Formal and informal training like this is a start, but in the next post we will discuss ways to improve communication with a cross-cultural audience.

Cross Cultural Communication Training - Part V

Summary and wrap-up

In these five posts you have learned how to define culture and how it can effect our communication.  You also learned that awareness is key and the first step in improving your communication with a cross-cultural audience.  And in the previous post, you hopefully wrote down a few tools that will aid in understanding different cultures.

Here are some of the skills or actions suggested.  How closely does your list match?

Learn the language, or at least enough to start and end conversations in the native language of your associate or customer.  English is spoken by a majority of international business people, but this doesn't mean that using their own language isn't important to people from cultures different from your own.  In fact, showing that you took the time to learn a few phrases prior to your engagement shows them that you ARE aware and can help build strong business relationships.

Visit the country, prior to travelling there on business.  Having some experience with the customs and behaviors of a culture without the added pressure of a business environment will give you background and the chance to

learn about the culture by experiencing it directly.  If you can't travel physically, you can always use the internet for a virtual tour.

As you learn about a culture, being aware of a single trait is only a start.  An example from the last video is the fact that the Chinese value relationships, family and respect for elders.  That is the trait, but part of the awareness and learning is knowing why.  Knowing that these values stem from a deep regard of Confucius' teachings is taking the extra step from being aware to being culturally competent.

Indicators of success

Having an awareness of the impact a particular communication style or word choice might have on cross-cultural relationships is the first step making changes where necessary.  This type of training will never have definitive right or wrong answers, so simply passing a test would only indicate that the student was a good test taker.

 For me to know if this training was successful or not, it would have to come from the people that viewed it.  It would be my hope that this format is in no way threatening and is more entertaining that most materials on the subject.  The result of having viewed this presentation should be that a person would have another reason in the back of their mind to be aware, and get into a habit of continuously trying to learn by using the skills offered here. 

References

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1.	Health MSf. The providers guide to quality and culture. Culturally competent organizations. Available at: http://erc.msh.org/mainpage.cfm?file=9.1.htm&module=provider&language=English. Accessed December 12, 2016.
2.	Wells Fargo Corporate Human Resources. Corporate Social Responsibility. Wells Fargo - About Us. January 01, 2017. Available at: https://www.wellsfargo.com/about/corporate-responsibility/. Accessed December 18, 2016.
3.	Choudhury I. Faculty Web Site. Texas A&M University. Available at: https://www.tamu.edu/faculty/choudhury/culture.html. Accessed December 02, 2016.

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Interdisciplinary Cultural Competence

Changes In Attitudes, Knowledge, And Skills

 What I have learned initially from this course is that a change in attitude is the first outcome of diversity training. It isn't a change from bad to good, but more a change from apathy to awareness.  For me, trudging through life dealing with issues with co-workers, family, pets and all the drama that life provides is sometimes all consuming. I have rarely slowed down enough to even become aware of the cultures around me or how my behavior or communication style may or may not fit. 
As many have said before me, awareness is the first step toward solving a problem. Admittedly, if I personally have been less than stellar in my intercultural dealings, nobody has said anything to the fact.  There is the key shift in attitude that I see - after going through some training, it becomes apparent that nobody should have to bring it to your attention. A person in a multicultural environment should desire the knowledge and skills of cultural competency. It is far better to have such skills and knowledge and not need them than vice versa.

A common definition

Cross has "a definition of cultural competence for child social services which has been used broadly since 1989. It defines cultural competence as a “set of congruent behaviors” for working effectively in cross‐cultural situations." 1 However I don't think that this is specific enough to be considered useful across either a broad range of fields or a broad range of cultures.  It is effectively true, but not as specific as the one I found in the LIS framework I wrote about in a previous post.

Cultural competence is the ability to recognize the significance of culture in one’s own life and in the lives of others; and to come to know and respect diverse cultural backgrounds and characteristics through interaction with individuals from diverse linguistic, cultural, and socioeconomic groups; and to fully integrate the culture of diverse groups into services, work, and institutions in order to enhance the lives of both those being served [by the library profession] and those engaged in service. 2

The above is quoted directly, however I added the brackets to indicate the words that I would remove to make this definition the one I would propose applies to anybody, in any field.

Reflection on progress 

Listed below are the three learning outcomes I chose for myself for this class.

1. Attain the ability to recognize cultural issues in both my personal and professional environments.

I think I have had a decent exposure to recognizing culture and inclusion issues, especially in my professional careers of the military and information technology. One of the gifts of the military experience, especially after a long career and the privilege of leadership is the exposure to one of the most diverse work forces anywhere. In both arenas I have had formal and informal training, sometimes web based yawn-fests that don’t have much impact, and sometimes facilitator lead classes that I find much more engaging.  Where the most learning occurs however is out there, in the offices, in the field, on the ships and shore stations.  Since I won’t be on the receiving end of any more military training, I believe that I have gained a new interest in maintaining a higher level of cultural competence.  I have a desire to advance out of the technical leadership role I have now and into management, so this is not a skill I should let go stale.

2. Reach a higher level of understanding how different cultures approach the "work" environment. 

Unfortunately, I have not made a great deal of progress with this item, perhaps because it was overly general and not as applicable to an educational setting as it would be in an on the job learning environment. When I wrote this outcome, I was thinking specifically of the different cultures I am exposed to at my job with Wells Fargo.  One of the things that makes this learning difficult is that I very often work from home.  My contact with co-workers is mostly via email and IM, some over the phone, but almost no direct, personal contact. I think this is an area where I will continue to self-educate, because I have a desire for the knowledge, but will likely not get it in a classroom setting.

3. Understand better the impact of culturally inappropriate behaviors on the workplace.

I think that the case-studies assignment gave me a great deal of insight into how behaviors can affect outcomes.  This is particularly true in the health care setting, and I would like to continue my learning and discover similarities in the world of information technology.  One of the key things that I have learned, and this doesn’t necessarily apply to any of the above three stated goals, is that the health care industry focus is just that, an industry focus.  What I suspected I would find, and did, was that in information technology, the focus on cultural competency is more employer based.  I suspect that if you moved between hospitals and clinics, you would find less variance in the attention paid to cultural issues than if you moved between difference technology employers.  This is reflected in the lack of formalized training recognized by the governing bodies of technology when compared to those of health care.  Who knows, maybe as I progress into management, this might be an area of my industry that I can help improve.

References:

1. Cross, Terry L.; Bazron, Barbara J.; Dennis, Karl W.; and Isaacs, Mareasa R. Towards a Culturally Competent System of Care. Washington, DC: CASSP Technical Assistance Center, 1989. 

2. Overall M. Cultural competence: a conceptual framework for library and information science professionals. The Library Quarterly. April 2009;79(2):175-204. Accessed here: http://www.journals.uchicago.edu.ezproxy.lib.uwm.edu/doi/abs/10.1086/597080