Cultural determinants of Health The Quality Improvement Perspective Pr. Marianne Samuelson Kos September 2005

Cultural determinants Cultural determinants of Healthof Health

The Quality Improvement The Quality Improvement PerspectivePerspective

Pr. Marianne SamuelsonPr. Marianne SamuelsonKos Kos

September 2005September 2005

September 2005Pr. Marianne Samuelson

Cultural determinants of Health and QI2

Cultural determinants of Health Cultural determinants of Health The QI perspective: 2 aspectsThe QI perspective: 2 aspects

1- Cultural determinants and Quality in the 1- Cultural determinants and Quality in the Patient-Physician encounterPatient-Physician encounter

2- 2- Cultural determinants in implementation Cultural determinants in implementation of Quality improvement methods in the of Quality improvement methods in the different European countriesdifferent European countries



1-Cultural determinants and Quality 1-Cultural determinants and Quality in the Physician-Patient contactin the Physician-Patient contact

StoryStoryThe “Tree-man”The “Tree-man”



QuickTime™ et undécompresseur TIFF (LZW)

sont requis pour visionner cette image.

The “Tree-man”The “Tree-man”

After Noelle Lasne



1-Cultural determinants and Quality 1-Cultural determinants and Quality in the Physician-Patient contactin the Physician-Patient contact

• • What is the main idea that What is the main idea that you take out for this you take out for this

story?story?One main idea per table , One main idea per table , Phrased in one sentencePhrased in one sentence



Cultural determinants and Quality in Cultural determinants and Quality in the Physician-Patient contactthe Physician-Patient contact

Can Primary Care Physician respond to the needs of Can Primary Care Physician respond to the needs of cultural diverse populations?cultural diverse populations?

Predominant medical model: pathophysiological basis and patient explanatory Predominant medical model: pathophysiological basis and patient explanatory

model of illnessmodel of illness

Self awareness and reflection on one's own values, and beliefs and genuine Self awareness and reflection on one's own values, and beliefs and genuine

curiosity and and humility curiosity and and humility

Cultural practices and norms / towards individual behaviour Cultural practices and norms / towards individual behaviour

Negotiate differences in language, wording and ways of addressing clinical Negotiate differences in language, wording and ways of addressing clinical

problemsproblems

Being knowledgeable, skill fullBeing knowledgeable, skill full Lifelong contacts and interactive learning processesLifelong contacts and interactive learning processes

Culture is neither seamless nor staticCulture is neither seamless nor static



2-Cultural determinants of Quality 2-Cultural determinants of Quality Improvement methods in the different Improvement methods in the different

European countriesEuropean countries The approach to reflection and The approach to reflection and

implementation of QI methods in Europe implementation of QI methods in Europe may vary according to the “cultural” may vary according to the “cultural” backgroundbackground



1. TransparencyAccountabilityEBM-guidelines

1

2

2. Flexibility“colloque singulier”

3

3. Population-orientedsystematic prevention

From Jan de Maeseneer



Cultural determinants of Quality Improvement Cultural determinants of Quality Improvement methods in the different European countriesmethods in the different European countries

Differences in performance?Differences in performance? Approach to changeApproach to change Implementation of changeImplementation of change Acceptance of measuringAcceptance of measuring How knowledge is produced and used…How knowledge is produced and used… Orientation toward PHC of the Health care systemOrientation toward PHC of the Health care system Culture of the organisation or the systemCulture of the organisation or the system Type and use of guidelines Type and use of guidelines ………….. …………..



There are differences in the way QI is There are differences in the way QI is undertaken in different European undertaken in different European

countries……countries……

What might the cultural influences be What might the cultural influences be behind these differences?behind these differences?

Theses are some of my thoughts…..could Theses are some of my thoughts…..could could think about some others? One idea could think about some others? One idea per table, one sentence.per table, one sentence.



What is EQuiP contribution…..What is EQuiP contribution….. Research or statement papers connected to Cultural Research or statement papers connected to Cultural

determinants and Quality in the Physician-Patient determinants and Quality in the Physician-Patient encounterencounter Europep: on patient satisfactionEuropep: on patient satisfaction Improve: on involvement of aging people in the decision making Improve: on involvement of aging people in the decision making

processprocess Dealing with Uncertainty…..Dealing with Uncertainty…..

Research connected to Cultural determinants to Research connected to Cultural determinants to implementation of Quality improvement methods in the implementation of Quality improvement methods in the different European countriesdifferent European countries EPA tools to assess differences in organisational aspects in EPA tools to assess differences in organisational aspects in

EuropeEurope Projects: Research on Cultural explanation to variation of Projects: Research on Cultural explanation to variation of

performance in the different European countries…….performance in the different European countries…….

Merci…

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Cultural determinants of Health The Quality Improvement Perspective Pr. Marianne Samuelson Kos September 2005