National Center for Cultural Competence

Cultural Competence Exchange Newsletter

November 1999

Editor's Note: The state of Wisconsin was chosen as one of the first three demonstration sites for the CSHN component of the NCCC. As will be evident, the combination of commitment from the Wisconsin State MCH Program, the effort of the local site, and follow up from the NCCC produced a dynamic approach to cultural competence.

State Efforts to Promote Cultural Competence

In 1993, the Wisconsin State MCH Program planned for a five year Title V (MCH Block Grant) funding cycle that started on October 1, 1994. We developed and affirmed Five Guiding Principles for MCH in Wisconsin:

family-centered care,
community wide leadership,
health promotion and resiliency,
needs assessment and outreach, and
cultural competence.

Since 1994, we have organized all of our MCH efforts within the framework of these Five Guiding Principles, and they have had a far-reaching influence on all kinds of MCH work in Wisconsin.

The most recent Request for Proposals (RFP) from the state agency mandated that these Five Guiding Principles apply to all MCH programs funded by the Wisconsin Division of Public Health starting on October 1, 1999. In relation to cultural competence, MCH funded agencies will be expected to conduct a self-assessment and develop a plan that incorporates the five Guiding Principles. All plans must include strategies for the following items:

set aside resources for culturally competent services and policies with detailed justification for each expenditure.
address cultural competence in all aspects of the work plan.
apply the principles and practice of family-centered care to cultural competence.
demonstrate work done to become more culturally competent.
describe how these are put into practice: training, job descriptions, hiring practices, program guidelines, mission statement, staff evaluations, consultants, subcontractors, modes of communication within the agency and with families.
include people of diverse cultures in all partnerships and collaborations.
use evaluation methodologies that draw on input from the diverse cultures in the community and reflect a sensitivity to and understanding of cultural behaviors, attitudes and preferences.
document written policies and procedures that address communication needs such as easy to understand educational materials (written, oral, and visual) and translators who can communicate at a skill level that is conversational and respectful of the culture.
collaborate with community based resources such as culture-specific medical practices, spiritual healing and traditional beliefs.
move toward a staffing pattern that reflects the diversity of the community.
include questions about cultural competence in the hiring process.
integrate cultural celebrations into day to day operations.

City of Milwaukee Health Department --A Local Perspective

In 1996, the City of Milwaukee Health Department (MHD) was selected as one of seven local demonstration sites by the National Center for Cultural Competence, Georgetown University Child Development Center. The Center assessed the MHD?s level of cultural competence, the organization?s ability to become more culturally competent and the technical assistance and resources needed to engage in the process of becoming more culturally competent.

After the assessment conducted by the National Center for Cultural Competence, the MHD faced five critical questions...

Do we believe that diversity adds value to the organization, to the individual and the quality of life in our community?
Do we believe that cultural competence lives in every area of our personal, professional and community lives?
Do we want to foster an environment that celebrates the skills, strengths, knowledge, cultural and creative expressions of families served, community, key stakeholders, and Milwaukee Health Department employees?
Are we ready to embark on the journey towards cultural competence, to respect the process and view it as an extraordinary learning opportunity that will transform our organization thereby leading us toward real family centered, culturally and linguistically competent service delivery?
Are we committed to the manifestation of cultural competence not only on the surface but also at the systems level? Can we develop a strategic plan based on four key systemic premises.....administration of policy; leadership development; program and practice competencies and organizational behavior?

Making Change Happen -- The Courage to Act

In 1998, eighteen professionals, at all levels of the health department, formed the Diversity Enhancement Committee (DEC) and committed themselves to the developmental process of achieving cultural competence. The DEC is a highly productive team of individuals who are striving toward diversity maturity.

The Diversity Enhancement Committee has engaged the Milwaukee Health Department and community in activities that are both superficial and systemic. Following are seven (7) dimensions of our work in process.

1. Clarify Our Motivation -- We constantly clarify our motivation and intent realizing that the journey toward cultural competence is linked to two important elements: 1) transfusing diversity within the context of an organization?s culture is not a matter of preference but of performance, and 2) diversity does not exist as a sub-set of the organization, it lives at every level, both horizontal and vertical; internal and external.

2. Audit the Corporate Culture -- The Diversity Enhancement Committee actively gathers data, allocates resources for valuing and managing diversity, monitors the personal and professional growth of employees, and makes sure that all of our departmental committees and workgroups are diverse and representative of all levels of the organization.

3. Clarify the Mission of Diversity Enhancement -- The Diversity Enhancement Committee is a unified body of health department professionals dedicated to learning and providing leadership in diversity management within the context of organizational culture.

4. Expand Our Goals -- Through the strategic planning subcommittee, we have developed a strategic plan to address four key premises: administration of policy; program and practice competency; leadership development; and conflict resolution. Our Action Plan 99, created by more than 100 professionals and family voices at our 1998 retreat, follows this section.

5. Modify Our Assumptions -- As a team we constantly examine our assumptions, our choices, and our behavior.

6. Implement Training -- As a learning organization, we constantly expand our capacity to adapt to changing circumstances. We began by creating awareness, then followed up with a newsletter and held three retreats emphasizing family-centered service delivery, leadership development and outcomes management/strategic planning.

7. Visionary Leadership -- The importance of leadership cannot be understated.

Diversity Enhancement Committee Action Plan for 1999 for Milwaukee Health Department

Administration of Policy

Review current public health services policies, procedures and standards of practices to assure the integration of cultural competence elements.
Collaborate with the Total Quality Improvement steering team to integrate cultural competence in the management and employee evaluation and feed back process.

Leadership Development

Conduct a skills inventory survey at all levels of the organization to identify organizational strengths and opportunities.
Facilitate a fall retreat to focus on leadership development, effective communication, and relationship building.

Program and Practice Competencies

Play a major role in a community wide health assessment using outcomes systems development and the MCH five guiding principles as the foundation.
Develop a customer feedback system.

Conflict Resolution

Activate a peer mediation sub-committee to create a neutral zone for managers and employees to resolve conflict effectively.

This journey towards cultural competence is necessary and rewarding. We have been surrounded by extraordinary people who deeply embrace this work. The common purpose and interplay between the state MCH program and the local community health department have greatly furthered our efforts.

Richard Aronson, MD, MPH
Chief Medical Officer
Maternal and Child Health
Bureau of Public Health
Wisconsin Division of Health
and
Jacqueline Holloway, MS, EMBA,
Director, Public Health Services
City of Milwaukee, WI

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Page last modified December 1999