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Culture, Professionalism and
 the Practice of Pharmacy


                   Billy Futter
                Rhodes University
                  South Africa
Key questions

1. What is Culture?

2. How does Culture influence:

  • Practice of Pharmacy?
  • Professional status?
4. Cultural Competence


              Communication

3. Professionalism               2. Culture


              1. Pharmacy Practice
1.   Pharmacy Practice
     Emphasis on Product
      Emphasis on People
People
Need medicine
People
          have
Medicine-related problems
Pharmaceutical care
     services

     Based on
 Relationship of trust
But . . .
People are different
See & do things differently

      How many legs?
Young lady?   Old lady?
Need to understand
    differences
  between people
So . . .?

•   Important differences?
•   Impact on pharmacy practice?

         What is Culture?
2. Culture

Society has many sub-groups
  Each has its own culture



        Society
2. Culture

Society has many sub-groups
  Each has its own culture



         Society
2. Culture

Society has many sub-groups
  Each has its own culture
                  Generic?
     Generic?                Generic?


Generic?         Society          Generic?


     Generic?                Generic?
                 Generic?
Different cultural groups

                 group
                          Generic
        group
                           group


group           Society             group


        group              group
                 group
Society

               GEOGRAPHIC

                     Chinese
       Generic                        Indian

Japanese                                   American
                     Society
  Australian                             Swedish
               European     African
Society

             LANGUAGE

                  Chinese
      Generic                       Hindi

Russian                                     English
                  Society
   Italian                                  Zulu
             French         Xhosa
Society

                RELIGION

                    Muslim
      Generic                   Hindu

Tao                                     Christian
                    Society
  Jew                               Mormon
                         Ancestor
            Sects
                          worship
Society

        AGE and GENDER

                     Female
       Generic                         Babies

Male                                            Kids
                 Society
 Elderly                                 Teenagers
            Mature            Early
            adults            Adults
Society

               ECONOMIC

                  Middle class
        Generic                  Upper class

Lower class                             Super rich
                      Society
   Destitute                            Rich
               Poor         Middle
Society

           SIZE and POWER

       Generic
                 MAJORITY           Minority

Minority                                   Minority
                    Society
  Minority                               Minority
             Minority         Minority
people
                                                       people



           Therefore
                                 people                     people
                                             Society
                                  people                   people
                                           people people




1. No generic cultural groups!
2. Each group has its own culture
people
                                              people

                       people                       people
                                    Society
                        people                     people


Group Culture                    people   people




 Group Behaviour
Routine, Predictable
Difficult to change
Prescribed limits
people
                                                   people

                              people                   people
                                         Society
                               people                people
                                       people people


 Cultural boundaries

“Right way of doing things”
  B.E.V.A.N.S.
people
                                                people



Different B.E.V.A.N.S
                          people                     people
                                      Society
                           people                   people
                                    people people




Beliefs
Expectations
Values
Assumptions & Attitudes
Norms
Symbols
people
                                                        people



 Different B.E.V.A.N.S
                                  people                     people
                                              Society
                                   people                   people
                                            people people




Beliefs – what is right and wrong
Expectations – what should happen
Values – priorities, standards
Assumptions & Attitudes – positive/ negative
Norms – traditional way of doing things
Symbols - group identity, convey meaning
Cultural Symbols



   age, gender,
 language, race
Status symbols
    Wheels!
Other Status symbols
Cultural symbols

          The Five Friendlies




Beibei JingJing Huanhuan Yingying Nini
               Bei jing huan ying ni
Fish    Panda   Olympic    Antelope   Swallow
            Welcome to
                 flame    Beijing
 sea    forest    fire       earth       sky
people




Influence of Culture on Behaviour
                                                                people


                                      people                          people
                                                     Society

                                        people                      people

                                                 people    people




  ‘BEVANS’
                  Routine       Qualityo
 Beliefs                         f life
 Expectations
 Values
                 Behaviour     Outcomes
 Attitudes
 Norms
 Symbols         Patterns     Quality of
                               service
So:
How does Culture influence

   1. Health behaviour?
    * Patients?
    * Health professionals?

   2. Health outcomes?
Health Beliefs of different cultures
  Yin yang             Yoga
Tai Chi
Gym
Traditional Healers



Rituals
Expectations

Queuing for health care
Values pyramid


               Care

           Courage

      Respect, Fairness


Competition, Equality, Informality
Values pyramid

             Care

          Respect

       Fairness, Honesty


Cooperation, Status, Formality
Norms

Right hand
Greetings
Responding to Visual cues
Responding to Visual cues




                    Oprah
How do you respond to HIV/ AIDS
 Response to HIV/ AIDS?
          LOGO?
ACTIVISTS?
VICTIMS?
Beliefs – Diagnosis?
          Cause of illness?
Stress                     Evil spell
Yin Yang imbalance         Hereditary
Lack of chi                Environment
Hot cold Imbalance         Bad habits
Punishment for sins        Old age

              Microbe or Virus
How do you respond to Symptoms?

      Visit Doctor or Pharmacist
      Get a prescription
      Self-medicate
      Vitamins
      Herbal treatments
      Rest and relax
Response to Symptoms?

   Restore balance
   Avoid hot / cold
   Remove “spell”
   Visit Traditional healers
   Consult ancestors
Conclusions
   Culture influences
Signs and Symptoms
– Interpretation   different
– Response         different

Communication      different
Consequences

Professional advice
   Not sought
   Not trusted
   Not followed
Serious?

 Health outcomes
Cultural inequalities
Unmet medicine needs
Medicine related problems
Serious?

Access
Quality of care
Quality of life
3. Implications
Professional Status
  of pharmacists?
3.    Professional status
Level of authority given by society
               to

      – make judgements
       – give directions
Who decides?

Society decides the roles it needs


Social institutions give and limit
authority to practice
Criteria for
    Professional Status?

Competent                    Committed
       to satisfy needs that are:



             Valued
             Complex
             Personal
Perceptual haze
         Evidence?


Competent                       Committed

            to satisfy needs that are:


               Valued
               Complex
               Personal
Combining criteria

             Hi
Commitment




             Lo

                  Lo                        Hi


                          Competence
Combining criteria
                Combining criteria

             Hi
Commitment


                             Professional


             Lo

                  Lo                   Hi


                       Competence
Combining criteria
                Combining criteria

             Hi
Commitment


                   Caregiver   Professional




             Lo

                  Lo                          Hi


                       Competence
Combining criteria
                Combining criteria

             Hi
Commitment


                       Caregiver    Professional




             Lo                      Robot
                  Lo                               Hi


                            Competence
Combining criteria
                Combining criteria

             Hi
Commitment


                       Caregiver   Professional



             Lo         Thief           Robot


                  Lo                              Hi


                           Competence
Combining criteria
                Combining criteria

             Hi
Commitment


                       Caregiver   Professional


             Lo          Thief           Robot


                  Lo                             Hi


                            Competence
Therefore
Professional status can be increased

Show evidence of
    Competence
    Commitment
Therefore
Professional status can be increased

Show evidence of
    Competence – applied
    Commitment – service before self
But:
REAL WORLD - not laboratory


                     group
                              Generic
            group
                               group


    group           Society            group


            group              group
                     group
REAL WORLD IS CHANGING
          In the next 20 years . . .

Global drift
    more people visiting foreign
countries

Urban rush
60 - 80% will live in town

Population explosion
additional 1.6 billion people on the planet
REAL WORLD IS CHANGING
REAL WORLD
   Communication

Digital Revolution
 Mobiles
Information on Web
 Web based marketing
REAL WORLD IS CHANGING


Professional tools
Communication challenges

Digital divide        - less access
Efficiency Pressure   - Impatience
Cultural filters      - Misunderstanding
Minorities            - Intolerant
Conclusion


Cultural diversity increasing
Communication challenges
So . . .
What can pharmacists do

         Agenda
Competence, Commitment?
Communication?
Professional status?
The Solution?


      Develop
Cultural Competence!
Cultural Competence

Ability of health system to deliver
consistent quality health care to
patients in cross cultural situations
irrespective of the culture of
     fellow professionals or
     patients.
Cultural Challenge


Lo                                  Hi

Incompetent              Competent
 1. Intolerant         5. Empathy
 2. Impatient          6. Concerned
 3. Dismissive         7. Caring
 4. Judgemental        8. Respect
Cultural ladder

Cultural Proficiency

    Cultural Competence

       Cultural Pre-competence

            Cultural Blindness

                Cultural Incapacity

                       Cultural Destructiveness
Pre-competence to Competence

                      COMPETENT
Hi
           (Empathy, concerned, caring, respect)


                         Desire
                      Encounter
                 Skill
            Knowledge
        Awareness
                    INCOMPETENT
Lo     (intolerant, impatient, dismissive, judgemental)
Everyone benefits!
Patients             - better QoC & QoL
Health professionals - higher esteem
Health system        - more cost effective
Medicine             - improved use
Employers            - Legal protection
                     - Satisfied staff
                     - Loyal patrons
And Pharmacists improve
               professional status!

              Hi
                            Professional
Commitment




               Lo
                    Lo                Hi

                         Cultural
                         Competence
This is not the end
      but the beginning!
Thank you

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Culture, Professionalism and the Practice Of Pharmacy

  • 1. Culture, Professionalism and the Practice of Pharmacy Billy Futter Rhodes University South Africa
  • 2. Key questions 1. What is Culture? 2. How does Culture influence: • Practice of Pharmacy? • Professional status?
  • 3. 4. Cultural Competence Communication 3. Professionalism 2. Culture 1. Pharmacy Practice
  • 4. 1. Pharmacy Practice Emphasis on Product Emphasis on People
  • 6. People have Medicine-related problems
  • 7. Pharmaceutical care services Based on Relationship of trust
  • 8. But . . . People are different
  • 9. See & do things differently How many legs?
  • 10. Young lady? Old lady?
  • 11. Need to understand differences between people
  • 12. So . . .? • Important differences? • Impact on pharmacy practice? What is Culture?
  • 13. 2. Culture Society has many sub-groups Each has its own culture Society
  • 14. 2. Culture Society has many sub-groups Each has its own culture Society
  • 15. 2. Culture Society has many sub-groups Each has its own culture Generic? Generic? Generic? Generic? Society Generic? Generic? Generic? Generic?
  • 16. Different cultural groups group Generic group group group Society group group group group
  • 17. Society GEOGRAPHIC Chinese Generic Indian Japanese American Society Australian Swedish European African
  • 18. Society LANGUAGE Chinese Generic Hindi Russian English Society Italian Zulu French Xhosa
  • 19. Society RELIGION Muslim Generic Hindu Tao Christian Society Jew Mormon Ancestor Sects worship
  • 20. Society AGE and GENDER Female Generic Babies Male Kids Society Elderly Teenagers Mature Early adults Adults
  • 21. Society ECONOMIC Middle class Generic Upper class Lower class Super rich Society Destitute Rich Poor Middle
  • 22. Society SIZE and POWER Generic MAJORITY Minority Minority Minority Society Minority Minority Minority Minority
  • 23. people people Therefore people people Society people people people people 1. No generic cultural groups! 2. Each group has its own culture
  • 24. people people people people Society people people Group Culture people people Group Behaviour Routine, Predictable Difficult to change Prescribed limits
  • 25. people people people people Society people people people people Cultural boundaries “Right way of doing things” B.E.V.A.N.S.
  • 26. people people Different B.E.V.A.N.S people people Society people people people people Beliefs Expectations Values Assumptions & Attitudes Norms Symbols
  • 27. people people Different B.E.V.A.N.S people people Society people people people people Beliefs – what is right and wrong Expectations – what should happen Values – priorities, standards Assumptions & Attitudes – positive/ negative Norms – traditional way of doing things Symbols - group identity, convey meaning
  • 28. Cultural Symbols age, gender, language, race
  • 29. Status symbols Wheels!
  • 31. Cultural symbols The Five Friendlies Beibei JingJing Huanhuan Yingying Nini Bei jing huan ying ni Fish Panda Olympic Antelope Swallow Welcome to flame Beijing sea forest fire earth sky
  • 32. people Influence of Culture on Behaviour people people people Society people people people people ‘BEVANS’ Routine Qualityo Beliefs f life Expectations Values Behaviour Outcomes Attitudes Norms Symbols Patterns Quality of service
  • 33. So: How does Culture influence 1. Health behaviour? * Patients? * Health professionals? 2. Health outcomes?
  • 34. Health Beliefs of different cultures Yin yang Yoga
  • 36. Gym
  • 39. Values pyramid Care Courage Respect, Fairness Competition, Equality, Informality
  • 40. Values pyramid Care Respect Fairness, Honesty Cooperation, Status, Formality
  • 43. Responding to Visual cues Oprah
  • 44. How do you respond to HIV/ AIDS Response to HIV/ AIDS? LOGO?
  • 47. Beliefs – Diagnosis? Cause of illness? Stress Evil spell Yin Yang imbalance Hereditary Lack of chi Environment Hot cold Imbalance Bad habits Punishment for sins Old age Microbe or Virus
  • 48. How do you respond to Symptoms? Visit Doctor or Pharmacist Get a prescription Self-medicate Vitamins Herbal treatments Rest and relax
  • 49. Response to Symptoms? Restore balance Avoid hot / cold Remove “spell” Visit Traditional healers Consult ancestors
  • 50. Conclusions Culture influences Signs and Symptoms – Interpretation different – Response different Communication different
  • 51. Consequences Professional advice Not sought Not trusted Not followed
  • 52. Serious? Health outcomes Cultural inequalities Unmet medicine needs Medicine related problems
  • 55. 3. Professional status Level of authority given by society to – make judgements – give directions
  • 56. Who decides? Society decides the roles it needs Social institutions give and limit authority to practice
  • 57. Criteria for Professional Status? Competent Committed to satisfy needs that are: Valued Complex Personal
  • 58. Perceptual haze Evidence? Competent Committed to satisfy needs that are: Valued Complex Personal
  • 59. Combining criteria Hi Commitment Lo Lo Hi Competence
  • 60. Combining criteria Combining criteria Hi Commitment Professional Lo Lo Hi Competence
  • 61. Combining criteria Combining criteria Hi Commitment Caregiver Professional Lo Lo Hi Competence
  • 62. Combining criteria Combining criteria Hi Commitment Caregiver Professional Lo Robot Lo Hi Competence
  • 63. Combining criteria Combining criteria Hi Commitment Caregiver Professional Lo Thief Robot Lo Hi Competence
  • 64. Combining criteria Combining criteria Hi Commitment Caregiver Professional Lo Thief Robot Lo Hi Competence
  • 65. Therefore Professional status can be increased Show evidence of Competence Commitment
  • 66. Therefore Professional status can be increased Show evidence of Competence – applied Commitment – service before self
  • 67. But: REAL WORLD - not laboratory group Generic group group group Society group group group group
  • 68. REAL WORLD IS CHANGING In the next 20 years . . . Global drift more people visiting foreign countries Urban rush 60 - 80% will live in town Population explosion additional 1.6 billion people on the planet
  • 69. REAL WORLD IS CHANGING
  • 70. REAL WORLD Communication Digital Revolution Mobiles Information on Web Web based marketing
  • 71. REAL WORLD IS CHANGING Professional tools
  • 72. Communication challenges Digital divide - less access Efficiency Pressure - Impatience Cultural filters - Misunderstanding Minorities - Intolerant
  • 74. So . . . What can pharmacists do Agenda Competence, Commitment? Communication? Professional status?
  • 75. The Solution? Develop Cultural Competence!
  • 76. Cultural Competence Ability of health system to deliver consistent quality health care to patients in cross cultural situations irrespective of the culture of fellow professionals or patients.
  • 77. Cultural Challenge Lo Hi Incompetent Competent 1. Intolerant 5. Empathy 2. Impatient 6. Concerned 3. Dismissive 7. Caring 4. Judgemental 8. Respect
  • 78. Cultural ladder Cultural Proficiency Cultural Competence Cultural Pre-competence Cultural Blindness Cultural Incapacity Cultural Destructiveness
  • 79. Pre-competence to Competence COMPETENT Hi (Empathy, concerned, caring, respect) Desire Encounter Skill Knowledge Awareness INCOMPETENT Lo (intolerant, impatient, dismissive, judgemental)
  • 80. Everyone benefits! Patients - better QoC & QoL Health professionals - higher esteem Health system - more cost effective Medicine - improved use Employers - Legal protection - Satisfied staff - Loyal patrons
  • 81. And Pharmacists improve professional status! Hi Professional Commitment Lo Lo Hi Cultural Competence
  • 82. This is not the end but the beginning!