Welcome! Cultural Competency - Key Considerations and Awareness for an Inclusive VA Workforce John Fuller, Ed.D. Chief Diversity Educator Office of Diversity.

welcome!

Cultural Competency -Key Considerations and

Awareness for an Inclusive VA Workforce

John Fuller, Ed.D.

Chief Diversity Educator

Office of Diversity and Inclusion

Learning Objectives

At the end of this session, you will have gained knowledge of key considerations for workforce inclusion through

Examining: How external and internal factors affect you and your employees

Identifying: Perceptions of Diversity, Inclusion, and CultureRecognizing: Cultural Competency is a lifelong processDiscussing: Various cultural awareness areas to include:

Generational, Religious and Veteran culturesConsidering : Cultural competency’s relation to Patient Centered

Care and awareness of Employee Self-Determination Theory

To fulfill the mission and vision

1. A Diverse Workforce: Build a diverse, high-performing workforce that reflects all segments of society.

2. An Inclusive Workplace: Cultivate a flexible, collaborative, and inclusive work environment that leverages cultural competency and empowers all contributors.

3. Outstanding Public Service: Facilitate outstanding, culturally competent public service and stakeholder relations through effective leadership and accountability.

DI Strategic Plan

Equality of Employees

Everyone has the ability to do something amazing; some just do it on a more regular basis.

Managers’ and Employees’ Workplace Challenges

Co-Responsibility

Our Customer is Changing

There will be more Veterans who:

•Live in Rural Areas

•Identify as LGBT

•Have service-connected disabilities

•Are Hispanic/Women

•Hold diverse religious beliefs

•Are from younger generations All Expect Inclusive

Services

From Road Rage to Desk Rage

• Commuting to work and someone cuts you off, accident or weather delays, etc.?

• Just received a foreclosure notice on your home?• Husband, wife, or partner lost their job

yesterday?• Listening to constant criticisms of the VA in the

media?• Not being allowed to telework if eligible?• Thinking about your current boss? or co-

workers?... Your tremendous workload?....then you arrive at work!

Presenteeism• Personal Problems 62%• Job overload 60%• Financial Stress 56%• Lack of Resources 47%• Depression/Anxiety 46%• Issues with co-workers 41%• Technology Issues 31%• Care giving Responsibilities 30%• Issues with supervisors 26%• Lack of training 23%

http://www.shrm.org/hrdisciplines/benefits/Articles/Pages/EmployeeWellBeing.aspx

“I just want to do my 8 hoursand go home. Help me makeit through the day!”

Non-productive Harassing or Incivil Workplace Behaviors

• Missing work, taking extended breaks, finishing projects late

• Accepting favors, like missing work without penalty

• Racial, ethnic, or sexual comments/slurs• Engaging in provocative conduct• Gossiping about anything• Using excessive profanity within your

communications

The Incivility Continuum

Negative Behavior•Rude comments (hey, nothing personal!)•Insensitive actions•Unintentional slights•Complaining•Gossip/rumors•Cultural bias•Crude jokes•Profanity•Rolling eyes

Verbal Aggression•Yelling / loud voice•Belittling comments•Intimidation / threats•Discriminatory comments•Cursing at someone•Humiliation

Physical/Sexual Aggression•Assault / Battery•Throwing objects•Violent outbursts (e.g., hitting the wall)•Inappropriate touching•Harassment

Humor - A Risky Behavior?

• Humor can relieve tension and energize– teasing and sarcasm, however, are high risk

communications.

• Does this mean that all fun is out of order in the workplace?

• "It was just a joke" is not an excuse.• People often have such different perspectives

on sarcasm, jokes, etc.• Remember that only the impact, and not the

intent• Make certain that your behavior; whether in

person, by phone, text, twitter, Facebook, or via email, is welcome.

What Can You Do?• Say you do not like it and ask the person to stop.

• Tell your supervisor– If you are a supervisor and witness this, stop the

behavior immediately.

• If the conduct is repeated it can become a violation and the offender can be advised of this.

• Inform employee to keep a log or diary of the conduct, including dates, times, witnesses, direct quotes, emails, tweets, Facebook postings, and any documents or photographs.

Psychological Safety

Is it safe to take a risk?

The right to express thoughts and opinions freely and encourage open expression within a climate of civility, sensitivity and mutual respect.

Are co-workers comfortable and capable of having a discussion with issues, i.e., Immigration, Religion, LGBT, Political Elections, Affirmative Action, in-house promotions, Tea Party, Unions, changes in the workplace, etc., openly and respectfully?

Veterans WILL talk about these subjects!

• When was the last time you received recognition at work for a job well done or gave recognition to someone else for a job well done?

• Does not have to be supervisor to subordinate– Encourage encouragement and set the

example

.

Rapid Demographic Changes1990-2010

• Only one-third of households now have children

• Since 1990 more Asians were added (4.3 million) to the population than Blacks (3.7 million)

• About 430,000 Asians arrived in the U.S. in 2010 representing 36% of all new immigrants that year.

• Almost one in six Americans are Hispanic (31% of immigrants)– More than doubled since 1990

• 11 Million people in 2012 on Social Security Disability Insurance compared to 4.2 Million in 1990

• Educational Gap is growing– Women make up nearly 60% of college

enrollment– More women receive graduate and doctorate

degrees• 5.5 Million 85+ years of age in population

– Doubled since 1990• 41% share of births by unmarried women in 2010

– (up from 26% in 1990)

Rapid Demographic Changes

It is not Quantum Physics but…What is Diversity…..really?

In its broadest context, diversity includes all that makes us unique:

Reprinted with permission from Loden Associates.

Nine Dimensions of Difference

race, color, gender, religion, national origin, age, disability, culture, sexual orientation, gender identity, parental status, educational background, socioeconomic status, intellectual perspective, organizational level, and more.

From ODI’s Glossary of Termshttp://www.diversity.va.gov/tools/glossary.aspx

YouIt is I!

Secondary Dimensions

• Characteristics that represent an individual’s group identity

• Unlike primary dimensions because of the element of choice

Reprinted with permission from Loden Associates.

What’s InclusionAn Inclusive Workplace allows leaders to leverage

the diverse talents and attributes of the entire workforce.

Empowering the full potential of all employees.

Inclusion: A practice that enables the full participation and contribution of the workforce in support of the mission of the organization by eliminating implicit and explicit barriers.

Inclusion: A practice that enables the full participation and contribution of the workforce in support of the mission of the organization by eliminating implicit and explicit barriers.

What is Culture?

Integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.

The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals. Oakbrook Terrace, IL: The Joint Commission,

2010.

Cultural Competence

Cultural Competence refers to a combination of knowledge, skills and awareness pertaining to cultural differences and different interpretations across groups

It includes the awareness of and respect for differences, without making assumptions that everyone from a particular background holds the same beliefs and practices.

Joint Commission Expectations

*Cultural competence requires organizations and their personnel to do the following: – (1) value diversity; – (2) assess themselves;– (3) manage the dynamics of difference; – (4) acquire and institutionalize cultural

knowledge; and – (5) adapt to diversity and the cultural

contexts of individuals and communities served

*The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals. Oakbrook Terrace, IL: The Joint Commission, 2010.

How Does Your Level of Cultural Competency Affect Veteran Care?

• Health care providers bring perception, traditions, and patters of communications based on cultural, racial and ethnic identity to the clinician-patient interaction.

• Cultural issues can influence appropriate diagnosis, treatment adherence as well as care seeking behavior and maintenance by Veterans leading to health care disparities.

• Patient (Veteran) centered;

• Characterized by team care;

• Continuously improving itself; and

• Data driven, evidence based

VHA Defining Excellence

Data Driven & Evidence Based10 Principles

1. Service quality and value are always defined by the Veteran;

2. Veteran participation adds value and quality to their service experience;

3. Everyone must believe that the Veteran matters and act that way (Veteran-focused culture);

4. Find, hire, train and retain competent and caring employees;

10 Principles, cont.

5. Veterans expect employees who are not only well trained but have good interpersonal skills;

6. Veterans expect the service experience to be seamless;

7. Avoid making Veterans wait for the service;

8. Create the setting (environment) the Veteran expects;

9. Measure all aspects of the service experience - ‘what gets measured gets managed’ - Ask Veterans about their experience at the time the service is being delivered; and

10. Commit to continuous quality improvement, i.e., patient satisfaction surveys, town hall meetings, etc.

• Army: Loyalty, Duty, Respect, Selfless Service, Honor, Integrity, Personal Courage

• Navy and Marine Corps: Honor, Courage, Commitment

• Air Force: Integrity, Service Before Self, Excellence

• Coast Guard: Honor, Respect, Devotion to Duty (Advocacy)

VA War Related Illness and Injury Study Center (WRIISC) )2011

Service Core Values Echo Throughout the VA

Defines Who We Are

IntegrityCommitment Advocacy Respect Excellence

Military vs. Civilian Work CultureMilitary: Command & Control Operations Model

• Hierarchical /vertical structure - more exact rules of conduct

• Veterans share a bond in beliefs, traditions, values, and the concept of rank and structure – Not just a job but a way of life

• Firm, fair and consistent plus always a sense of urgency in getting the mission accomplished

•Far less time spent in meetings – •The B vs. L&M Principle

Civilian vs. Military Work CultureCorporate/Non-military:

•Collaborative Model

• More implied or "understood" rules of conduct

• Flexible/ambiguous roles & status - variations across teams

• Less defined career progression or lateral assignment opportunity

No matter the length of service or era, all Veterans still have much of their military culture ingrained in

them.

However, separating active duty members and current Veterans of the

VA need to be able to adjust and collaborate.

Language Awareness for CiviliansMilitary Cultural Competence

• AIT• Tunnel Rat• FUBAR• O Dark 30• Head• MOS

• ADA• In Country• DEROS• Butter Bar• Green Zone• IED

If you don’t know, it’s okay to ask (or to Google!)

Average age of soldiers

World War II – 26Volunteers and Draft

Average age of soldiers

Vietnam – 19Draft and Volunteers

Average age of soldiers

Iraq/Afghanistan 30

All Vounteer

Some Guidelines – Interacting with Veterans

• It is never OK to ask a Veteran if he or she has killed someone in combat or joke about it.

• When you thank a Veteran for their service it is appreciated.

• Don’t tell us that wars are a waste of dollars or lives or was fought for oil – – What we may hear in that is that our best friend or other

brothers and sisters in arms died for nothing.

• Many more of us today have PTSD or TBI. • We can be sensitive about our acquired disability and

that war injuries today are different and often not visible. – It is not OK to tell someone they “don’t look disabled”

Cultural Implications for Female Veterans

300,000 Female VA Patients

Over 1.8 Million Female Veterans

• Struggling to find work – Can be choice or circumstance, i.e., family, school, disability preventing full time work. • nearly one out of five women who served in the

military at home or abroad during the two wars is now without a job, according to the new Bureau of Labor Statistics report

• More than 40% of women Veterans surveyed were very dissatisfied with the competence level of the VA for women-specific or gender-specific issues

• Women have had difficulty gaining recognition for their combat service.

Women Veterans

Women Veterans

• VA and DoD finds assaults more common – study shows more happen in war zones and becoming more frequent in all locations.

• Nearly 50% of women sent to Iraq and Afghanistan report being sexually harassed.

• 42% experience PTSD as a resultHimmelfarb, N., Yaeger, D., & Mintz, J. Posttraumatic stress disorder in female veterans with military and civilian sexual

trauma. Journal of Traumatic Stress, 19, 837-846.

Religious/SpiritualBeliefs and Practices

Religion & Culture – Americans who say they are…….

68% are either Moderately or Very Religious

32 % are either not religious or Non Affiliated

How Many Symbols Can You Identify?

Christian Cross Star of David Muslim Crescent Hindu Omkar Shinto Torii

Hindu Lotus Flower

Sikh Khanda Toaist Taiji ZoroastrianFaravahar

Baha’I Nine Pointed Star

Buddhist Dharma Wheel

Jainism Wicca Unitarian-Universalism

Unification Church

Asian American Religious Beliefs*

• Christian 42% • Unaffiliated 26%• Buddhist 14%• Hindu 10%• Muslim 4%• Other Religion 2%• Sikh 1%

*www.pewsocialtrends.org/2012/6/1/the-rise-of-asian-americans

* Pew Forum on Religion & Public Life

“While the U.S. is generally considered a highly religious nation, African-Americans are markedly more religious on a variety of measures than the U.S. population as a whole, including level of affiliation with a religion, attendance at religious services, frequency of prayer and religion’s importance in life (79%)…..nearly 80% Protestant.”**

Generational Perspectives

• Whatever your age, the other ages you have are still inside of you.

• That’s what gives you the compassion and patience for those who are irritatingly younger (or older) than you!

• The principles other generations used to get through life remain relevant – yet you may need a completely different set of tools in order to tackle modern nuances of the current workplace.

What is a Generation?

“In addition to coincidence of birth year grouping, a generation is also defined by common tastes, attitudes, and experience…. Those times encompass a myriad of circumstances – economic, social, sociological, and, of course, demographic.”

Zemke, R. Raines, C., & Filipczak, B. (2010) Generations at work: Managing the clash of Veterans, Boomers, Xers, and Nexters in your workplace. New York:Amacon.

Generational Differences• Preferred Leadership Approach• Communication Style• Motivational Buttons• How They Interact with Others• Preferred Approach to Feedback• View toward the VAWhen generations fail to communicate with each other:

May impact turnover rates, recruitment, hiring, training, retention)

May impact grievances and complaintsMay impact perceptions of fairness & equity

Department of Veterans Affairs by Generations

Source: ODI Workforce Analysis Team, May 2011

2%

82%

15%

3%

69%

28%

1%2%

55%

36%

7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Traditionalist Baby Boom Generation X Generation Y/ Millenial

Senior Executives Managers & Supervisors Employees

April 2011

Department of Veterans Affairs by Generations

Source: ODI Workforce Analysis Team

*2 SES Millennial

Current Working Generations• Veterans or Traditionalists

(1900-1945)• Baby Boomers

(1946-1964)• Generation X

(1965-1980)• Generation Next or Millennials

(1981-1999)

Veterans or Traditionalists:Born 1900 - 1945

Veterans or Traditionalists: 1900-1945• Also known as the Greatest Generation• Defining events: Great Depression, New Deal,

World War II, Korean War; remembers life before TV and fireside chats with FDR.

• Faith in institutions; loyal; patriotic and actually did ball room dancing.

• “Save for a rainy day,” “Waste not, want not”• Remembers cars with running boards.• Influential people: Ella Fitzgerald, Charles

Lindberg, Franklin Delano Roosevelt

Baby Boomers:Born 1946 to

1964

Baby Boomers: 1946-1964• Defining events: television, Vietnam, women’s and human

rights movements, wanted to join the Mickey Mouse Club; saw every episode of Leave it to Beaver.

• Optimistic and competitive; prosperous• Promise of good education = opportunities their parents

didn’t have; used a typewriter to write term papers• Influential people: Martin Luther King, John F. Kennedy,

Richard Nixon, Beaver Cleaver• Now dealing with difficult life decisions; retire or not to

retire?

Generation X: Born 1960-1980

Generation Xers: Born 1965-1980• Defining events: Challenger explosion, fall of Berlin

Wall, fall of Soviet Union, personal computer, played Asteroids on an Atari, Schoolhouse Rock, and cell phones; comfortable with smart phones.

• Skepticism; institutions called into question, rise of single parents and both parents working of Gen X (latchkey kids), record player is antique, Ipod is a given; environmentally conscious.

• Now in middle and upper management waiting for those “old folks” to get out of the way

• Leading people: Monica Lewinsky, O.J. Simpson, Supermodels, Michael Jordan, Dilbert

Millennials:Born 1981 -1999

Millennials: Born 1981-1999 • Also known as Echo Boom, Generation Y, Baby

Busters• Defining events: Oklahoma City bombing,

Columbine High School massacre, death of Princess Diana, Lewinsky scandal, smart phones – live on social networks with texting as major communication vehicle

• Realistic; optimistic yet cautious; multiculturalism, believe in group consciousness and collaboration

• “Personal Safety” is a workplace concern; appreciate diversity; deeply worried about future and employment

• Influential people: Barney, Backstreet Boys, Venus and Serena Williams, Tinky Winky

What Generation?

• Seeking challenge• Looking for meaningful work• Chance to prove themselves and show they can

perform well• Enjoys contact with people• Desire to be in a position of responsibility• Resents being looked at as though they have no

experience• Tends to be more job mobile• Less respectful of authority

Training and Development Journal November, 1970

When We are FocusedWe See with Clarity

– Each person has a different perspective

– The brain filters reality through experience, beliefs, education and imprints a new reality.

Recruiting Strategies• Specify the need for skills to work effectively in

a diverse environment in the job, for example: "demonstrated ability to work effectively in a diverse work environment."

• Make sure that good faith efforts are made to recruit a diverse applicant pool.

• Focus on the job requirements in the interview, and assess experience but also consider:– transferable skills and demonstrated

competencies, such as analytical, organizational, communication, coordination.

Considerations Before Interviewing

• Prior experience has not necessarily meant effectiveness or success on the job.

• Know your own cultural biases; assess yourself. • What stereotypes do you have of people from

different groups and how well they may perform on the job?

• What communication styles do you prefer? • Sometimes what we consider to be appropriate or

desirable qualities in a candidate may reflect more about our personal preferences than…• about the skills needed to perform the job.

Fairness Best Practices

• Many people think that "fairness" means "treating everyone the same.“– How well does treating everyone the same work

for a diverse staff? • While distributing emails to all staff is "treating

everyone the same," this approach may not communicate essential information to everyone.

• A staff member who missed out on essential information might feel that the communication process was "unfair.“

• A process that takes account of the diverse levels of English language and reading proficiency among employees.

A Manager’s Three Best Practices

• Fully recognize and understand the employee’s perspective. • An employee’s unique perspective is the “truth” from

which that employee operates. • Effective managers develop a deep understanding of

employees’ perspectives.• Communicate to the point of “Over Communication”

• Information helps employees understand their work and make wise choices.

• Controlling/judgmental communication blocks engaging dialogue.

• Generate opportunities for choice – Examine practices

How Can Managers Support Internal Motivation?

• Leaders can’t create internal motivation in their employees. They can support internal motivation by creating conditions that allow employees to satisfy their own needs for competence, relatedness, and autonomy.

• Leaders should recognize that they are not solely responsible for thinking of a solution but arriving at one.

COMPETENCE • The need to feel valued as knowledgeable,

skilled, and experienced.– People have a powerful need to hone and

demonstrate skills, whether technical, interpersonal, or leadership.

Employee Self Determination

RELATEDNESS

•The need to collaborate with others.•Most employees actually want to work with others. •Studies show this internal need is powerful motivator.

•Working effectively with others improves business results through a melding of views and experiences.

• The need to exercise self-regulation, within guidelines, to achieve business goals. – No one has total freedom in the workplace

because everyone must contribute to shared results. Still, people crave autonomy, or freedom to shape their work to support. the work of others.

Autonomy

Consequences of Status Quo

• Ignoring cultural issues costs time, money, and efficiency.

• Some of the consequences can include:– unhealthy tensions between people of

differing gender, race, ethnicity, age, abilities or generations, etc.

– loss of productivity because of increased conflict;

– inability to attract and retain talented people of all kinds; EEO complaints and other actions.

Summary• Internal and external factors influencing workplace

respect and productivity• Diversity should be broadly defined• Inclusion is about valuing all employees• Cultural Competency is a continuous process• Evidence based Patient Centered Care• Religious dynamics, unique Veteran culture, and

workplace generations • Managers’ best practices facilitating employee self

determination

Department of Veterans AffairsOffice of Diversity and Inclusion

John Fuller, Ed.D.Chief Diversity EducatorOffice of Diversity and

[email protected]

202-491-5969

Honor, Courage, Commitment

Semper Fi