SickKids opens cultural competence education to the world

“Axserunds, I janhdnlu lochkey you jspajgcl go.”

For many new immigrants in Ontario, understanding the health-care system is about as clear as the phrase above. Language difficulties can add to an already daunting number of issues faced by new immigrants when they or a family member fall  ill.

To enhance the quality of culturally competent care across Ontario, The Hospital for Sick Children (SickKids) has launched a series of free educational tools designed to enhance cultural competence in health care.

Margaret Keatings, Chief Interprofessional Practice and Chief Nurse Executive at SickKids, says it’s essential to incorporate cultural competence into care. “Ontario is an incredibly diverse province, and health equity has emerged as an important issue that needs immediate action. A way we can combat health inequity is to implement self-reflection and education, based on best practices, to help staff understand the many elements that can impact health outcomes.”

Keatings points to the “healthy immigrant effect” to illustrate the need for cultural competence training. “When immigrants first move to Canada, they are often healthier than people who have lived in Canada for their entire lives,” she says. “But over time, their health deteriorates until it is worse than an average Canadian’s.”

Part of this, she says, is attributable to newcomer difficulties in accessing healthcare. “Not only do people have trouble navigating the system, but they have trouble explaining their health concerns and understanding care instructions. There can also be issues where belief and value systems are divergent with those of care team members.” Cultural competence is an avenue for health care professionals to learn how to better address health disparities, especially those faced by new immigrants, and improve health outcomes.

Knowing this, SickKids applied for and received funding from Citizenship and Immigration Canada and established the SickKids New Immigrant Support Network (NISN) in 2009. NISN implemented a number of initiatives focused on enhancing the quality of healthcare and health information for newcomers, such as translating important health information into multiple languages. The group also created and delivered cultural competence education to SickKids staff.

“Cultural competence education can make the difference between good and excellent care,” says Karima Karmali, Director, SickKids Centre for Innovation and Excellence in Child and Family Centred Care. “Understanding patient needs and health beliefs, and recognizing how our own beliefs and values affect interactions with patients, can help to build the trust between a patient and health care team. Providing equitable and quality care means understanding and responding to cultural factors that influence concepts of health and illness, health behaviour and help seeking.”

SickKids has seen the positive impact of cultural competence training. Over 2,000 SickKids staff attended cultural competence workshops in 2010 and 2011 and made commitments to enhancing their practice to be more culturally competent. “We’ve seen a five per cent increase in in-patient satisfaction related to staff cultural sensitivity since the training began,” says Karmali.

The group also designed a Train-the-Trainers program, which provides interested health-care organizations with the tools required to facilitate the development and delivery of a cultural competence education program for paediatric and adult settings. The workshops are include a 300-page manual with all materials needed to deliver clinical, non-clinical, and manager cultural competence workshops at any health care organization.

The workshops, which address specific cultural competence needs for health-care professionals, clinical managers and administrative staff, are currently being held across Ontario and are free of charge.

Jane Hollett, Patient-Centred Care Project Manager at University Health Network (UHN), attended the Train-the-Trainer  workshop to identify ways to align and integrate UHN’s patient-centred care philosophy with cultural competence education. “I was also keen to understand how the program could include all team members across a large organization,” she says. Hollett is now working on implementing a cultural competence program at UHN.

Jan Lackstrom, Clinical Director Departments of Psychiatry, Allied Health, Family and Community Health and Spiritual Care and Chair, Health Equity Council at UHN says the workshops offer tremendous value to organizations looking to enhance their cultural competence. “It gave me a wonderful opportunity to think about how to further the work UHN has been doing in the area of cultural intelligence,” she says.  “SickKids enhanced our ability to think critically about our approach to care and staff education – both of which will no doubt increase our ability to work with patients as partners in their care. “

Supporting the Train-the-Trainers workshops, NISN developed a host of other educational resources that are available online. A 20-minute educational training film, Journey to Cultural Competence, incorporates the perspectives of patients, families and health-care professionals and demonstrates the impact of cultural competence.

Those interested in more specific aspects of cultural competence can also download 15 interactive e-learning modules. Subjects include: Introduction to Clinical Cultural Competence, Pain and Cultural Competence, Working Effectively with Health-care Interpreters and Mental Health and Cultural competence.

The educational resources, complete Train-the-Trainer program and registration and information about NISN and culturally competent care are available at Materials were developed by the SickKids New Immigrant Support Network as a result of funding from Citizenship and Immigration Canada.

The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally.  Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health care professionals; and champion an accessible, comprehensive and sustainable child health system. For more information, please visit