A Multicultural Holiday DisplayIn consulting with health organizations about ethics and strategy, I'm often asked about the concept of "ethics culture." In my view, culture wins hands down over mission/vision statements, formal strategy, and codes of conduct as a driver of patients' experience of care. Steve's comments connect nicely to this issue.
At first, I was tempted to just comment on the provocative blog, “Can Christmas Decorations Be Psychologically Harmful?”, posted by Terry Stawar here on November 30. I would have commented that yes, they can be psychologically harmful, both to an individual, but also to a group of people. And, unlike Ben Stein (who was referenced in that blog and who I generally admire), I as a Jew would be one of those offended if that was done in my work setting. Indeed, it is our work settings that I especially want to address.
To address this kind of question and challenge to the multicultural nature of our country, our staff, and our patients, the clinics I have led over the years have long held a multicultural holiday display during a good part of December. This tradition was started when I co-led a large community mental health center with an African-American woman. This has always – and still does – include the Muslim perspective, along with Christian, Jewish, Hindu, and any other religious or cultural perspective we can reflect, such as Kwanzaa and the Hmong New Year. Traditional cultural dress is encouraged.
The display not only includes holiday symbols like a small Christmas tree and Hanukah menorah, but also food for the patients. This is food that the staff brings in, such as the usual Christmas cookies. I usually bring in Hanukah donuts, called Sufganiyot in Israel. These are usually raspberry filled donuts fried in oil to represent the oil that miraculously burned for 8 days in the ancient temple of Jerusalem, after the Maccabean revolt restored our freedom of religion. In the USA, reasonable representatives can be bought at Dunkin Donuts. All this is supplemented by simple educational handouts about the holidays and cultures.
Why might this be important, even beyond the holiday time? Any system or clinic that purports to have cultural competence needs, at the very least – to be culturally sensitive and respectful – of all the cultures served. This should also be displayed in the treatment plans tailored to the patient’s cultural beliefs. Holiday displays are one way to show that to everyone.
What does your organization display, or not display, during this season? And why?
I often quote Albert Schweitzer's wise aphorism: "example is not the main thing in influencing others; it is the only thing." For those associated with a health organization as employees or independent contractors (like doctors in relation to a hospital), the organization sets the "example" through its culture, which is itself created by hundreds, probably thousands, of actions.
As an example of culture running amok, watch the video of "Enron: The Smartest Guys in the Room" if you haven't already seen it.
Culture emerges from patterns. If the kind of holiday recognition Steve describes so nicely is consistent with other behaviors showing respect for diversity and taking pleasure in human variety, the organization will evince cultural competence. But if respect and curiosity aren't a way of life for the organization, the same holiday practices could evoke cynicism.
Malpractice lawyers teach that patients and families are less likely to sue after bad outcomes in the context of a good patient-doctor relationship. Organizational culture is like the clinical relationship writ large. When it's positive we forgive the inevitable frustrations that occur. We're likelier to fix problems and not hunker down with bitterness. These alternative reactions affect patient care.
The bottom line is that we should take the spirit that infuses the holiday practices Steve describes and apply it throughout the year!