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Chapter 9: Group Identity Development and Health Care Delivery

To discuss theory and research that undergird the majority and minority group identity development frameworks presented in this chapter

To distinguish between out-group (minority) and in-group (majority) identities

To describe the process of group identity development for individuals who are members of a minority or out-group

To describe the process of group identity development for individuals who are members of a majority or in-group

To illustrate the impact of group identity status on interactions in diverse health care organizations

To explain the relationship between group identity status and cultural competence at the individual and organizational levels

Chapter Objectives

The process by which we form the attitudes and behaviors that shape what we see and do in the context of diversity

Differs by dimension of diversity: race, ethnicity, sexual orientation, gender, etc.

Dominant identity status can change over time and is dynamic not static

Accessible identity statuses can change situationally

Group Identity Status Development

In-group: A group of people united by a common identity and shared beliefs, attitudes, or interests, with the collective social power and influence to exclude outsiders

Out-group: A group of people united by a common identity and excluded from belonging to the in-group; relative to the in-group is seen as less powerful, socially desirable or contemptibly different

Dominant identity status: Describes our usual and customary reactions in situations when our group affiliation is salient

Accessible identity status: The group identity statuses that from time to time describe our reactions in situations where our group affiliation is salient

Important Definitions

How Does Minority Identity Status Influence Health Care Interactions?

Individual: Personally held attitudes, beliefs, and behaviors that reinforce the presumed superiority of the majority and inferiority of the minority

Institutional: Policies, laws, and regulations that have the effect of systematically giving the advantage to one group and disadvantaging another

Cultural: Societal beliefs and customs that reinforce the assumption that majority culture—for example, dialect, traditions, and appearance—is superior and minority culture is inferior

Three Aspects of Majority Group Bias:
Backdrop for Identity Development

How Does Majority Identity Status Influence Health Care Interactions?

What About the Organization?
Chrobot-Mason and Thomas (2002)

A mono-cultural workplace in which differences are either ignored or devalued will encourage individuals at low statuses of identity development to remain static and individuals at higher statuses of identity development to regress.

A multicultural workplace where diversity is important to the business strategy will encourage individuals with low identity development to progress and those at high statuses of identity development to sustain that personal growth.

What About the Leaders?
Chrobot-Mason and Thomas (2002, page 337)

Progressive, Parallel, Regressive: Leader/Follower Statuses

“It is critical to understand the racial identity development of organizational leaders whose influence is manifested in the corporate values that guide diversity practices that shape the organizational climate for diversity.”

Interactions in a Diversity Context

Situations

Identity Status

  • Disagreement over team roles
  • Different interpretations of what someone meant by what they said or did
  • Reason for a missed deadline
  • Interpretation of a joke
  • Reaction to a performance review
  • Reaction to patient or provider behavior
  • Majority: naiveté, dissonance, defensive, liberal, self exploration, transcultural
  • Minority: conformity, dissonance, resistance & immersion, introspection, synergy


Impact on Health Care Interactions?

Role & Power Dynamics:

Majority Leader/Minority Follower or Minority Leader/Majority Follower?

Majority Patient/Minority Caregiver or Minority Patient/Majority Caregiver?

Individual Identity Statuses of leaders, followers, patients, caregivers

Organization’s Identity Status?

A mono-cultural health care organization in which differences are either ignored or devalued

A multicultural health care organization where diversity is important to the business strategy and culturally competent care is a goal

Recognize that identity status affects provider and patient perceptions and behavior in health care encounters

Don’t stereotype based on identity status: people can regress to earlier identity statuses or evolve to higher identity statuses

Remember that multiple and overlapping group and personal identities are operating at once in interpersonal interactions

Using the Models

Emphasize Self-Awareness

First, identify your major group affiliations including race and ethnicity, gender, and sexual orientation

Second, for each group affiliation determine whether it is an out-group minority identity such as black or Latino, female, or LGBT or an in-group majority identity such as white, male, or heterosexual.

Third, reflect on your attitudes, beliefs, and behaviors toward yourself as a member of the identity group as well as toward people who share your group affiliation and people who do not. Be frank and honest with yourself. Consider what you really feel, think, and do, not what you believe you “should” feel, think, and do.

Review the status descriptions in Table 9.1 for your out-group minority identities and in Table 9.2 for your in-group majority identities

Address these questions (separately for each of your group identities):

Which status best describes your dominant group identity status?

Which statuses best describe your accessible group identity statuses?

How do you know? What evidence do you have to support your self characterization?

Emphasize Self Awareness cont.

We begin developing our group identity statuses in our families, communities, and other social networks

Group identity status is not immutable; it can be changed through

Experiences

Self-reflection

Conscious decisions on the part of the individual

The health care organization is a system that provides a context that can encourage or discourage group identity development

Remember

Key Terms

  • Accessible statuses
  • Cultural bias
  • Dominant status
  • Group identity status
  • Individual bias
  • In-groups
  • Institutional bias
  • Out-groups
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