The Role of Leadership in Achieving Cultural and Linguistic Competence in Health Care Organizations: Lessons Learned

Transcription

1 The Business Case for Culturally & Linguistically Competent Care : Moving Your Organization Toward Equitable Care Senior Executive Breakfast Emeryville, CA The Role of Leadership in Achieving Cultural and Linguistic Competence in Health Care Organizations: Lessons Learned Tawara D. Goode National Center for Cultural Competence Georgetown University Center for Child and Human Development University Center of Excellence in Developmental Disabilities June 11,

2 Rationale for Cultural and Linguistic Competence in Health & Mental Health Care Respond to current and projected demographic change Eliminate long-standing disparities in health & mental status and strive for health equity Improve quality of care, services and outcome Meet legislative, regulatory and accreditation mandates Gain & maintain a competitive edge in the market place (Excerpt from NCCC Policy Brief 1 Revised 2003) Rationale for Cultural and Linguistic Competence in Health & Mental Health Care Work force diversity Formal education of staff & volunteers Decrease risk of liability/malpractice Emerging research validates its efficacy (Excerpt from NCCC Policy Brief 1 Revised 2003) 2

3 Cultural & Linguistic Competence Benefits Patients, their Families & Communities, Health and Mental Health Care Providers & Systems quality & effectiveness of care health outcomes & well being effectiveness of patient-provider communication provider knowledge & skills patient and provider satisfaction mutual respect & shared decision-making D E C R E A S E I N C R E A S E health & mental health disparities disproportionate burden of disease & mortality system costs bias & discrimination Slide Source: The National Center for Cultural Competence, 2007 A Word About the Evidence The evidence base for cultural and linguistic competence in health and mental health care is in an early developmental phase and holds great promise. Emerging empirical studies Numerous examples of impact on quality and effectiveness of care (weighted toward providers) Address immediate outcomes of short-term targeted interventions Data Source: Goode, T., Dunne, C. & Bronheim, S., (2006) The Evidence base for cultural and Linguistic Competence in Health Care. New York, NY: The Commonwealth Fund. New 3

4 WATCH FOR SIGNS ALONG THE ROAD!! Detour Stop Sign U-Turn Hidden Entrance Work Zone Divided Highway New Traffic Pattern Hazardous Driving Conditions Watch for Pedestrians & Cyclists Slow Speed Toll Ahead LESSONS OF THE JOURNEY Leadership Shared Ownership The ISMs - Confronting the Undercurrents Keeping it Real Weave into the Fabric of the Organization 4

5 LEADERSHIP cultivating leadership at all levels leaders (with & without authority) revisiting the role of the leader Fears and Concerns about Cultural & Linguistic Competency If I am asked to learn about cultural competence, then they must be implying that I am incompetent! If I am authentic about this, I will stir up a hornet s nest in this place. Then there will be repercussions. I am not willing to take that risk. There are too many cultures. I can t possibly learn about all of them. This is futile. I am a person of color. I know what it means to be culturally competent. I don t need any special training. I have examined studies about various cultures, changed some of my thoughts, and now I feel competent. I may discover I have more biases than I care to admit. If we really get into this my colleagues will discover that I don t know as much as I think I need to know. Slide Source: National Center for Cultural Competence,

6 Considering Cultural & Linguistic Competence within the Context of Organizational Change Adaptive Challenge vs. Technical Challenge Does making progress require changes in people s values, attitudes and or habits of behaviors? Reference: Heifetz, R.A. (1994). Leadership Without Easy Answers. Cambridge, MA: The Belknap Press of Harvard University Press The Work of the Leader Get on the Balcony Identify the Adaptive Challenge Regulate Distress Maintain Disciplined Attention Give the Work Back to the People Protect Voices from Below 6

7 Are we on the same page? Culturally aware Culturally competent Cultural humility Culturally relevant Cultural sensitivity Culturally & linguistically competent Multicultural Competence Culturally appropriate Linguistically competent Culturally effective Cultural Proficiency SHARED OWNERSHIP on the same page (conceptual frameworks & definitions) Oh that s only for people of color. the indispensable opposition getting buy in 7

8 THE ISMs Confronting the Undercurrents Call it what it is! create a climate of intolerance offer a safe refuge for authentic discussions use conflict management & resolution invoke legal interventions when necessary Organizational Change Theories Applied to Cultural & Linguistic Competence Resistance is a characteristic of any major organizational change effort and a major reason why organizational change efforts fail. (Prochaska, Prochaska and Levesque, 2001). Resistance should be expected in different stages of multicultural organizational change because the topics of prejudice, discrimination and oppression are controversial and emotionally charged. (Brantley, Frost and Razak, 1996). The Transtheoretical Model of Change suggests that it is counterproductive to forge ahead with action without addressing issues such as resistance, that stand in the way of individual and organizational readiness for change. Data Source: Mayeno, L. Multicultural Organizational Development: A Resource for Health Equity, in Cultural Competence in Health Care Series, The California Endowment and Compasspoint Nonprofit Services, April

9 KEEPING IT REAL create & nurture a community of learners make training relevant tailor to individual interests, preferences & needs incorporate into specific job functions & performance measures offer incentives Weave into the Fabric of the Organization eliminate the perception of add on establish the business case link to quality of care legitimize in policy, structures, practices, procedures, & resources set bench marks & measure progress at regular intervals assure it is woven into the culture of the organization 9

10 What are the leadership implications for cultural & linguistic related to CORE FUNCTIONS What we do.. HUMAN RESOURCES & STAFF DEVELOPMENT Who we are FISCAL RESOURCES & ALLOCATION Where the money goes COLLABORATION & COMMUNITY ENGAGEMENT Who our partners are CONTRACTS Whom do we entrust to deliver services and supports Cultural and linguistic competence It s a life s journey not a destination Safe travels! Slide Source: National Center for Cultural Competence,