REL Data Collection: Building Organizational Momentum

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1 REL Data Collection: Building Organizational Momentum Brooke Cunningham, MD, PhD Department of Family Medicine and Community Health University of Minnesota 1

2014 2009 Indicators with trends Minnesota 2014 Overall Health = 1 Equity = 15 No Change

2 Indicators with trends Minnesota 2014 Overall Health = 1 Equity = 15 No Change Gap Narrow Gap Wider Equity Low- Income Race/ Ethnicity

3 Data from InsBtute for Diversity in Health Management/HRET

4 Kotter s Key Steps for Organizational Change 4

5 Applying Kotter s Steps to REL Data STAGE STEPS ACTION REL DATA Create the Climate for Change Increase Urgency Build the Team Get the Vision Right Convince key stakeholders that the status quo not using REL data--is more dangerous than change Assemble a group with commitment AND power; Create a true team Not too complicated or vague Link REL data collection and reducing disparities to competitive advantage and mission; point to emerging external pressures to respond More is better; Power (title, position, information, expertise, reputation, relationships); will include people who are not part of senior management Make it plain Keep it short Inspire! 5

6 Applying Kotter s Steps to REL Data STAGE STEPS ACTION REL DATA Engage and Enable the Whole Organization Communicate for Buy-In Empower Action Create Shortterm Wins Communicate about equity all day everyday, Leaders role-model behaviors consistent with vision Align incentives, Remove barriers that undermine vision, Create credibility Identify a project that can be: Designed and launched now By a small team With upside potential Is visible to others Reference REL data in all of your communications (KN/internal and external website, s, presentations, routine discussions) REL metrics on performance evaluation; recognize good work to address disparities; listen and address staff concerns What s an easy REL win: --Is there a simple QI initiative that you can tie to reducing disparities? 6

7 Applying Kotter s Steps to REL Data STAGE STEPS ACTION REL DATA Implement and Sustain Change Don t Let Up Use win to inform system behavior in ways that support the vision Hire strategically Develop new projects Make it Stick Shared values and norms Strategic alliances (with board members, mission effectiveness committees) Keep REL data and disparities conversations in the forefront; Be realistic about the timeline Identify how performance on REL data is improving REL data becomes part of everyday work Plan executive succession carefully 7

8 Create Urgency: Is there a business case? Current payment reform: paying for value Future payment reform: paying to reduce disparities Decrease future health care costs Increase market share, or minimally don t get left behind Challenges of financial analysis Costs/Rewards may be difficult to measure Returns might be realized by other parties 8

9 Respond to Barriers around Data Collection Lack of staff knowledge about the purpose of REL data collection Staff discomfort collecting REL data REL data collection being too time-consuming Patients not understanding the term race or ethnicity Patients reacting negatively to being asked for REL data Response options for race or ethnicity not broad enough or don t seem to fit your patients 9

10 Evaluate Process and Outcome Measures screening rates immunization rates disease outcomes treatment for disease/illness referrals for disease/illness medical error/adverse events patient satisfaction/experience of care utilization of ambulatory care utilization of emergency department care utilization of inpatient care 10

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12 ICSI

Other Resources America s Health Insurance Plans, Tools to Address Disparities in Health: Data as Building Blocks for Change, 2005, http://www.vdh.virginia.

13 Other Resources America s Health Insurance Plans, Tools to Address Disparities in Health: Data as Building Blocks for Change, 2005, National Quality Forum, A Comprehensive Framework and Preferred Practices for Measuring and Reporting Cultural Competency: A Consensus Report, 2009, A_Comprehensive_Framework_and_Preferred_Practices_for_Measuring_and_Reporting_Cultural_ Competency.aspx The Joint Commission, A Crosswalk of the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care to The Joint Commission Hospital Accreditation Standards, 2014,

14 Collect Data on System Performance Percent staff with health equity training and mean number of training hours Health equity training: Healthcare Disparities 101 The Evidence Communication Skills Implicit Bias Percent staff by job title that represent the demographics of the patient population CAHPS Cultural Competence Item Set Equity on Employee Engagement Surveys ICSI

15 Organizations as Conversations We approach the work of organizational change differently when we view organizations as conversations rather than machines. the core value is not to be in control but to be in right relation. Without unrealistic expectations of control, there is less anxiety and defensiveness, opening more space for curiosity, experimentation, dialog, and critical reflection ideal circumstances for adaptability and innovation. Suchman A, Organizations as Machines, Organizations as Conversations, Medical Care, 49 (12):S43-S48. Is there an organizational conversation around REL data? What is said? What is unsaid? Is it explicit, open, safe, and energizing, or is does it feel unsafe, uncomfortable, risky, and draining? ICSI

Jeff Oxidine, UC Berkeley

Jeff Oxidine, UC Berkeley Leading Change The Disparities Leadership Program May 29 th, 2008 Cambridge, Massachusetts Roderick K. King, MD, MPH Senior Faculty, MGH Disparities Solutions Center Instructor, Dept of Social Medicine