Building Cultural Competence through Sustainable Change: Findings from the NCHL Diversity Leadership Demonstra?on Project

Transcription

1 Building Cultural Competence through Sustainable Change: Findings from the NCHL Diversity Leadership Demonstra?on Project Judith G. Bryant, MSOD NCHL Diversity Leadership Organizational Coach Janice L. Dreachslin, Ph.D., Principal Investigator Professor of Health Policy & Administration, Penn State University Great Valley School of Graduate Professional Studies Rob Weech-Maldonado, Ph.D., Co-Principal Investigator Professor & L.R. Jordan Endowed Chair Department of Health Services Administration University of Alabama at Birmingham

2 Agenda Introduc?ons Project Overview PowerPoint Presenta?on Panel Discussion and Dialogue Closing 2

3 Defining Cultural Competency Na?onal Quality Forum. (2008). Endorsing a Framework and Preferred Prac?ces for Measuring and Repor?ng Culturally Competent Care Quality. Washington DC: Na?onal Quality Forum. The Na(onal Quality Forum (NQF) (2008. p3) defines cultural competency as the: "ongoing capacity of healthcare systems, organiza(ons, and professionals to provide for diverse pa(ent popula(ons highquality care that is safe, pa(ent and family centered, evidence based, and equitable. And states that Cultural competency is achieved through: "policies, learning processes, and structures by which organiza(ons and individuals develop the antudes, behaviors, and systems that are needed for effec(ve crosscultural interac(ons 3

4 Need for Project The Business Case Social Responsibility Changing Regulatory Environment Changing Demographics & Social ANtudes Ongoing Dispari(es Career accomplishment Percep(ons of equity & opportunity in the workplace Process & outcome of care Pa(ent percep(ons of quality Best Prac(ces & Organiza(onal Performance 4

5 Need for A Leadership Focused Systems Approach Five year study of associa(on between race and gender diversity and business performance (Kochan 2003) Diversity won t automa(cally translate into be[er (or worse) results Diversity is a labor market impera(ve and social expecta(on or value The business case for diversity is complex and nuanced Impact of demographic diversity depends on the context Context includes organiza(onal culture, HR prac(ces, and strategy The BoUom Line: Unless explicit auen?on is given to managing diversity, its impact is likely to be nega?ve 5

6 Strategic Diversity Leadership Diversity leadership is a differen(a(on strategy that is responsive to demographic shi`s and changing social antudes among both the pa(ents and the workforce. (Dreachslin, 1999:428) The diversity sensi(ve orienta(on of leaders drives investment in diversity management and culturally & linguis(cally appropriate care (Dansky et. al., 2003) 6

7 Diversity Leadership Predicts CLAS Adherence Strategic Plan Strategic plan goals for diversity in two areas: Recruitment and Reten(on of a Culturally Diverse Workforce Provision of Culturally and Linguis(cally Appropriate Pa(ent Care Performance Metrics Rou(ne assessment of diversity goal achievement as part of strategic planning Accountability Dedicated person, office or commi[ee assigned responsibility to promote the hospital s cultural diversity goals Community Involvement Annually report to the community about the hospital s performance in mee(ng the cultural and language needs of the service area. Source: Weech Maldonado, R., M.N. Ellio[, C. Schiller, A. Hall, J.L. Dreachslin, and R.D. Hays. 2007a. Organiza(onal and Market Characteris(cs Associated with Hospital s Adherence to the CLAS Standards. Presenta(on at the APHA Annual Mee1ng in Washington, D.C. on November 5. 7

8 Diversity Leadership & Organiza?onal Prac?ces Source: Weech Maldonado, R., M.N. EllioU, C. Schiller, A. Hall, and R.D. Hays. 2007b. Adherence to the CLAS standards resulted in significant increases in sa?sfac?on for all pa?ents, irrespec?ve of race, ethnicity or primary Diversity leadership can result in across the board improvement in pa?ent percep?ons of high quality health care. 8

9 NCHL Leadership Development & Transforma?on System Aligning leadership development and business strategy The key principles for managing innova(on and performance improvement that are essen(al for systema(c and sustainable change: Leadership development and organiza(onal business strategy are aligned Board is accountable for leadership succession Learning is competency based, inter professional, and ac(on oriented Key talent management and strategic human resource processes are integrated and aligned Leadership development dashboard tracks key measurable outcomes 9

10 The NCHL Diversity Leadership Demonstra?on Project Project began in 2007 with a review of the evidencebase for diversity management 1 First study that employs pre post interven(on assessment of system wide diversity change ini(a(ves Currently involves three (3) major heath care systems 2 hospitals per system Funding provided by Sodexo, par(cipa(ng organiza(ons, and NCHL fundraising 1 Cur(s, E.F., & Dreachslin, J.L. (2008). Diversity management interven(ons and organiza(onal performance: A synthesis of current literature. Human Resource Development Review, 7(1),

11 Goals of the Research Evaluate impact of a planned series of diversity interven(ons on organiza(onal performance Contribute to the literature: Current published research is limited 1 Rigor: over emphasis on case study, literature review, self reported results Collabora(on: necessary to balance prac(cality with rigor to build the business case 1 Cur(s, E.F., & Dreachslin, J.L. (2008). Diversity management interven(ons and organiza(onal performance: A synthesis of current literature. Human Resource Development Review, 7(1),

12 Research Study Ques?on The overarching research ques?on: What impact does a formal, phased and mul( faceted strategic diversity leadership interven(on have on performance metrics at the individual, group, and organiza(onal levels? 12

13 Project Design Control Hospital Baseline Assessment Organiza(onal Individual Leaders Nursing Unit Staff Repeat Assessments a`er 18 Months 13 Interven?on Hospital Baseline Assessment Organiza(onal Individual Leaders Nursing Unit Staff Systema(c Interven(ons Leadership Infrastructure Nursing Unit Repeat Assessments a`er 18 Month Interven(on Phase

14 Pre Post Outcomes and Assessments Structured Interviews & Focus Groups Individual Level Outcomes Diversity Self Awareness Discovering Diversity Profile Racial/Ethnic Iden(ty Status Racial Iden(ty ANtude Scales Implicit Bias Implicit ANtude Test Hospital Level Outcomes Organiza(onal Climate Survey Strategic Human Resources Management Na(onal Leadership Index Diversity Leadership Diversity & Cultural Proficiency Assessment Pa(ent Cultural Competency Cultural Competency Assessment Tool for Hospitals (CCATH) Diversity Climate Mor Barak Assessment 14

15 Addi?onal Pre Post Outcomes Measures Financial & Human Resources Financial performance: opera(ng & total profit margins pre post Human resource outcomes: Diversity demographics prepost by level Employee turnover rate prepost Pa?ent Pa(ent experiences with inpa(ent care pre post Hospital CAHPS Pa(ent clinical outcomes pre post Agency for Healthcare Quality & Research (AHRQ) Pa(ent Safety Indicators Medicare Hospital Compare Outcomes 15

16 Data Analysis Quasi experimental study design with pre and postinterven(on analysis Analysis of Covariance (ANCOVA) with covariates Dependent variables: Post interven(on scores Covariates: Pre interven(on scores, hospital type (experimental vs. control), and demographic variables of par(cipants (age, educa(on, and gender) 16

17 Diversity Demonstra?on Project Interven?on Flow Diagram Pre Assessments 3 Months Interviews Focus Groups Archival Data Organiza(onal Level Instruments o OCS o NCHL Diversity Assessment o Na(onal Leadership Index o CCATH o Diversity Climate Assessment Individual Level Instruments o Discovering Diversity Profile o Racial Iden(ty Scales o Implicit Bias Assessments Feedback and Consulta?on 1 Month Diversity Coach CEO & Leadership Team Organiza?onal Level Ac?on Plan 1 Month Diversity Coach CEO & Leadership Team Post Project Feedback & Planning for Sustainable Change & Con?nuous Improvement 1 Month Diversity Coach CEO & Leadership Team Post Assessments 2 Months Individual Team Organiza(onal 17 Interven?ons 18 months Infrastructure Development Human resource/talent management systems Pa(ent care delivery Diversity leadership Execu?ve Coaching & Ac?on Plans Training o Standard Basic Awareness Training o Standard Advanced Training o Customized Advanced Training Staff Individual Level Ac?on Plans Other Individual Interven?ons

18 Diversity Management Infrastructure: Selected Examples of Evidence Based Best Prac?ces Recruitment & Selec(on Review the recruitment and selec(on process and retool as needed for cultural sensi(vity and equity of impact Job Design/Work Systems Iden(fy needed changes for post demonstra(on project implementa(on Learning & Development Diversity training and coaching, resul(ng in organiza(onal and individual diversity leadership development plans Performance Management Add a diversity competency to the exis(ng performance management system Reward & Recogni(on Link compensa(on to diversity goals Implement peer nominated Champion of Diversity Award program peer with formal evalua(on criteria/process and reward appropriate to organiza(onal culture Succession Planning Implement formal mentoring program that includes mentor training/ development and stretch assignments 18

19 Culturally & Linguis?cally Appropriate Care Infrastructure: Selected Examples of Evidence Based Best Prac?ces Review and retool policies & prac(ces as needed: Interpreter services Transla(on services Visita(on Food services Physical Plant Artwork, Signage, Design, e.g. wai(ng rooms Informa(on Collec(on of race/ethnic and other demographic data Use of race/ethnic and other demographic data Pa(ent/Caregiver rela(onship Concordance Communica(on 19

20 Challenge and Opportunity Challenge To move past inac(on and resistance to ac(on and involvement Opportunity To Emerge as the Exemplar of Diversity Leadership and Renew the Historic Values and Mission of Healthcare Organiza(ons 20

21 Rohini Anand, Ph.D., Global Chief Diversity Officer Sodexho "This project has the poten(al of genera(ng groundbreaking research to inform execu(ve office and board room issues confron(ng healthcare today. We expect this demonstra(on project to offer insights into understand the impact of diversity and cultural competence on performance at healthcare organiza(ons, including the impact of leadership structures on cri(cal outcomes such as pa(ent safety." 21

22 Project Advisory CommiUee Rohini Anand, PhD Global Chief Diversity Officer Sodexho Joseph Betancourt, MD, MPH The Dispari(es Solu(ons Center Massachuse[s General Hospital Linda Burnes Bolton, DrPH, RN, FAAN Vice President and Chief Nursing Officer Cedars Sinai Medical Center Frederick D. Hobby President and CEO Ins(tute for Diversity in Health Management William Lee Director, Corporate Diversity, Inclusion, and Compliance Abbo[ Marie Sinioris President and CEO Na(onal Center for Healthcare Leadership Shoshanna Sofaer, DrPH Robert P. Luciano Professor of Health Care Policy School of Public Affairs, BaruchCollege Bernard J. Tyson SVP, Health Plan and Hospitals Opera(ons Kaiser Permanente 22

23 Selected References Cur(s, E.F., & Dreachslin, J.L. (2008). Diversity management interven(ons and organiza(onal performance: A synthesis of current literature. Human Resource Development Review, 7(1), Dansky, K., Maldonado, R.W., DeSouza G., & Dreachslin, J.L. (2003). Organiza(onal strategy and diversity management: Diversity sensi(ve orienta(on as a modera(ng influence. Health Care Management Review, 28(3), Dreachslin, J.L. (1999). Diversity and organiza(onal transforma(on: Performance indicators for health services organiza(ons. Journal of Healthcare Management, 45(1), Dreachslin J.L., Maldonado R.W., & Dansky K.G. (2004). Racial and ethnic diversity: A focused research agenda for health services management. Social Science and Medicine, 59(5), Dreachslin, J.L. & Cur(s, E.F. (2004). Factors affec(ng the career advancement of women and racially/ ethnically diverse individuals in healthcare management. Journal of Health Administra(on Educa(on, 21(4), Dreachslin, J.L. (2007). Diversity management and cultural competence: Research, prac(ce, and the business case. Journal of Healthcare Management, 52(2), Dreachslin, J.L. & Hobby, F. (2008). Racial and ethnic dispari(es: Why diversity leadership ma[ers. Journal of Healthcare Management, 53(1), Kochan, T., K. Bezrukova, R. Ely, S. Jackson, A. Joshi, K. Jehn, J. Leonard, D. Levine, and D. Thomas The Effects of Diversity on Business Performance: Report of the Diversity Research Network. Human Resource Management 42 (1): Weech Maldonado, R., M.N. Ellio[, C. Schiller, A. Hall, J.L. Dreachslin, and R.D. Hays. 2007a. Organiza(onal and Market Characteris(cs Associated with Hospital s Adherence to the CLAS Standards. Presenta(on at the APHA Annual Mee1ng in Washington, D.C. on November 5. Weech Maldonado, R., M.N. Ellio[, C. Schiller, A. Hall, and R.D. Hays. 2007b. Does Hospital s Adherence to the CLAS Standards Predict Diverse Pa(ents Experiences with Inpa(ent Care? Presenta(on at the APHA Annual Mee1ng in Washington, D.C. on November 5. 23