A Continuous Quality Improvement Approach to Organizational Cultural Competence

Transcription

1 A Continuous Quality Improvement Approach to Organizational Cultural Competence Thomas LaVeist, PhD & Cheri Wilson, MA, MHS, CPHQ Hopkins Center for Health Disparities Solutions Johns Hopkins Bloomberg School of Public Health

2 General Housekeeping If you experience any technical difficulties during the webinar, please contact GoToMeeting.com Customer Support at: or

3 Presentation Outline Review changing U.S. demographics related to race, ethnicity, and language Define cultural competence Describe the current federal mandates and regulatory standards related to cultural competency Overview of the Cultural Competency Organizational Assessment-360 (COA360) Discussion of the Culture-Quality-Collaborative Collaborative (CQC) Share COA360 and CQC Satisfaction Results

4 About Us Exploration and Intervention for Health Equality Designated a National Center of Excellence by the National Institutes of Health, National Institute on Minority Health and Health Disparities

5 ICHAD.ORG

6 Recent Webinar Quality Healthcare for Lesbian, Gay, Bisexual & Transgender People: A Four-Part Cultural Competence Webinar Series Part 1: Understanding the Health Needs of LGBT People: An Introduction Tuesday, June 19, 2012, 3:30 p.m-5:00 p.m. EST In collaboration with

7 Percentage Resident Population by Race/Ethnicity, U.S % 90% 80% 70% Hispanici 60% 50% Asian/PI American Ind 40% Black 30% White 20% 10% 0%

8 Projected Percentage Resident Population by Race/Ethnicity, U.S % 75% Hispanic Asian/PI 50% American Ind Black 25% White 0%

9 Changing State Demographics In 2008, four states Hawaii (75%), New Mexico (58%), California (58%), and Texas (53%) plus the District of Columbia (67%) were already minority majority. majority. In the rest of the U.S., minorities constitute 36.3% of the population. Source: 2009 American Community Survey and 2010 U.S. Census

10 Changing U.S. Demographics Increased number of foreign born residents Almost 35 million U.S. residents (11.1%) Increased numbers speak a language other than English at home Almost 55 million U.S. residents (19.7%) Increased numbers speak English less than "very well" and are considered limited English proficient (LEP) More than 24 million U.S. residents (8.7%) Source: 2000 U.S. Census and 2009 American Community Survey

11 Changing U.S. Demographics Between 1990 and 2000, 15 states experienced more than 100% growth in their LEP populations. Arkansas, Colorado, Georgia, Idaho, Kansas, Kentucky, Minnesota, Nebraska, Nevada, North Carolina, Oregon, South Carolina, Tennessee, Utah, and Washington In 9 states, more than 10% of the overall population is already LEP. California, Texas, New York, Nevada, Arizona, New Jersey, Florida, New Mexico, and Hawaii

12 What is Cultural Competence? A developmental process that evolves over an extended period of time. Individuals, organizations, and systems are at various levels of awareness, knowledge and skills along the cultural competence continuum. Source: Terry L. Cross. Towards a Culturally Competent System of Care: A Monograph on Effective Services for Minority Children Who Are Severely Emotionally Disturbed. Washington, DC: CASSP Technical Assistance Center, Georgetown University Child Development Center, 1989.

13 What is Cultural Competence? It requires organizations to: 1. Have a defined set of values and principles, p and demonstrate behaviors, attitudes, policies, and structures that enable them to work effectively cross-culturally; Source: Terry L. Cross. Towards a Culturally Competent System of Care: A Monograph on Effective Services for Minority Children Who Are Severely Emotionally Disturbed. Washington, DC: CASSP Technical Assistance Center, Georgetown University Child Development Center, 1989.

14 What is Cultural Competence? 2. Have the capacity to: (a) value diversity, (b) conduct self-assessment, (c) manage the dynamics of difference, (d) acquire and institutionalize cultural knowledge, and (e) adapt to the diversity and cultural contexts of communities they serve; Source: Terry L. Cross. Towards a Culturally Competent System of Care: A Monograph on Effective Services for Minority Children Who Are Severely Emotionally Disturbed. Washington, DC: CASSP Technical Assistance Center, Georgetown University Child Development Center, 1989.

15 What is Cultural Competence? 3. Incorporate the above into all aspects of: (a) policymaking, (b) administration, (c) practice and service delivery, (d) and systematically involve consumers, key stakeholders and communities. Source: Terry L. Cross. Towards a Culturally Competent System of Care: A Monograph on Effective Services for Minority Children Who Are Severely Emotionally Disturbed. Washington, DC: CASSP Technical Assistance Center, Georgetown University Child Development Center, 1989.

16 Federal Mandates and Regulatory Standards

17 Federal Mandates and Regulatory Standards Title VI of the Civil Rights Act of 1964 Executive Order (August 11, 2000) CLAS Standards (2001) enhanced (2012) NQF: A Comprehensive Framework and Preferred Practices for Measuring and Reporting Cultural Competency

18 Federal Mandates and Regulatory Standards The Joint Commission Effective Communication, Cultural Competence, and Patient-Centered Care Standards (effective 1/1/2011) NCQA Multicultural Health Care Standards: Distinction Program (effective 7/1/2010) Meaningful Use of Electronic Health Records (EHRs)

19 Economic Burden of Health Inequalities Direct Medical Care Costs $229.4 billion for the years Indirect Costs of disability and illness $50.3 billion Cost of Premature Deaths were $957.5 billion Total $1.24 trillion (in 2008 inflation-adjusted adjusted dollars).

20 COA360 Overview COA360TM

21 COA360 Validation Article Journal of Healthcare Management 53:4 (July/August 2008):

22 Winner, 2008 Innovation Award National Center on Minority Health and Health Disparities (NCMHD)

23 COA360 Overview Web-based tool Assessment of healthcare organizations, not individuals Identifies strengths and areas for improvement Suitable for any size healthcare organization Assesses unique configuration of diversity in the service area (race, ethnicity, language, and religion) Plan to incorporate sexual orientation

24 COA360 Overview Measures: CLAS Standards Joint Commission Standards CAHPS patient experience, including health literacy and cultural competency item sets

25 360 View of the Organization Clinical Staff Non Clinical Staff Organization Patients/ Clients Administrators

26 The COA360/CQC Continuous Quality Improvement (CQI) Cycle Assess Re-assess COA360 Identify Deficiencies Tailored Interventionsentions

27 Brief COA360 Demo Point of Contact Survey Administrator/Clinical Staff/Non-Clinical Staff Survey Patient/Client Survey

28 Survey Invitation

29 Survey Login Page

30 Participant Home Page

31 Point of Contact Survey

32 Point of Contact Survey

33 Point of Contact Survey

34 Point of Contact Survey

35 Administrator/Clinical Staff/ Non-Clinical Staff Survey

36 Administrator/Clinical Staff/ Non-Clinical Staff Survey

37 Administrator/Clinical Staff/ Non-Clinical Staff Survey

38 Administrator/Clinical Staff/ Non-Clinical Staff Survey

39 Administrator/Clinical Staff/ Non-Clinical Staff Survey

40 Administrator/Clinical Staff/ Non-Clinical Staff Survey

41 Administrator/Clinical Staff/ Non-Clinical Staff Survey

42 Administrator/Clinical Staff/ Non-Clinical Staff Survey

43 Administrator/Clinical Staff/ Non-Clinical Staff Survey

44 Patient/Client Survey

45 Patient/Client Survey

46 Patient/Client Survey

47 Patient/Client Survey

48 Patient/Client Survey

49 Patient/Client Survey

50 COA360 Report

51 COA360 Report

52 COA360 Report

53 COA360 Report

54 COA360 Report

55 COA360 Report

56 COA360 Report

57 COA360 Report

58 COA360 Report

59 COA360 Report

60 COA360 Report

61 COA360 Certified Consultants Andrea Thompson and Michael Thompson Marblestone Consulting Group Nadia Sawaya Amy Wilson-Stronks Wilson-Stronks, LLC Yolanda Robles Culturalink LaVonna Blair Lewis University of Southern California

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63 Culture-Quality-Collaborative (CQC) A learning exchange of healthcare organizations Co-learning Participating in the COA360/CQC CQI Cycle Assess Identify deficiencies Tailored interventions Re-assess Share findings

64 The COA360/CQC Continuous Quality Improvement (CQI) Cycle Assess Re-assess COA360 Identify Deficiencies Tailored Interventionsentions

65 Programming through June 2012 Date Event Type Category Topic March 2011 April 2011 June 2011 Webinar Webinar Webinar Data Collection and Quality Improvement Cultural Competency Training Regulatory Environment and Legislation July 2011 Webinar Health Disparities Collecting and Using race, ethnicity, and language data (ex. stratify patient satisfaction, quality, and safety data, creating equity dashboards, etc.) Cultural competency training for clinical staff (e.g. physicians, nurses, and other direct patient care providers) State laws/regulations and cultural competency Appraising the evolving evidence on cultural competency and health disparities August 2011 Webinar Health Disparitiesiti Culturally competent approaches to combating health disparities September New Directions in the National best practices and innovations: Webinar st Century AHRQ Innovations Exchange Regulatory October 2011 Webinar Environment and Joint Commission i Standards d Legislation

66 Programming through June 2012 Date Event Type Category Topic November 2011 Webinar Language Services December 2011 Webinar Business Case January 2012 February 2012 March 2012 Webinar Webinar Webinar New Directions in the 21st Century Regulatory Environment and Legislation New Directions in the 21st Century Provision of language services and overcoming language barriers Putting the Lessons Learned from the CQC in Practice Harnessing the community to improve organizational cultural competency The economic burden of health inequalities Cultural competency lessons from other industries and implications for the health care system May 2012 Webinar Language Services Assessing language competency of bilingual staff June 2012 Webinar Data Collection and Quality Improvement Review of CQC Members COA360 Results

67 CQC Founding Members

68 CQC Founding Members

69 COA360 AND CQC SATISFACTION RESULTS

70 COA360 SATISFACTION RESULTS

71 Quantitative Results: Satisfaction with Overall COA360 Experience Strongly Disagree/Disagree 5 Neutral 22 Strongly Agree/Agree N = 391

72 Quantitative Results: Satisfaction with COA360 Functionality Strongly Disagree/Disagree 4 Neutral 18 Strongly Agree/Agree N = 384

73 Quantitative Results: Satisfaction with COA360 Usability Strongly Disagree/Disagree 3 Neutral 18 Strongly Agree/Agree N = 388

74 Qualitative Results The COA360 has given us detailed insight related to our cultural and linguistic competency in a variety of domains, and it has allowed us to determine targeted t steps we can take in order to provide more culturally competent services to our clients.

75 Qualitative Results Used to determine whether a unit-based education approach along with organizational supports leads to improved patient satisfaction, employee engagement, clinical i l quality, and organizational cultural competence in the Labor & Delivery unit of our hospital. If successful, this intervention could be tailored to other units in the hospital to improve care for all patients.

76 Qualitative Results innovative, user friendly, and easy to understand for our patients, staff and leaders. The reports, provided by expert staff, have given us meaningful results, thorough data analysis, and helpful recommendations. This information is critically important to our hospital, given that it serves patients from a wide variety of races, ethnicities and cultural backgrounds.

77 CQC SATISFACTION RESULTS

78 Quantitative Results: Overall CQC Satisfaction Very Dissatisfied/Somewhat Dissatisfied 0 Neutral 11 Very Satisfied/Somewhat Satisfied N = 19

79 Quantitative Results: Recommend CQC to a Colleague No 5 Yes N=19

80 Qualitative Results: Most useful CQC aspects Webinars and the opportunity to network with other health systems. Learning from other providers. Access to the COA360; knowing more about what other organizations are doing. Webinar subjects Developing a knowledge base in areas where I do not normally focus my attention.

81 Qualitative Results: Most useful CQC aspects Balance between the academic and practitioner examples Diversity of topics and frequency Resources from speakers and other members Access to seminar information Identification of barriers

82 Q&A