360 o care: reducing health disparities through organizational cultural competence 2012 usphs...

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360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th , 2012 Center on Health Disparities Emeobong E. Martin, MPH Marcos Pesquera, RPh, MPH

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Page 1: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

360OCARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE

2012 USPHS Scientific and Training Symposium

Wednesday, June 20th, 2012 Center on Health Disparities

Emeobong E. Martin, MPH Marcos Pesquera, RPh, MPH

Page 2: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Cultural Competency in Health Care

WHO: Physicians and other Health Professionals, Administrators, Students, Support Staff, Organization

WHAT: Knowledge, Skills, Abilities, Attitudes and Behaviors

MEASURES: Patient Outcomes (health status, health

care utilization, satisfaction) Provider Outcomes (cultural knowledge and

sensitivity, patient-centeredness, effective communication, satisfaction)

Page 3: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Culturally Competent Care and Improved Health Outcomes

Research shows: Cultural competency training can

be effective and beneficial (Lie et al. 2010)

A few result in positive patient outcomes (e.g., Majumdar 2004, McElmurry 2009)

Some have moderate to no effect on outcomes

None have had a negative effect on outcomes

Page 4: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

What isCultural Competence?

Practitioner’s Guide “The delivery of health care services that

acknowledges and understands cultural diversity in the clinical setting, respects patients’ health beliefs and practices and values cross-cultural communication.” (Kaiser Permanente)

Organizational Application “A set of congruent behaviors, attitudes and policies

that come together in a system, agency or among professionals that enables effective work in cross-cultural situations.” (Health Resources and Services Administration)

Page 5: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Why is cultural competence important?

Patient Protection & Affordable Care Act Joint Commission Standards, CLAS

Standards Title VI Changing Demographics of our

Communities Health Disparities are well-documented

in the literature Improve Patient Experience

Page 6: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

How do you achieve cultural competence?Organizational Assessment Overview*

Organizational Values

Governance

Planning, Monitoring & Evaluation

Communication

Staff Development

Organizational Infrastructure

Services & Interventions

Culturally Competent

Patient-Centered Care

*Seven Domains Courtesy of Health Resources and Services Administration

Page 7: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Organizational Values

Culturally Competent

Patient-Centered Care

Perspective Attitude Commitment

An organization's perspective and attitudes with respect to the worth and importance of cultural competence and its commitment to provide culturally competent care.

Page 8: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Organizational Values

Governance

Goals Policy Oversight

The goal-setting, policy-making, and other oversight vehicles an organization uses to help ensure the delivery of culturally competent care.

Page 9: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Organizational Values

Governance

Planning, Monitoring & Evaluation

Mechanisms Processes Systems Activities

The mechanisms and processes used for: a) long- and short-term policy, programmatic, and

operational cultural competence planning that is informed by external and internal consumers; and

b) the systems and activities needed to proactively track and assess an organization's level of cultural competence.

Page 10: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Organizational Values

Governance

Planning, Monitoring & Evaluation

Communication

Exchange of information internally and externally

The exchange of information between the organization/providers and the clients/population, and internally among staff, in ways that promote cultural competence.

Page 11: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Organizational Values

Governance

Planning, Monitoring & Evaluation

Communication

Staff Development

Attitude Knowledge Skills An organization's efforts to

ensure staff and other service providers have the necessary attitudes, knowledge and skills for delivering culturally competent services.

Page 12: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Organizational Values

Governance

Planning, Monitoring & Evaluation

Communication

Staff Development

Organizational Infrastructure

Resource availability

The organizational resources required to deliver or facilitate the delivery of culturally competent services.

Page 13: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Organizational Values

Governance

Planning, Monitoring & Evaluation

Communication

Staff Development

Organizational Infrastructure

Delivery Facilitation

An organization's delivery or facilitation of clinical, public-health, and health related services in a culturally competent manner.

Services & Interventions

Page 14: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Organizational Values

Governance

Planning, Monitoring & Evaluation

Communication

Staff Development

Organizational Infrastructure

Services & Interventions

Culturally Competent Patient-Centered Care

Page 15: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Organizational Assessment Applied

Page 16: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Provider since 1981 Diverse community

Children, adolescents, adults, geriatrics U.S. born, immigrant populations Private and public insurance

Services: Acute In-patient Partial hospitalization

More than 780 employees Five Maryland locations

Page 17: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Adventist Behavioral Health (ABH) Locations

•ABH-Rockville

•The Reginald S. Lourie Center (Rockville)

•ABH at Washington Adventist Hospital (Takoma Park)

•ABH – Anne Arundel (Crownsville)

•ABH – Eastern Shore (Cambridge)

Location, Location, Location…

Page 18: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

38 LeadershipInterviews

14Staff Focus Groups(~10 people/group)

8 CommunityInterviews

ABH Organizational Cultural Competence Assessment Overview

Page 19: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Phase I

Page 20: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Sample Questions

How do you see cultural competence applied in treating (X) population within your institution?

How do you or your organization currently support the provision of culturally competent care?

What do you think is necessary to: Provide patient-centered care? Improve the overall patient experience

at ABH?

Page 21: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Assessment Data

>60 hours of audio recordings

~5 hours of transcription/qualitative session

>600 pages of transcribed text

Page 22: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Assessment Results

StrengthsOpportunities for Improvement

RecommendationsNotable Quotes

Page 23: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Sub-section of HRSA DomainLeadership Perceptions Staff Perceptions Community Perceptions

Strengths

Opportunities for Improvement

Recommendations

HRSA Domain

Page 24: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Phase II

January 2013 & Beyond:

Implementation Support

Page 25: 360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th,

Thank You!

1801 Research Boulevard, Suite 300

Rockville, Maryland 20850

www.adventisthealthcare.com/disparities