360 o care: reducing health disparities through organizational cultural competence 2012 usphs...
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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
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)
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
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)
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
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
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.
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.
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.
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.
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.
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.
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
Organizational Values
Governance
Planning, Monitoring & Evaluation
Communication
Staff Development
Organizational Infrastructure
Services & Interventions
Culturally Competent Patient-Centered Care
Organizational Assessment Applied
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
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…
38 LeadershipInterviews
14Staff Focus Groups(~10 people/group)
8 CommunityInterviews
ABH Organizational Cultural Competence Assessment Overview
Phase I
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?
Assessment Data
>60 hours of audio recordings
~5 hours of transcription/qualitative session
>600 pages of transcribed text
Assessment Results
StrengthsOpportunities for Improvement
RecommendationsNotable Quotes
Sub-section of HRSA DomainLeadership Perceptions Staff Perceptions Community Perceptions
Strengths
Opportunities for Improvement
Recommendations
HRSA Domain
Phase II
January 2013 & Beyond:
Implementation Support
Thank You!
1801 Research Boulevard, Suite 300
Rockville, Maryland 20850
www.adventisthealthcare.com/disparities