How Well are Our Hospitals Doing in CLAS

How Well are Our Hospitals Doing in CLAS

Agenda

1. What is Cultural Competency and CLAS

2. What is the Big Deal?

3. How do we Measure Performance/Compliance?

4. What have we learned?

5. How do we Build on that Learning?

Situation: What Hospitals Face • Cost/Revenue Squeeze

-Acuity, Technology, &

Facility

-Employers, Providers &

Payers• Competitive Inflation

-Hospitals & Health Systems

-Physicians

-Other Private Institutions

• Distinction Extinction

-Limited Options

-Commodity Imagery

Healthcare in U.S. Under Stress• Exponential Growth of Diversity

- Absolute Size

- Education & Spending Power

- Geographic Dispersion• Persistent Impact of Disparity

- Access

- Care

- Outcomes• Serious Threat to Quality

- Diabetes

- Heart Disease

- Cancer

• Enhance Healthcare Quality

- Rising Tide Theory

- Bigger Boat Theory

• Revitalize Healthcare Institutions

- Revenue/Share Enhancement

- Operational Efficiency

- Risk Management Protection

Addressing Health Disparities: A Two for One Benefit

Meeting the Need: More than Just a New Positioning

Culturally Competent Care/Service• Extension of clinical care and personal service • Based on the unique characteristics of an

institution’s:– Patients/customers

– Family members

– Guests/visitors

– Caregivers/associates

A new road to quality improvement, market differentiation & profitability.

Benefits of Organizational Cultural Competence

External• Comfort within Communities• Trust among Families• Compliance by Patients• Satisfaction for everyone

Benefits of Organizational Cultural

Competence

Internal• Quality for the CNO• Cost Containment for the CFO• Efficiency for the COO• Growth & Market Share for the CEO

What is CLAS?

• Standards for delivering Culturally and Linguistically Appropriate Service

• Developed by HHS/OMH

• Accepted Broadly

• Basis for CMCHO Products & Services

Methods for Measuring Cultural Competence & CLAS Compliance

• Testing-Questionnaires

• Observing-On-site examination

• Sampling-Process or Procedural Trial

Understanding Your Needs

“You can’t get started or go anywhere until you know where you are and how you got there”

Assessment Options

• Individual or Organizational

• Internal or External

• Paper or Personal

• Remote or On-site

• Self or Third Party

Individual vs. Organizational

• Individual

- Awareness

- Attitudes

- Behaviors• Organizational

- Global

- Systemic

- Infrastructure

CMCHO Organizational CMCHO Organizational Assessment/Survey Assessment/Survey

Community Survey

Discharge Data Analysis

Community Mapping

Leadership Conference

Management Conference

Policy/ Document Review

Patient Chart Reviews & Tracking/ Clinical

Interviews

Employee Interviews & Facility Tours

Surveyors’ Pre- Assessment

Closing Session

The Data-Community Survey Which hospital in your community is most prepared to meet the language, racial, ethnic, and cultural needs of the community?

Most Prepared (First Mention)

4%

6%

8%

11%

17%

0% 2% 4% 6% 8% 10% 12% 14% 16% 18%

Community

Ohio Valley

Presbyterian

University

St. Mary's

Ho

sp

ita

l

Percent

Most Prepared (First Mention)

4%

6%

8%

11%

17%

0% 2% 4% 6% 8% 10% 12% 14% 16% 18%

Community

Ohio Valley

Presbyterian

University

St. Mary's

Ho

sp

ita

l

PercentImplications:

• No hospital is mentioned by more than 20% of consumers.

• Each has an opportunity to become the leader in Cultural Competency.

Comparative Data-African American

AFRICAN AMERICAN Comparative Analysis

10.52%

6.41%6.81%

7.11%

11.35%

6.18%

0%

2%

4%

6%

8%

10%

12%

Service Area % Admit % Death % Billed Procedure % Readmits % Patient Days %

Current Population Trends

Native American/Inuit/Aleut (2002)

White (2002)

African American (2002)Asian/Pacific Islander (2002)

Other Race (2002)

Leadership & Management Conferences

• Ask questions that cover all 14 CLAS standards

• Use both open- and closed-ended question format

• Designed to probe for in-depth discussion

Document, Policy/Procedures Review

Review– Thorough review by Survey Team of policies/procedures

that relate to cultural competency. – Survey team looks for consistency in understanding and

application.– Survey team interviews random selection of employees and

physicians for understanding of policies and procedures.

Report – Client provided areas in which vulnerabilities exist.

Recommendation– Particular attention is given to areas of potential exposure,

and/or misunderstanding.

Patient Chart Review & Tracking: Review Assessment

Review– Random selection of charts for review.

– Documentation reviewed in the following categories:• Communicating with patient

• Ability to address needs of culturally diverse patients

• Care/service Decisions

• Continuum of Care/service

Report– Comments provided from survey team provide an

indication of strengths and alerts.

Employee InterviewsReview

– Random selection of employees and physicians identified for interview.

• Physicians, Nurses• Administrators, sales staff• Technicians• Housekeeping

– Interviews based upon the following categories:• Understanding cultural competency (policies/procedures)• Communicating with patients/customers• Ability to address needs of culturally diverse patients/customers• Care/service Decisions

Report– Attention to “knowledge gaps”– Identify misunderstanding that can lead to unintentional

negative outcomes

Review Closing Session

• Provide Insights

• Review Observations

• Present Recommendations

CMCHO Survey/Assessment Insights

• Community Study Perceptions

- Little to no awareness of competitive edge

- Diversity seen as important

- Awareness & ratings lower among diverse

respondents

Survey/Assessment Insights Continued

• Discharge Data

- Males over-represented in IP & under-

represented in OP & ER

- Blacks & Hispanics over-represented in ER

- Asians under-represented everywhere

- High AMAs among Blacks & Hispanics in IP &

OP

- Readmits for Blacks & Hispanics polarized

Survey/Assessment Insights Continued

• On-site Assessment/Survey - Awareness/understanding of CC highest at leadership level - Knowledge of CC principles & practices highest at staff level - Little to no awareness/understanding of CLAS at any level - Facilities have either plans or activities, not both

Survey/Assessment Insights continued

• On-site Assessment/Survey cont.

- Plans, policies & procedures not integrated

- Greatest gaps in language services

- Language/culture focus imbalance

- Lack of awareness or responsiveness to

professional diversity issues

Building Cultural Competency • Start with Top-Down Commitment - From CEO to Car Lot Attendant• Insist on Full Integration - Strategically (mission/vision/values) - Operationally (policies/procedures/plans)• Insure Complete Accountability - Goals & Objectives - Metrics & Measures - Rewards & Consequences• Maintain Broad View of Diversity & Cultural Competence

Building BlockExample: Diversity or Cultural

Competence• Commitment

- CEO as champion and chief advocate

• Integration

- One vision, one mission, one plan

• Accountability

- Responsibility, Measurement, Rewards &

Consequences

What is CMCHO

• A National Consortium

• Diverse Healthcare Thought Leaders

• Assess, Train, Certify & Consult

• Focus on Cultural Competency

• Focus on Organizational Infrastructure

• Focus on CLAS

Plug Into

A Healthier Future For You,

Your Organization, and the Communities You Serve