managing diversity:using the clas standards to guide organizational change
DESCRIPTION
Reviews the evolution of the National Standards on Culturally and Linguistically Appropriate Services in health care, with discussion of three case studies.TRANSCRIPT
Managing Diversity:Using the CLAS Standards
to guide organizational change
Julia Puebla Fortier Executive Director
DiversityRx: Resources for Cross Cultural Health Care
US-based NGO founded in 1995 providing education, technical assistance, research and policy development on improving health care for diverse populations
National standards for culturally and linguistically appropriate health care (CLAS)
National conferences
Website and resource database: www.DiversityRx.org
Online education, professional development, and discussion forums
Key messages
Policy shapes practice
Standards offer a roadmap
Integration with mainstream health agendas
Social and political support is key
Key questions
How can health care organizations provide the same quality of care for migrants as for nationals?
How can this be realized?
Why should you do it?
Same quality, same services?
Services need to be adapted to the needs of individuals and families - patient centered care
System must anticipate different needs, and plan for them
Staff must be flexible enough to understand differences and accommodate them
From ideas to action
Mindset
Consultation
Preparation
Collaborative evaluation
Why do this?
Humane and ethical
Makes it easier for staff to do their jobs well
Prioritises patient safety
Addresses medical errors, quality improvement and outcomes
Improves efficiency and saves money
National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards)Issued by the Federal government in
2001 after a multi-year development process involving multiple stakeholders and public comment process
CLAS Standards: Categories of interventions
Culturally Sensitive Interventions Cultural competence education Race, ethnic and linguistic concordance Community health workers and culturally
competent health promotion
Language Assistance Bilingual services, oral interpretation,
translated written materials
CLAS Standards: Categories of interventions
Organizational Supports for Cultural Competence Management and policy strategies Community engagement Information and data for planning and
evaluation Appropriate ethics and conflict resolution
processes Public reporting
The importance of strategic leadership: HealthEast, Minnesota:Effort led by CEO and Board of Directors
Organizational assessment
Leaders addressed needs identified in assessment immediately hired interpreters improved translated materials trained staff to work with interpreters collected patient data related to language and origin
Culturally responsive services integrated into mission statements and quality improvement activities
A director for cross cultural health was hired, reporting directly to the Chief Medical Officer
How to engage leadership: Lehigh Valley Health Network, Pennsylvania Maintain patient-centered care focus
Connect cultural awareness to other organizational goals
Engage leaders through a transformational event
Communicate achievements internally and externally
Work with recognized cultural experts to provide feedback and next steps
Partnering with the community: Children's Mercy Hospitals and Clinics, KansasObjective: to improve communication
between families and the hospital. Parents learn about hospital practice and policy, hospital staff get feedback about patient experiences12 families participatedHospital improvements include new orientation
materials in Spanish, symbol-based wayfinding system
Menu and TV channel accomodationsOngoing dialogue with community
ICMs: Community House Calls, Harborview Medical Center, Seattle115,000 interventions/year in 6 languages: Amharic, Cambodian, Somali, Tigrigna, Spanish and Vietnamese
Services for patients:
Interpretation
Advocacy for patients in healthcare, social service, school and agency settings.
Assist with applications for health insurance
Coordination of patient care, including arranging transportation
Help with forms and applications
Health education
Home visits
ICMs: Community House Calls
Services for providers
Interpretation
Cultural mediation, including facilitating clinical encounters that involve cultural differences
Cultural consultation about issues affecting patient care
Education sessions to provide cultural information about a variety of topics, such as health beliefs, traditional health practices, explaining diagnoses to patients, end-of-life issues and parenting practices
Services for the community
Community education programs about tuberculosis, cancer, asthma, depression, HIV/AIDS and other topics.
Standards: A starting placeand the power of perception
Recommended standards, not regulations
Something to point to
Leverage to move forward
Many voluntary ‘compliance’ efforts
Other quality organizations follow
Initiatives from key health care quality and accreditation organizations:The Joint CommissionNational Committee for Quality
AssuranceThe National Quality Forum
The Joint Commission
Required accreditation process
Early interest in cultural, linguistic issues
Comparison of CLAS standards and JC standards
Hospital, Language and Culture study
Standards and implementation guide released in 2011
National Committee for Quality Assurance
Voluntary standards and accrediting body for managed care plans
Test waters with CLAS awards program – highlight best practices
Multicultural Health Standards released this year
Focus on data collection, staff diversity/ cultural competence, language services
National Quality Forum
Comprehensive voluntary framework and preferred practices for measuring and reporting cultural competency
45 preferred practices in 6 domains: Leadership Integration into management systems Patient-provider communication Care delivery structures Workforce diversity and training Community engagement
Unique social acceptance factors
Civil rights movement
Rise of minority group powerPoliticalDemographic
Disgrace of disparities
Health professions societies
Political and financial challenges
Anti-immigrant sentimentInterpersonalPolitical
Financial crisis
New paradigms, new imperatives
Role of foundations and government
The California Endowment, The Commonwealth Fund, The Robert Wood Johnson Foundation
Funding for demonstration projects and research
For more information:
Julia Puebla Fortier, Executive Director
DiversityRx - Resources for Cross Cultural Health Care
www.diversityRx.org
www.diversityRx.org
Thank You
Merci beaucoup
Dank u