Managing Diversity: Using the CLAS Standards to guide organizational change


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Reviews the evolution of the National Standards on Culturally and Linguistically Appropriate Services in health care, with discussion of three case studies.

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  • Tell the story of how a combination of obscure issues, practices and policies came to capture the attention of the Federal government and the top health care quality agencies in the United States. Rooted in the minority and refugee health programs and civil rights law, the CLAS standards evolved from an interplay of practice, policy and perception that continues to this day. We ’ll review. Tell this story from as the Principle Investigator that led two Federally funded projects to develop the CLAS standards, supported before and after by years of gathering and disseminating information about best practices, policies and research related to culturally and linguistically appropriate health care.
  • CLAS Standards:
  • NCQA awards program, best practices and toolkit: Proposed CLAS standards within their overall standards framework: Final standards and accompanying tools:
  • Project summary: Framework summary:
  • The California Endowment: click on: Publications -> Program Areas -> Cultural Competent Health Systems The Robert Wood Johnson Foundation Search cultural competence and interpretation for a full list of publications and projects The Commonwealth Fund: Also search cultural competence and interpretation for a full list of publications and projects
  • Managing Diversity: Using the CLAS Standards to guide organizational change

    1. 1. Managing Diversity: Using the CLAS Standards to guide organizational change Julia Puebla Fortier Executive Director
    2. 2. DiversityRx: Resources for Cross Cultural Health Care <ul><li>US-based NGO founded in 1995 providing education, technical assistance, research and policy development on improving health care for diverse populations </li></ul><ul><li>National standards for culturally and linguistically appropriate health care (CLAS) </li></ul><ul><li>National conferences </li></ul><ul><li>Website and resource database: </li></ul><ul><li>Online education, professional development, and discussion forums </li></ul>
    3. 3. Key messages <ul><li>Policy shapes practice </li></ul><ul><li>Standards offer a roadmap </li></ul><ul><li>Integration with mainstream health agendas </li></ul><ul><li>Social and political support is key </li></ul>
    4. 4. Key questions <ul><li>How can health care organizations provide the same quality of care for migrants as for nationals? </li></ul><ul><li>How can this be realized? </li></ul><ul><li>Why should you do it? </li></ul>
    5. 5. Same quality, same services? <ul><li>Services need to be adapted to the needs of individuals and families - patient centered care </li></ul><ul><li>System must anticipate different needs, and plan for them </li></ul><ul><li>Staff must be flexible enough to understand differences and accommodate them </li></ul>
    6. 6. From ideas to action <ul><li>Mindset </li></ul><ul><li>Consultation </li></ul><ul><li>Preparation </li></ul><ul><li>Collaborative evaluation </li></ul>
    7. 7. Why do this? <ul><li>Humane and ethical </li></ul><ul><li>Makes it easier for staff to do their jobs well </li></ul><ul><li>Prioritises patient safety </li></ul><ul><li>Addresses medical errors, quality improvement and outcomes </li></ul><ul><li>Improves efficiency and saves money </li></ul>
    8. 8. National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS Standards) <ul><li>Issued by the Federal government in 2001 after a multi-year development process involving multiple stakeholders and public comment process </li></ul>
    9. 9. CLAS Standards: Categories of interventions <ul><li>Culturally Sensitive Interventions </li></ul><ul><ul><li>Cultural competence education </li></ul></ul><ul><ul><li>Race, ethnic and linguistic concordance </li></ul></ul><ul><ul><li>Community health workers and culturally competent health promotion </li></ul></ul><ul><li>Language Assistance </li></ul><ul><ul><li>Bilingual services, oral interpretation, translated written materials </li></ul></ul>
    10. 10. CLAS Standards: Categories of interventions <ul><li>Organizational Supports for Cultural Competence </li></ul><ul><ul><li>Management and policy strategies </li></ul></ul><ul><ul><li>Community engagement </li></ul></ul><ul><ul><li>Information and data for planning and evaluation </li></ul></ul><ul><ul><li>Appropriate ethics and conflict resolution processes </li></ul></ul><ul><ul><li>Public reporting </li></ul></ul>
    11. 11. The importance of strategic leadership: HealthEast, Minnesota: <ul><li>Effort led by CEO and Board of Directors </li></ul><ul><li>Organizational assessment </li></ul><ul><li>Leaders addressed needs identified in assessment immediately </li></ul><ul><ul><li>hired interpreters </li></ul></ul><ul><ul><li>improved translated materials </li></ul></ul><ul><ul><li>trained staff to work with interpreters </li></ul></ul><ul><ul><li>collected patient data related to language and origin </li></ul></ul><ul><li>Culturally responsive services integrated into mission statements and quality improvement activities </li></ul><ul><li>A director for cross cultural health was hired, reporting directly to the Chief Medical Officer </li></ul>
    12. 12. How to engage leadership: Lehigh Valley Health Network, Pennsylvania <ul><li>Maintain patient-centered care focus </li></ul><ul><li>Connect cultural awareness to other organizational goals </li></ul><ul><li>Engage leaders through a transformational event </li></ul><ul><li>Communicate achievements internally and externally </li></ul><ul><li>Work with recognized cultural experts to provide feedback and next steps </li></ul>
    13. 13. Partnering with the community: Children's Mercy Hospitals and Clinics, Kansas <ul><li>Objective: to improve communication between families and the hospital. Parents learn about hospital practice and policy, hospital staff get feedback about patient experiences </li></ul><ul><ul><li>12 families participated </li></ul></ul><ul><ul><li>Hospital improvements include new orientation materials in Spanish, symbol-based wayfinding system </li></ul></ul><ul><ul><li>Menu and TV channel accomodations </li></ul></ul><ul><ul><li>Ongoing dialogue with community </li></ul></ul>
    14. 14. ICMs: Community House Calls, Harborview Medical Center, Seattle <ul><li>115,000 interventions/year in 6 languages: Amharic, Cambodian, Somali, Tigrigna, Spanish and Vietnamese </li></ul><ul><li>Services for patients: </li></ul><ul><li>Interpretation </li></ul><ul><li>Advocacy for patients in healthcare, social service, school and agency settings. </li></ul><ul><li>Assist with applications for health insurance </li></ul><ul><li>Coordination of patient care, including arranging transportation </li></ul><ul><li>Help with forms and applications </li></ul><ul><li>Health education </li></ul><ul><li>Home visits </li></ul>
    15. 15. ICMs: Community House Calls <ul><li>Services for providers </li></ul><ul><li>Interpretation </li></ul><ul><li>Cultural mediation, including facilitating clinical encounters that involve cultural differences </li></ul><ul><li>Cultural consultation about issues affecting patient care </li></ul><ul><li>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 </li></ul><ul><li>Services for the community </li></ul><ul><li>Community education programs about tuberculosis, cancer, asthma, depression, HIV/AIDS and other topics. </li></ul>
    16. 16. Standards: A starting place and the power of perception <ul><li>Recommended standards, not regulations </li></ul><ul><li>Something to point to </li></ul><ul><li>Leverage to move forward </li></ul><ul><li>Many voluntary ‘compliance’ efforts </li></ul>
    17. 17. Other quality organizations follow <ul><li>Initiatives from key health care quality and accreditation organizations: </li></ul><ul><ul><li>The Joint Commission </li></ul></ul><ul><ul><li>National Committee for Quality Assurance </li></ul></ul><ul><ul><li>The National Quality Forum </li></ul></ul>
    18. 18. The Joint Commission <ul><li>Required accreditation process </li></ul><ul><li>Early interest in cultural, linguistic issues </li></ul><ul><li>Comparison of CLAS standards and JC standards </li></ul><ul><li>Hospital, Language and Culture study </li></ul><ul><li>Standards and implementation guide released in 2011 </li></ul>
    19. 19. National Committee for Quality Assurance <ul><li>Voluntary standards and accrediting body for managed care plans </li></ul><ul><li>Test waters with CLAS awards program – highlight best practices </li></ul><ul><li>Multicultural Health Standards released this year </li></ul><ul><li>Focus on data collection, staff diversity/ cultural competence, language services </li></ul>
    20. 20. National Quality Forum <ul><li>Comprehensive voluntary framework and preferred practices for measuring and reporting cultural competency </li></ul><ul><li>45 preferred practices in 6 domains: </li></ul><ul><ul><li>Leadership </li></ul></ul><ul><ul><li>Integration into management systems </li></ul></ul><ul><ul><li>Patient-provider communication </li></ul></ul><ul><ul><li>Care delivery structures </li></ul></ul><ul><ul><li>Workforce diversity and training </li></ul></ul><ul><ul><li>Community engagement </li></ul></ul>
    21. 21. Unique social acceptance factors <ul><li>Civil rights movement </li></ul><ul><li>Rise of minority group power </li></ul><ul><ul><li>Political </li></ul></ul><ul><ul><li>Demographic </li></ul></ul><ul><li>Disgrace of disparities </li></ul><ul><li>Health professions societies </li></ul>
    22. 22. Political and financial challenges <ul><li>Anti-immigrant sentiment </li></ul><ul><ul><li>Interpersonal </li></ul></ul><ul><ul><li>Political </li></ul></ul><ul><li>Financial crisis </li></ul><ul><li>New paradigms, new imperatives </li></ul>
    23. 23. Role of foundations and government <ul><li>The California Endowment, The Commonwealth Fund, The Robert Wood Johnson Foundation </li></ul><ul><li>Funding for demonstration projects and research </li></ul>
    24. 24. For more information: <ul><li>Julia Puebla Fortier , Executive Director </li></ul><ul><li>[email_address] </li></ul><ul><li>DiversityRx - Resources for Cross Cultural Health Care </li></ul><ul><li> </li></ul>
    25. 25.
    26. 26. <ul><li>Thank You </li></ul><ul><li>Merci beaucoup </li></ul><ul><li>Dank u </li></ul>