Tampa Bay Diversity Council - Educational Portion 8.5.11 - Moffitt Cancer Center
Moffitt Diversity ACCESS to Care:Building a Culture of Diversity & Inclusion Cathy Grant, Director Friday, August 5, 2011 Florida Diversity Council
Objective• About Moffitt• Health Disparities• Cultural and Linguistic Competence• Diversity & Inclusion at Moffitt
About Moffitt Cancer Center• Single Mission – The Prevention and cure of cancer• Celebrating 25th Anniversary• Only NCI designate cancer center in FL• Staff –4,287 Total Employees• Moffitt is licensed for 206 beds• From 2009 to 2010 • Admissions grew from 7,742 to 8,616 • Outpatient grew from 289,502 to 320,558• As of October 2010, grant funding at Moffitt increased to $83.8 million
Cancer Programs• Blood & Marrow Transplantation• Don & Erika Wallace Comprehensive Breast Program• Cutaneous Oncology• Gastrointestinal Malignancies• Genitourinary Oncology• Gynecologic Oncology• Head & Neck Oncology• Internal and Hospital Medicine• Malignant Hematology• Neuro-Oncology• Psychosocial & Palliative Care• Radiation Oncology• Sarcoma• Senior Adult Oncology• Thoracic Oncology
Demographics White Latino Black Asian Multicultural (Not Hispanic) United States 63.7% 16.3% 12.6% 4.8% 2.9% Florida 57.9% 22.5% 16.0% 2.4% 2.5% Hillsborough 53.7% 24.9% 16.7% 3.4% 3.1% CountySource: US Census: http://quickfacts.census.gov/qfd/states/12/12057.html
Language 24% speak a language other than English at home 77% speak Spanish 23% other language 40% reported not speaking English “very well”Source: U.S. Census Bureau, 2005-2009 American Community Survey
Health DisparitiesDifferences or gaps in care experienced by one population compared with another population which can result in less access to care, a poorer quality of care, and higher death rates from certain diseases.
Prostate Cancer Age-Adjusted Death Rates per 100,000 Persons By Race & Hispanic Origin: U.S. (2005) A ge-A djusted D eath R ate per 100,000 Persons 60 53.3 55 50 45 40 35 30 24.5 25 22.6 17.6 18.5 20 15 10.4 10 5 0 All Races White African American Asian/Pacific Hispanic American Indian/Alaska Islander NativeCenter for Disease Control and Prevention, Office of Minority Health and HealthDisparities. An Overview. http://www.pitt.edu/~super4/39011-40001/39961.ppt#259,1,Office of Minority Health and Health Disparities (OMHD)
Breast Cancer Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S. (2005) A g e -A d ju s te d D e a th R a te p e r 1 0 0 ,0 0 0 P e rs o n s 35 32.8 30 24.1 23.4 25 20 15.2 15.0 15 12.2 10 5 0 All Races White African American Asian/Pacific Hispanic American Indian/Alaska Islander NativeCenter for Disease Control and Prevention, Office of Minority Health and Health Disparities.An Overview. http://www.pitt.edu/~super4/39011-40001/39961.ppt#259,1,Office of MinorityHealth and Health Disparities (OMHD)
Colon, Rectum & Anus Cancer Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S. (2005) 24.8 Age-Adjusted Death Rate per 100,000 Persons 25 20 17.5 16.9 15 12.0 12.4 11.2 10 5 0 All Races White African American Asian/Pacific Hispanic American Indian/Alaska Islander NativeCenter for Disease Control and Prevention, Office of Minority Health and HealthDisparities. An Overview. http://www.pitt.edu/~super4/39011-40001/39961.ppt#259,1,Office of Minority Health and Health Disparities (OMHD)
Trachea, Bronchus & Lung Cancer Age-Adjusted Death Rates per 100,000 Persons by Race & Hispanic Origin: U.S. (2005) 58.4 A g e -A d ju s te d D e a th R a te p e r 1 0 0 ,0 0 0 P e rs o n s 60 55 52.6 53.1 50 45 40 34.1 35 30 25.7 25 22.4 20 15 10 5 0 All Races White African American Asian/Pacific Hispanic American Indian/Alaska Islander NativeCenter for Disease Control and Prevention, Office of Minority Health and HealthDisparities. An Overview. http://www.pitt.edu/~super4/39011-40001/39961.ppt#259,1,Office of Minority Health and Health Disparities (OMHD)
Racial/Ethnic Disparities in Health CareDifferential utilization based on race for within Medicare: Mammography (Gornick et al.) Amputations (Gornick et al.) Influenza vaccination (Gornick et al.) Lung Ca Surgery (Bach et al.) Renal Transplantation (Ayanian et al.) Cardiac catherization & angioplasty (Harris et al, Ayanian et al.) Coronary artery bypass graft (Peterson et al.) Treatment of chest pain (Johnson et al.) Referral to cardiology specialist care (Schulman et al.) Pain management (Todd et al.)
Potential Reasons for Disparities in Care Patient Level Health Care Organization / • Patient preferences Systems Level • Treatment resistance / • Lack of access to care compliance • Lack of interpretation and • Health perceptions translation services • Care seeking behaviors and • Time pressures on attitudes physicians and other • Clinical appropriateness of clinical staff care • Geographic availability of health care institutions Provider Level • Bias • Changes in the financing • Stereotyping and delivery of health care • Clinical uncertainty services • Poorer quality of care • Lack of patient-centered care • Unconscious and automaticSource: Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare,March 2002.
Minorities Less Involved in Their Health Care Decisions Than They Would Like to BePercent of adults involved in health care decision as much as they wanted 75% 78% 80% 73% 65% 56% 40% 0% Total White African Hispanic Asian American American Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Hispanics and African AmericansMore Likely to Feel Treated with Disrespect Percent of adults who felt they were treated with disrespect 20% 18% 16% 13% 11% 10% 9% 0% Total White African Hispanic Asian American American Source: The Commonwealth Fund 2001 Health Care Quality Survey.
Focus of EffortsA.C.C.E.S.S. to Care• Enhance Moffitt Cancer Center’s image among at-risk and underserved communities through delivery of culturally and linguistically competent care, prevention education and mutually beneficial partnerships;Culture of Diversity & Inclusion• Serve as a resource, as well as, identify opportunities to increase Moffitt’s preparedness when serving diverse communities.
A.C.C.E.S.S.• Awareness and Education• Community Outreach• Cultural and Linguistic Competence• Equity and Inclusion• Support Other initiatives (Technical Assistance)• Strong Partnerships
Definition of CultureIntegrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, roles, relationships, and institutions of racial, ethnic, religious, or social groups
Cultural CompetenceCultural Competence is defined as “a set of behaviors, skills, attitudes, knowledge, practices, policies, and strategies that together enables the Moffitt workforce to work effectively in cross-cultural situations to improve: (1) Patient safety; (2) Patient satisfaction; (3) Access to and utilization of care; and (4) Quality of care (5) Workforce diversity; and (6) Participation in clinical trials and research
Why CLC?• Beyond the “right thing to do”………..• Changing demographics• Health care services that are respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of diverse patients can help bring about positive health outcomes.•• Growing evidence as an important strategy for reducing health disparities• Legal and regulatory mandates
Improving Quality of Care• Diverse and Limited English Proficiency (LEP) patients are less likely than others to receive the most effective, evidence-based treatments for certain conditions• Diverse populations report more communication difficulties with their physicians, less involvement in clinical decisions, more difficulty understanding instructions on prescriptions, and instructions from physician’s staff
Improving Patient Safety• Diverse and Limited English Proficiency (LEP) patients suffer more medical errors with greater clinical consequences• Communication problems may lead to misdiagnosis, inappropriate treatment, and limit authentic informed consent
Improving Patient SatisfactionGood patient/provider communication is linked to better patient satisfaction, adherence to treatment recommendations, and improved health outcomes
Reducing LiabilityCommunication issues are a key component of claims filed by patients whose culture, ethnicity, religion and/or English language ability differ from that of the healthcare provider
Five Essential Elements of a Culturally Competent System• Value Diversity• Have the capacity for cultural self-assessment• Be conscious of the dynamics inherent when cultures interact• Have institutionalized cultural knowledge• Have developed adaptations to diversity 27
Linguistic CompetenceReadily available and culturally appropriate communication and language services and supports, and vital documents and informing materials, for patients and family members through such means as bilingual/bicultural staff, and professional medical interpreters and translators
Impact of Language Barriers• When Lacking Language Assistance • Less likely to have a Primary Care Physician (PCP) • More likely to not go to follow up appointments • More like to be in fair or poor health • Medication instructions errors • Less satisfied with the health care received• With available Language Assistance • Successful patient-provider relationship • Standard medical interview techniques – complete exchange of information • Empathic connection
It’s the Law! Title VI of the Civil Rights Act of 1964 “No person in the United States shall, on ground of race, color, or national origin, be excluded from participation in, or be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.”• Who is covered?• Extent of obligation: Four-factor analysis• State requirements www.os.dhhs.gov/ocr/civilrights/resources/specialtopics/lep/
Awareness and EducationFocused on each person’s role in reaching the center’s Diversity-related mission and goals • Diversity Unplugged • Employee Networks – GLAAM • New Hire Orientation • Diverse Voices – E-Newsletter • National Minority Cancer Awareness Week
Community Outreach/RelationsIncrease visibility and knowledge by providing information about the importance of cancer prevention, healthy lifestyles, and early detection of cancer to our most at-risk, under-served and under- insured communities. • Capacity – Building Programs • Lay Health Advisors • Cancer Education Toolkits • Health Education Workshops • Culturally relevant; low literacy • Prostate; Breast; Cervical; Colon; Healthy Lifestyles • Haitian Initiative / Witness Project (Komen) • EmpowerMENt Project • Moffitt Healthy KIDZ • ¡Salud! • Access to Mammography Screening
Community Outreach/Relations (cont.)• Annual Men’s Health Forum (English / Spanish)• Community Benefit• National Minority Cancer Awareness Week (NMCAW) - 3rd Week of April• Micro Award for Cancer Community Health Initiatives (MACCHI)
Language Services• Staff • Two Translators • Five Spanish Interpreters • One Spanish/American Sign Language interpreter• Pacific Interpreters - 180 languages and dialects• Video Remote Interpreting (VRI)
Other Inclusion Efforts• Supplier Diversity• Recruitment & Retention Diversity Scholarship School at Work Candidate pool
Ongoing Challenges• History• Resistance to change: internal and external• Competing priorities• Culture: internal and external• Trust• Resources / Money: Internal and external