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Adapting health systems to the challenge of diversity in the US and Europe


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A review of how cultural and linguistic competence in health care has advanced in the US, and lessons for Europe

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Adapting health systems to the challenge of diversity in the US and Europe

  1. 1. Adapting health systems to the challenge of diversity in the USA and Europe Practice, policy and politics Julia Puebla Fortier Executive Director
  2. 2. Key messages <ul><li>Good models drive policy </li></ul><ul><li>Policy drives institutionalization </li></ul><ul><li>Integration with mainstream health agendas </li></ul><ul><li>Social and political support is key </li></ul>
  3. 3. Early practice models <ul><li>Organizational settings </li></ul><ul><ul><li>community clinics, public health departments, public hospitals </li></ul></ul><ul><li>Interventions </li></ul><ul><ul><li>Ethnic-specific practices/hours </li></ul></ul><ul><ul><li>Bilingual/bicultural staff </li></ul></ul><ul><ul><li>Interpretation/translation </li></ul></ul><ul><ul><li>Community health workers/cultural liaisons </li></ul></ul><ul><ul><li>Cultural competence training </li></ul></ul>
  4. 4. Some advanced practices <ul><li>Institution-wide cultural competence plans </li></ul><ul><li>Race-ethnicity-language (REL) data collection </li></ul><ul><li>Video medical interpreting – internal and multi-institution </li></ul><ul><li>Mentorship-quality improvement projects </li></ul><ul><li>Certification and practice standards </li></ul>
  5. 5. The policy ladder – U.S. <ul><li>Title VI of the Civil Rights Act </li></ul><ul><li>State activity: CA, WA and MA </li></ul><ul><li>Federal demonstrations and program requirements </li></ul><ul><ul><li>Office of Minority Health </li></ul></ul><ul><ul><li>HRSA (Community and migrant health centers) </li></ul></ul>
  6. 6. 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>
  7. 7. 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>
  8. 8. A foot in the door 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>Plethora of voluntary ‘compliance’ efforts </li></ul>
  9. 9. Picking up the ball <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>
  10. 10. The Joint Commission <ul><li>Required accreditation process </li></ul><ul><li>Early interest in cultural, linguistic issues </li></ul><ul><li>Crosswalk of CLAS standards and JC standards </li></ul><ul><li>Hospital, Language and Culture study </li></ul><ul><li>Standards and implementation guide released this year </li></ul>
  11. 11. 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>
  12. 12. 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>
  13. 13. Health care reform <ul><li>Federal requirements that extend to all health plans related to: </li></ul><ul><ul><li>Language access </li></ul></ul><ul><ul><li>REL data collection </li></ul></ul><ul><ul><li>Disparities reduction </li></ul></ul>
  14. 14. Fitting in to the mainstream <ul><li>Access to care (civil rights/advocacy) </li></ul><ul><li>Legal and quasi-legal (requirements/liability avoidance) </li></ul><ul><li>Business case (cost effectiveness, ROI) </li></ul><ul><li>Quality improvement (process) </li></ul><ul><li>Does it make a difference (outcomes) </li></ul>
  15. 15. Other mainstream agendas <ul><li>Patient safety </li></ul><ul><li>Health literacy </li></ul><ul><li>Emergency preparedness </li></ul><ul><li>Outcomes, evidence base </li></ul>
  16. 16. Social acceptance <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>
  17. 17. 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>
  18. 18. 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>
  19. 19. 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>
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