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Managing Diversity: Using the CLAS Standards to guide organizational change

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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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>