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Cultural Competency Healthcare Meeting the
Challenges of Diverse SocietiesTools for
Change

• Young Lee
• Director, HR/Training Development
• Coney Island Hospital
• New York City Health Hospitals Corporation
• Brooklyn, NY
• Email Young.Lee_at_nychhc.org

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Best Wishes!
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Webinar Presentation Goals

1. Define cultural competence in context of
   healthcare
2. Examine critical issues for developing cultural
   competence in healthcare
3. Provide Tools for Change Developing cultural
   excellence
4. Continuing cultural excellence Moving forward

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Cultural Competency Healthcare Meeting the
Challenges of Diverse Societies

• 1. Challenge Defined

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Cultural Diversity is a Fact

• The World has some 6,000 communities and as many
  distinct languages.
• Difference leads to diversity of vision, values,
  beliefs, practice and expression.
• Each culture deserves equal respect and dignity.
• -- Source United Nations, 2007

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Cultural Diversity is an Everyday Reality

• The international migration rate is growing
  faster every year
• We live in an increasingly heterogeneous society
• -- Source United Nations, 2007

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Reflecting the Respect of Fundamental Rights

• Culture is a set of distinctive spiritual,
  material, intellectual and emotional features of
  society or a social group
• Respecting and safeguarding culture is a matter
  of human rights
• Cultural diversity presupposes respect of all
  persons to participate in the cultural life of
  one's choice
• -- Source United Nations, 2007

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Cultural Diversity is our Collective Strength

• Rich diversity collective strength Quality
  Healthcare
• Cultural diversity is a natural fact that we need
  simply recognize and respect
• It is about plurality of knowledge, wisdom and
  energy which all contribute to improving and
  moving the World forward
• -- Source United Nations, 2007

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Best Patients

• (If you) ask staff to describe patients or
  families they like and do not like, they usually
  like patients or families who are grateful or
  people from the same culture or who speak the
  same language, but beyond that the attributes of
  popular patients (and) families become pretty
  grim. The most popular patients never ring their
  call lights, never ask for help, never ask
  questions or challenge their nurses and doctors,
  and never, ever read medical books or use the
  internet for help. Their families are not
  present, and they do not have any friends. In
  fact, they are close to dead as possible.
• -- Source Healthcare Quality Book, 2005

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Cultural Competency Healthcare Meeting the
Challenges of Diverse Societies

• 2. Critical Issues in
• Cultural Competency

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Why is Cultural Competence Gaining Importance?

• Meeting the needs on an increasingly diverse
  society
• Reducing health disparities and improving health
  care quality
• Tailoring health care delivery to meet population
  and individual needs
• Meeting federal requirements
• Increasing treatment compliance, patient safety
  and reducing medical error
• Supporting organizational business strategies and
  objectives
• Growing accreditation interest
• -- Dennis Andrulis, Drexel University, May, 2007

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Hospitals, Language and Culture A Snapshot of
the Nation

• Exploring Cultural and Linguistic Services in the
  Nations Hospitals - A Report of Findings A
  Report of findings from the Joint Commission
• March 29, 2007
• http//www.jointcommission.org/NR/rdonlyres/E64E5E
  89-5734-4D1D-BB4D-C4ACD4BF8BD3/0/hlc_paper.pdf
• The Joint Commission, 2007

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Hospitals, Language and Culture A Snapshot of
the Nation

• Providing Culturally and Linguistically
  Appropriate Care is Challenging
• Six research areas studied
• Leadership
• Quality Improvement and Data use
• Workforce
• Patient Safety and Provision of Care
• Language Services
• Community Engagement

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Hospitals, Language and Culture A Snapshot of
the Nation

• Coordinate services relating to language and
  culture as part of part of organization to
  quality.
• Create uniform data collection mechanism related
  to providing quality care Ethnic, linguistic,
  cultural
• The Joint Commission, 2007

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Hospitals, Language and Culture A Snapshot of
the Nation

• Linguistically and culturally appropriate care
  has direct impact on quality and safety, and is a
  growing issue that is not going away.
• -- Paul M. Schyve, M.D.,
• Senior Vice President, The Joint Commission

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Hospitals, Language and Culture A Snapshot of
the Nation
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Hospitals, Language and Culture A Snapshot of
the Nation
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Hospitals, Language and Culture A Snapshot of
the Nation
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Hospitals, Language and Culture A Snapshot of
the Nation
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Hospitals, Language and Culture A Snapshot of
the Nation
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Hospitals, Language and Culture A Snapshot of
the Nation
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Linguistic Competence

• Language/Interpretation services an important
  part of total communication
• Medically Trained Interpreters
• Clinical skills vs. Interpretation skills
• Telephonic translations, interpreter services,
  literacy assistance
• Cultural Liaisons M. Schlesinger
• Importance of varied approaches to meet diverse
  needs.

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Model for Developing Cultural Competence

• Change agents public/private
• Organizational culture, structural/systemic
  realities, everyday interaction with diversity
• Education, Modeling, Secret Shopper/Systemic
  Behaviors, Push-Pull factors
• Internal/external controls and buy-in from key
  stakeholders

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Increasing Cultural Competence in Healthcare

• Dearth of research and quantitative data
  cultural diversity awareness research is in its
  infancy.
• Need for research, best practice database,
  systemic maturity, patient-centered care, patient
  safety, etc.
• Measuring Staff competence to deal with cultural
  diversity
• Example The CMS H-CAHP Survey, in USA

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Commonwealth Fund

• Evidence to support that cultural and linguistic
  competence would result in decreased system
  costs, is not currently in the literature.
• -- Source Commonwealth Fund, 2006

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Joint Commission Cultural Competence and
Communication

• Joint Commission, March, 2007

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Institute of Medicine (IOM)

• To Err is Human, IOM report 1999
• 48,000 to 98,000 preventable hospital patient
  deaths per year caused by medical errors.
• 2007 Updated data 100,000 preventable patient
  deaths from Medication Errors alone.
• Ineffective Communication Top cause of all
  errors
• -- Source Institute Of Medicine, 2007

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2007 Joint Commission New Standards Crosswalk
on Cultural Competence

• Rights Responsibilities and Ethics
• Provision of Care, Treatment and Services
• Leadership
• Management of Human Resources
• Improving Organizational Performance
• Management of Information
• -- Source Joint Commission, 2007

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Joint Commission 2007 Do Not Use List

• cc
• IU
• qd
• QOD, q.o.d., qod, and QD, q.d., qd
• U
• MSO4, MgSO4, MS
• Abbreviations for Drug Names

• gt or lt
• Apothecary Units
• _at_
• Q6PM
• X3D
• No zero before decimal dose
• Zero after decimal dose
• µg
• -- Source Joint Commission, 2007

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Que?????? Health Literacy

• "Mr. Smith is 55 years old and was admitted for
  LUQ pain, which was also associated with maybe EG
  or CP. Possibly he may have ACS or LLL consolid
  but the only thing against it is he has NVBS. We
  did a CE profile which is negative, we may have
  to do a ABDCT. Put him on ampnafgent to cover for
  any GNB
• -- Source Coney Island Hospital, 2006

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Cultural Competence Health Literacy

• Challenges that Broach Cultures
• Culture-Unique Health Literacy Challenges
  Example LGBT and Unique needs of patient
  populations
• Healthcare Comfort within our own culture of
  complexity Need to re-think our methods
• Health literacy cultural competence
• Engaging the Community a Source of Information
  and Linkage

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Health Literacy What Did The Doctor Say?

• The safety of patients cannot be assured without
  mitigating the negative effects of low health
  literacy and ineffective communication on patient
  care.
• Source What Did the Doctor Say? Improving
  Health Literacy to Protect Patient Safety
• Joint Commission 2007

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2007 U.S. National Cultural Competence Standards

• U.S. National Cultural and Linguistically
  Appropriate Services (CLAS) Standards
• 14 Key Standards in providing quality care
• Standardized manner in which to Provide
  Culturally Appropriate Healthcare Services
• -- Source U.S. Department of HHS, 2005

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Cultural Competency Healthcare Meeting the
Challenges of Diverse Societies

• 3. Meeting the Challenge

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Coney Island Hospital NYC Health Hospitals
Corporation

• 11 acute-care hospitals, 100 different languages
  spoken
• 400K uninsured accessed care, 5 million
  out-patient visits per year
• TEMIS (U.N. Style translation system), on-site
  interpreters, impact of 9/11
• -- Source NYC Health Hospitals Corporation,
  2007

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Building Culturally Competent Organizations

• View from Coney Island Hospital
• How adults learn
• Literacy challenges
• How organizations learn
• Cultural challenges
• Teaching Healthcare Workers to be Culturally
  Competent and Sensitive
• Reinforcement Building a Culture of Safety

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Cultural Diversity and Sensitivity Training
Coney Island Hospital

• Organizations Patient Safety Focus
• Leadership Support and Exigence
• All Employees Systems
• Mandated In-Service Training
• New Employee Orientation Program
• Evidence of training effectiveness Patient
  Satisfaction Rates, Error Reduction Rates
• Department and Team Training

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Good ? Great

• Good to Great by Jim Collins and the Culture
  of Excellence
• Good is the enemy of Great?
• Is Cultural Competence enemy of Cultural
  Excellence?
• Are you On or Off the bus?
• -- Source Good to Great, Jim Collins, 2005

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Good to Great Jim Collins

• Get on the Bus with Culturally Competent/Excellent
  Care for all Patients

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Cultural Competency Healthcare Meeting the
Challenges of Diverse Societies

• 3. Tools for Change

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Conceptual Framework for Cultural Excellence

• Inter-connections in Cultural Excellence

-- Source Coney Island Hospital, 2007
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Tools for Change

1. Cultural Excellence Assessment Profile Tool
2. DiSC Behavior Profile Tool
3. Secret Shopper Tool
4. Patient Community Involvement Tool

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Tool 1

• Cultural Excellence
• Assessment Profile
• Tool for assessing organizational values
• Governance
• Planning Monitoring
• Communication
• Staff Development
• Infrastructure Service
• http//www.hrsa.gov/culturalcompetence/indicators/
  default.htmcomponents
• -- Source U.S. HHS HRSA, 2007

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Tool 2

• DiSC Profile
• Tool for assessing and highlighting individual
  health worker behavior patterns
• Learning from what we do
• Strengths Weaknesses
• Strategies for Behavior Change
• -- Source DiSC Profile Program, Carlson Company,
  2004

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Tool 3

• Secret Shopper
• Proactive uncovering of risk areas
• Highlights organizational culture and challenges
• Identifies opportunities for systemic change and
  tracking
• Proactive involvement of cross-section of
  organization
• -- Source Peak Performance Consulting, 2003 and
  Coney Island Hospital, 2007

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Tool 4

• Patient Community Involvement Initiative
• Partnership Programs Example Coney Island
  Hospital Shorefront YM-YWHA, Partner Sue Fox
• Interactive Learning Sessions Learning from
  Stories
• Celebration of Diversity and Learning
• Personalization of Challenges
• -- Source Coney Island Hospital, 2007

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Trends in Cultural Excellence

• Need for more research
• Need for measurable impact of cultural competency
  interventions
• Public health response to increasingly
  diversifying patient base education advocacy
• Changing competencies for healthcare workers and
  organizations

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Cultural Competency Healthcare Meeting the
Challenges of Diverse Societies

• 4. Next Steps

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Cultural Excellence What is Needed Now

• Role of Advocacy
• Active Patient Involvement
• Developing hospital-based learning models
• Constant pursuit of Excellence in Healthcare
• Exchange of ideas for creation of Best Practice
  Databases and Resource Banks for culturally
  excellent healthcare delivery
• Action Plan for Follow Up

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Developing Cultural Excellence

• Urgent need for research is Not a call for
  Non-Action
• No single magic bullet solution
• Cultural excellence developed through myriad
  efforts of many key stakeholders
• Enough data to launch innovative projects across
  our borders
• Important ingredients partnerships, humble
  service, shared experiences, action based on
  knowledge, rewarded accomplishments, teamwork,
  managing change, patient involvement and common
  ground

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Conclusions

1. Recognize complexity and multifaceted-ness of
   challenges
2. Launch collaborations and partnerships to build
   new tools and conduct new research for cultural
   excellence
3. Support non-parentalistic systems that
   fundamentally involve patients in their own care
4. Resources and action must follow new knowledge
   for developing cultural excellence
5. Be the Change

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• THANK YOU!