360oCare: Reducing Health Disparities through Organizational Cultural Competence

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360oCare Reducing Health Disparities through
Organizational Cultural Competence

• 2012 USPHS Scientific and Training Symposium
• Wednesday, June 20th, 2012
• Center on Health Disparities
• Emeobong E. Martin, MPH Marcos Pesquera,
  RPh, MPH

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Cultural Competency in Health Care

• WHO Physicians and other Health Professionals,
  Administrators, Students, Support Staff,
  Organization
• WHAT Knowledge, Skills, Abilities, Attitudes and
  Behaviors
• MEASURES
• Patient Outcomes (health status, health care
  utilization, satisfaction)
• Provider Outcomes (cultural knowledge and
  sensitivity, patient-centeredness, effective
  communication, satisfaction)

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Culturally Competent Care and Improved Health
Outcomes

• Research shows
• Cultural competency training can be effective and
  beneficial (Lie et al. 2010)
• A few result in positive patient outcomes (e.g.,
  Majumdar 2004, McElmurry 2009)
• Some have moderate to no effect on outcomes
• None have had a negative effect on outcomes

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What isCultural Competence?

• Practitioners Guide
• The delivery of health care services that
  acknowledges and understands cultural diversity
  in the clinical setting, respects patients
  health beliefs and practices and values
  cross-cultural communication. (Kaiser
  Permanente)
• Organizational Application
• A set of congruent behaviors, attitudes and
  policies that come together in a system, agency
  or among professionals that enables effective
  work in cross-cultural situations. (Health
  Resources and Services Administration)

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Why is cultural competence important?

• Patient Protection Affordable Care Act
• Joint Commission Standards, CLAS Standards
• Title VI
• Changing Demographics of our Communities
• Health Disparities are well-documented in the
  literature
• Improve Patient Experience

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How do you achieve cultural competence?Organizati
onal Assessment Overview
Organizational Values
Governance
Planning, Monitoring Evaluation
Communication
Staff Development
Organizational Infrastructure
Services Interventions
Culturally Competent Patient-Centered Care
Seven Domains Courtesy of Health Resources and
Services Administration
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Organizational Values

• Perspective ?
  Attitude ?
  Commitment

• An organization's perspective and attitudes with
  respect to the worth and importance of cultural
  competence and its commitment to provide
  culturally competent care.

Culturally Competent Patient-Centered Care
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Organizational Values
Governance

• Goals ?
  Policy ? Oversight

• The goal-setting, policy-making, and other
  oversight vehicles an organization uses to help
  ensure the delivery of culturally competent care.

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Organizational Values
Governance
Planning, Monitoring Evaluation

• Mechanisms ? Processes ? Systems
  ? Activities

• The mechanisms and processes used for
• a) long- and short-term policy, programmatic, and
  operational cultural competence planning that is
  informed by external and internal consumers and
• b) the systems and activities needed to
  proactively track and assess an organization's
  level of cultural competence.

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Organizational Values
Governance
Planning, Monitoring Evaluation
Communication

• Exchange of information internally and externally

• The exchange of information between the
  organization/providers and the clients/population,
  and internally among staff, in ways that promote
  cultural competence.

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Organizational Values
Governance
Planning, Monitoring Evaluation
Communication
Staff Development

• Attitude ? Knowledge ?
  Skills

• An organization's efforts to ensure staff and
  other service providers have the necessary
  attitudes, knowledge and skills for delivering
  culturally competent services.

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Organizational Values
Governance
Planning, Monitoring Evaluation
Communication
Staff Development
Organizational Infrastructure

• Resource availability

• The organizational resources required to deliver
  or facilitate the delivery of culturally
  competent services.

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Organizational Values
Governance
Planning, Monitoring Evaluation
Communication
Staff Development
Organizational Infrastructure
Services Interventions

• Delivery ? Facilitation

• An organization's delivery or facilitation of
  clinical, public-health, and health related
  services in a culturally competent manner.

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Culturally Competent Patient-Centered Care
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• Organizational Assessment Applied

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• Provider since 1981
• Diverse community
• Children, adolescents, adults, geriatrics
• U.S. born, immigrant populations
• Private and public insurance
• Services
• Acute
• In-patient
• Partial hospitalization
• More than 780 employees
• Five Maryland locations

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Location, Location, Location

• Adventist Behavioral Health (ABH) Locations
• ABH-Rockville
• The Reginald S. Lourie Center (Rockville)
• ABH at Washington Adventist Hospital (Takoma
  Park)
• ABH Anne Arundel (Crownsville)
• ABH Eastern Shore (Cambridge)

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ABH Organizational Cultural Competence Assessment
Overview
38 LeadershipInterviews
14Staff Focus Groups(10 people/group)
8 CommunityInterviews
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Phase I
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Sample Questions

• How do you see cultural competence applied in
  treating (X) population within your institution?
• How do you or your organization currently support
  the provision of culturally competent care?
• What do you think is necessary to
• Provide patient-centered care?
• Improve the overall patient experience at ABH?

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Assessment Data

• gt60 hours of audio recordings
• 5 hours of transcription/qualitative session
• gt600 pages of transcribed text

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Assessment Results

• Strengths
• Opportunities for Improvement
• Recommendations
• Notable Quotes

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HRSA Domain
Sub-section of HRSA Domain Sub-section of HRSA Domain Sub-section of HRSA Domain Sub-section of HRSA Domain
Leadership Perceptions Staff Perceptions Community Perceptions
Strengths
Opportunities for Improvement
Recommendations Recommendations Recommendations Recommendations
Reporting Format
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Phase II
January 2013 Beyond Implementation Support
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Thank You!
1801 Research Boulevard, Suite 300 Rockville,
Maryland 20850 www.adventisthealthcare.com/dispari
ties