10/1/2012
About Us
A Continuous Quality
Improvement Approach to
Organizational Cultural
Competence
C
t
Thomas LaVeist, PhD & Cheri Wilson, MA, MHS, CPHQ
Hopkins Center for Health Disparities Solutions
Johns Hopkins Bloomberg School of Public Health
“Exploration and Intervention for Health
Equality…”
Designated a “National Center of Excellence”
by the National Institutes of Health,
National Institute on Minority Health and Health Disparities
Presentation Outline
Percentage Resident Population by
Race/Ethnicity, U.S. 1950-2000
• Review changing U.S. demographics related to race,
ethnicity, and language
• Define cultural competence
• Describe the current federal mandates and regulatory
standards
t d d related
l t d tto cultural
lt l competency
t
• Overview of the Cultural Competency Organizational
Assessment-360 (COA360) and the Culture-QualityCollaborative (CQC)
Projected Percentage Resident Population
by Race/Ethnicity, U.S. 2010-2070
As of July 1, 2011, the U.S. Census Bureau
estimated that 50.4% of the population younger
than 1 was minority.
Changing State Demographics
• In 2008, four states—Hawaii (77.1%), California (60.3%), New Mexico (59.8%), and Texas (55.2%)‐‐plus the District of Columbia (64.7%) were already majority minority. • In the rest of the U.S., minorities constitute 36.6% of the population.
Source: 2009 American Community Survey, 2010 U.S. Census, 2011
U.S. Census Bureau
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What is Cultural Competence?
Changing U.S. Demographics
• Increased number of foreign born residents
• A developmental process that evolves over an
extended period of time.
– 12.7% of U.S. residents
• Increased numbers speak a language other than English at
home
– 20.6% of U.S. residents
g
, and systems
y
are at
• Individuals,, organizations,
various levels of awareness, knowledge and skills
along the cultural competence continuum.
• Increased numbers speak English less than "very well" and are
considered limited English proficient (LEP)
– 8.7% of U.S. residents
• Between 1990 and 2010, the U.S. LEP population increased
80%.
Source: Terry L. Cross. Towards a Culturally Competent System of Care: A Monograph on Effective
Services for Minority Children Who Are Severely Emotionally Disturbed. Washington, DC: CASSP
Technical Assistance Center, Georgetown University Child Development Center, 1989.
Source: 2010 U.S. Census and 2011 American Community Survey
Cultural Competence Continuum
(Cross, Bazron, Dennis and Isaacs, 1989)
What is Cultural Competence?
Cultural
Proficiency
Cultural
Competence
Cultural
Pre‐Competence
Cultural Blindness
It requires organizations to:
1. Have a defined set of values and principles, and
demonstrate behaviors, attitudes, policies, and
t t
th t enable
bl them
th
t workk effectively
ff ti l
structures
that
to
cross-culturally;
Cultural
Incapacity
Cultural Destructiveness
Source: Terry L. Cross. Towards a Culturally Competent System of Care: A Monograph on Effective
Services for Minority Children Who Are Severely Emotionally Disturbed. Washington, DC: CASSP
Technical Assistance Center, Georgetown University Child Development Center, 1989.
Slide Source: National Center for Cultural Competence, 2008
What is Cultural Competence?
2. Have the capacity to:
(a) value diversity,
What is Cultural Competence?
3. Incorporate the above into all aspects of:
(a) policymaking,
(b) conduct self-assessment,
(b) administration,
(c) manage the dynamics of difference,
difference
(c) practice and service delivery
delivery,
(d) acquire and institutionalize cultural knowledge, and
(d) and systematically involve consumers, key
stakeholders and communities.
(e) adapt to the diversity and cultural contexts of
communities they serve;
Source: Terry L. Cross. Towards a Culturally Competent System of Care: A Monograph on Effective
Services for Minority Children Who Are Severely Emotionally Disturbed. Washington, DC: CASSP
Technical Assistance Center, Georgetown University Child Development Center, 1989.
Source: Terry L. Cross. Towards a Culturally Competent System of Care: A Monograph on Effective
Services for Minority Children Who Are Severely Emotionally Disturbed. Washington, DC: CASSP
Technical Assistance Center, Georgetown University Child Development Center, 1989.
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Federal Mandates and Regulatory
Standards
Federal Mandates and Regulatory
Standards
• Title VI of the Civil Rights Act of 1964
• Executive Order 13166 (August 11, 2000)
• CLAS Standards ((2001)) enhanced ((2012))
• NQF: A Comprehensive Framework and Preferred
Practices for Measuring and Reporting Cultural
Competency
Federal Mandates and Regulatory
Standards
• The Joint Commission “Effective Communication,
Cultural Competence, and Patient-Centered Care”
Standards (effective 1/1/2011)
• NCQA Multicultural Health Care Standards:
Distinction Program (effective 7/1/2010)
• Meaningful Use of Electronic Health Records
(EHRs)
Clearview Organizational Assessments-360
(COA360) Overview
Economic Burden of Health Inequalities
• Direct Medical Care
Costs $229.4 billion for
the years 2003-2006.
• Indirect Costs of
disability and illness
$50.3 billion
• Cost of Premature
Deaths were $957.5
billion
• Total $1.24 trillion (in
2008 inflation-adjusted
dollars).
COA360 Validation Article
COA360
TM
Journal of Healthcare Management 53:4 (July/August 2008):
257-267.
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Winner, 2008 Innovation Award
National Center on Minority Health and
Health Disparities (NCMHD)
The Clearview360 Suite of Tools
• COA360u – For departments or units of a
healthcare organization (Launched 2010)
• COA360h – For hospitals or healthcare
organizations
i ti
(T
(To be
b llaunched
h dN
November
b 2012)
• PCMH360 – For medical practices (To be
launched April 2013)
COA360 Overview
COA360 Overview
• Web-based tool
• Assessment of healthcare organizations, not
individuals
and areas for improvement
• Identifies strengths
g
p
• Measures:
– CLAS Standards
• Suitable for any size healthcare organization
• Assesses unique configuration of diversity in the
service area (race, ethnicity, language,
religion/spirituality, and sexual identity)
– Joint Commission Standards
– HCAHPS patient experience
360° View of the Organization
The COA360/CQC Continuous Quality
Improvement (CQI) Cycle
Assess
Clinical Staff
Non Clinical Staff
Re-assess
COA360
Identify
Deficiencies
Organization
Patients/
Clients
Administrators
Tailored
Interventions
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Survey Invitation Email
Brief COA360 Demo
• Point of Contact Survey
• Administrator/Clinical Staff/Non-Clinical Staff
Survey
• Patient/Client Survey
Survey Login Page
Point of Contact Survey
Participant Home Page
Point of Contact Survey
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Administrator/Clinical Staff/
Non-Clinical Staff Survey
Administrator/Clinical Staff/
Non-Clinical Staff Survey
Administrator/Clinical Staff/
Non-Clinical Staff Survey
Administrator/Clinical Staff/
Non-Clinical Staff Survey
Patient/Client Survey
Patient/Client Survey
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Patient/Client Survey
COA360 Report
COA360 Report
Patient/Client Survey
COA360 Report
COA360 Report
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COA360 Report
COA360 Report
COA360 Report
COA360 Report
COA360 Report
COA360 SATISFACTION
RESULTS
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Quantitative Results:
Satisfaction with Overall COA360
Experience
Quantitative Results:
Satisfaction with COA360 Functionality
19, 4%
24, 5%
92, 19%
110, 22%
374, 77%
358, 73%
Strongly Agree/Agree
Strongly Agree/Agree
Neutral
Neutral
Strongly Disagree/Disagree
Strongly Disagree/Disagree
N = 485
N = 492
Quantitative Results:
Satisfaction with COA360 Usability
Qualitative Results
“The COA360 has given us detailed insight related
to our cultural and linguistic competency in a
variety of domains, and it has allowed us to
determine targeted steps we can take in order to
provide more culturally competent services to our
clients.”
12, 3%
90, 18%
386, 79%
Strongly Agree/Agree
Neutral
Strongly Disagree/Disagree
N = 488
Qualitative Results
“Used… to determine whether a unit-based
education approach along with organizational
supports leads to improved patient satisfaction,
employee engagement, clinical quality, and
organizational cultural competence in the Labor &
Delivery unit of our hospital.”
“If successful, this intervention could be tailored to
other units in the hospital to improve care for all
patients.”
Qualitative Results
“…innovative, user friendly, and easy to
understand for our patients, staff and leaders.”
“The reports, provided by expert staff, have given
us meaningful
thorough
data
i f l results,
lt th
hd
t analysis,
l i and
d
helpful recommendations.”
“This information is critically important to our
hospital, given that it serves patients from a wide
variety of races, ethnicities and cultural
backgrounds.”
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Culture-Quality-Collaborative (CQC)
• A learning exchange of healthcare organizations
• Co-learning
• Participating in the COA360/CQC CQI Cycle
– Assess
– Identify deficiencies
– Tailored interventions
– Re-assess
– Share findings
The COA360/CQC Continuous Quality
Improvement (CQI) Cycle
Programming through June 2012
Date
Event Type
Assess
Re-assess
COA360
Identify
Deficiencies
Tailored
Interventions
Programming through June 2012
Date
Event Type
Category
November 2011
Webinar
Language Services
December 2011
Webinar
January 2012
Webinar
Business Case
Webinar
April 2011
Webinar
June 2011
Webinar
July 2011
Webinar
August 2011
Webinar
September
2011
Webinar
October 2011
Webinar
Topic
Health Disparities
Health Disparities
New Directions in the
21st Century
Regulatory
Environment and
Legislation
Appraising the evolving evidence on cultural
competency and health disparities
Culturally competent approaches to
combating health disparities
National best practices and innovations:
AHRQ Innovations Exchange
Joint Commission Standards
CQC Founding Members
Topic
Provision of language services and
overcoming language barriers
Putting the Lessons Learned from the CQC
in Practice
Harnessing the community to improve
organizational cultural competency
New Directions in the
21st Century
Regulatory Environment
The economic burden of health inequalities
and Legislation
Cultural competency lessons from other
New Directions in the
industries and implications for the health
21st Century
care system
February 2012
Webinar
March 2012
Webinar
May 2012
Webinar
Language Services
Assessing language competency of
bilingual staff
Webinar
Data Collection and
Quality Improvement
Review of CQC Members’ COA360
Results
June 2012
March 2011
Category
Collecting and Using race, ethnicity, and
Data Collection and language data (ex. stratify patient satisfaction,
quality, and safety data, creating equity
Quality Improvement
dashboards, etc.)
Cultural competency training for clinical staff
Cultural Competency
(e.g. physicians, nurses, and other direct
Training
patient care p
p
providers))
Regulatory
State laws/regulations and cultural
Environment and
competency
Legislation
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CQC Founding Members
Q&A
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