Transcript Cultural Competence in Health Administration

Cultural Competence in
Health Administration
Philippa Strelitz, PhD, MPAff
Department of Health Administration
Alumni Conference
November 17, 2006
Texas State University, San Marcos
7/17/2015
1
Overview




Cultural competence drivers.
What is cultural competence? What is it NOT?
Some Best Practices for achieving cultural
competence: data collection and assessment.
Cultural competence in the Health
Administration curriculum.
7/17/2015
2
Cultural competence
drivers
7/17/2015
3
What is driving the current focus on
cultural competence?

Demographic changes

Quality
 Patient
safety
 Health disparities
7/17/2015
4
America’s Changing
Demographics
7/17/2015
5
Institute of Medicine (2001):
Improve Quality
Health care Quality
Dimensions:
•Safe
•Timely
•Patient-Centered
•Effective
•Efficient
•Equitable
7/17/2015
6
Two overarching domains of
Quality
 Clinical/Technical
aspects of
patient care
 Experiential
7/17/2015
aspects of patient care
7
Why is it important to link culture and
quality?
 Cultural competence is integrally related to the
two core elements: clinical/technical aspect of
patient care and experiential dimension of
patient care.
 Knowledge of clinical and experiential factors
that affect racially and ethnically diverse patients
can significantly affect quality.
7/17/2015
8
Archives of Internal Medicine, 2006; 166:675-681
7/17/2015
9
7/17/2015
The American Journal of Medicine, 2005; 118:529-535
10
Consequences of not acknowledging the
intersection of culture and quality
7/17/2015

Inability of the patient to understand English
can lead to medical error in medications or in
other treatment guidance.

Lack of organizational support—signage,
adequate interpreter services, effective
community links—can compromise timeliness
of care delivery and access to care.
11
Linking Cultural Competence to Quality

Key IOM recommendations:
 Support
race/ethnicity data collection, quality
improvement, use of evidence-based guidelines.
 Facilitate interpretation services.
 Provider education (mechanisms of decision
making, cultural competence).
 Patient education (health care system navigation,
activation in the medical encounter).
7/17/2015
12
Preliminary work show cultural
competence improves quality of care
Prevent medication
under use among
children with persistent
asthma
80
70
60
50
40
30
20
10
0
7/17/2015
Exc.
Good
Fair
Poor
Cultural competence
score
Source: Lieu TA et al., Competence Policies and other Predictors of Asthma Care Quality
for Medicaid-Insured Children. Pediatrics 114, no. 1 (2003) 102-110.
13
Institute of Medicine (1999):
Ensure Patient Safety
“First, do no harm…”
Mis-use
Over-use
Under-use
of medications and medical
procedures:
44,000-98,000 deaths each year
7/17/2015
14
Institute of Medicine (2002):
Reduce Health Disparities

Disparities and
Quality:

7/17/2015
There is a critical
gap in the quality
of treatment of
patients from
racial and ethnic
minority groups.
15
Health and Healthcare Disparities: A
National Problem

African Americans are:
Less likely to have a kidney transplant, surgery
for lung cancer, bypass surgery.
 More likely to have a foot amputation.
 More likely to die prematurely.


Latinos/Hispanics are:


7/17/2015
Less likely to receive pain medications.
Chinese? Pakistanis? Croatians? Iranians?
16
Linking cultural competence to disparities reduction:
three domains
1.
2.
3.
Patient activation
Language/communication assistance
Organizational supports (practices, policies,
structures) for cultural competence/disparities
reduction
↓
Dimensions of Quality
Patient-centered care, safety, efficiency,
effectiveness
7/17/2015
17
Take Home Message
The “natural fit” of language and
culture within the quality
framework offers opportunity for
practitioners and administrators to
significantly improve quality for
racially/ethnically diverse patients.
7/17/2015
18
What is cultural
competence? What is it
NOT?
7/17/2015
19
Defining Cultural Competence
A set of congruent behaviors, attitudes, and
policies that come together in a system,
agency, or among professionals, and enable
that system, agency, or those professionals
to work effectively in cross-cultural
situations.
7/17/2015
20
Dimensions of Cultural
Competence
practices
behaviors
Cultural
competence
attitudes
7/17/2015
policies
structures
21
History of cultural competence

Early conceptions of cultural competence

Evolution of cultural competence

Expansion to consider racial/ethnic
disparities
7/17/2015
22
Expansion of cultural competence
Early
Models
crosscultural
Recent Model
cultural
competence
Newer
Model
CLAS/
quality
Populations immigrants,
+ All people of
+ everyone
color (those affected
by disparities)
Concepts
+ prejudice,
stereotyping, social
determinants of
health
+ safety,
disparities
+ health care
organizations
+ systems,
communities
Scope
7/17/2015
refugees,
LEP,
non-Western
culture,
language
interpersonal
interactions
23
Cultural competence and patientcentered care



Emphasize different aspects of quality –
significant common ground
Patient-centered care: provide individualized
care and restore emphasis on personal
relationships
Cultural competence: increase health equity
and reduce disparities
7/17/2015
24
Cultural competence is NOT:

A “cultural cook book” approach to health care.
Culture is not simply a matter of race, ethnicity, or
social status.
 There is no “African American patient,” “Latino
patient,” “Asian patient.”

7/17/2015
25
OMH Culturally and Linguistically
Appropriate Services (CLAS)
Culturally Competent Care
Promote and support staff skills
Management strategy
Community and consumer
involvement
Language Access Services
Strategies to diversify staff
Ongoing education for staff
Provide interpretation services
Provide notices of free
interpreter services
7/17/2015
Organizational Supports for
Cultural Competence
 Translate materials for
predominant language groups
 Train interpreters
 primary language and
race/ethnicity in patient records
 Collect accurate data
 Organizational self-assessments
 Ability to address cross-cultural
ethical and legal conflicts
 Annual progress report on
adopting CLAS standards
26
Cultural Competence What Are You Doing
About It?”

Public Service Announcement.

http://www.hret.org/hret/programs/cclpsa.html
 Raises
critical questions for health care
organizations to consider in addressing the
challenges of serving patients from diverse
communities.
 Provides a provocative visual presentation of
the experience.
7/17/2015
27
Best Practices
for achieving
cultural competence
7/17/2015
28
Cultural competence and diversity
management
Representation
Attempt to
racially/culturally
reflect the
communities we
serve
Metrics: Numbers;
Retention
7/17/2015
Inclusiveness
How we create an
environment that is
welcoming to patients
and staff
Metric: Employee, Provider
Satisfaction
Cultural
Competence
Care delivery that is
sensitive to and
respectful of the
patient’s background
and health beliefs
Metrics: Patient
Satisfaction, Safety,
Disparities
29
Why support cultural
competence/diversity initiatives?
Mission, Values.
 It’s a community responsibility.
 It’s a moral issue.
 It’s a legal issue.

7/17/2015
30
There is a strong business case:
Source of patients/market share
 To address workforce shortages
 Strategic advantage
 Enriches our organizations
 Improve capabilities—more input/perspectives
into what works
 Technical competency/quality
 Community expectations/relations
 Avoid regulatory/legal problems

7/17/2015
31
The Cultural Competence Agenda





Increase awareness
Collect/monitor data on health disparities
Change systems
Improve communication/trust
Engage communities
7/17/2015
32
Diversity/Cultural Competence
Best Practices
1. C-Suite leadership commitment

Dedicated Diversity Officer

Dedicated resources for Diversity Initiatives

Clear metrics, vision and mission
2. Continuous benchmarking and improvement
3. Outstanding communication strategy
7/17/2015
33
Race, ethnicity, language
data collection
IOM Report, Unequal Treatment: Confronting Racial and
Ethnic Disparities in Healthcare:

Disparities are more likely to result from unconscious
stereotyping than from overt racism.

2003 Report on The Right to Equal Treatment:
“Data collection is more critical in health care
because discrimination is rarely apparent.”
7/17/2015
34
Why Should We Collect Patient Race/Ethnicity,
and Primary Language Data?
Monitor quality of care.
1.
Design innovative programs to eliminate
disparities and rigorously test them.
2.
Know our patients so we can better meet their
needs and show communities that we deliver the
best care possible to them.
3.
Satisfy legal, regulatory and accreditation
requirements (i.e.: JCAHO, CMS, etc.).
4.
Take a national leadership position and show
other health care organizations what is possible.
7/17/2015
35
Cultural competence in
the Health
Administration
curriculum
7/17/2015
36
Cultural Competence in the Health
Administration Curriculum



Assess cultural competence education in health
administration curriculum.
Determine training characteristics that predict
preparedness to manage care for diverse
patients.
Provide evidence directly linking cultural
competence training in health administration to
improvements in health care quality.
7/17/2015
37
Overview of proposed research
activities


Survey cultural competence training in leading
programs in health administration through
review of syllabi for cultural competence
content.
Interview core faculty of leading programs in
health administration regarding the nature and
extent of cultural competence training in their
course, and their constructions of centrality of
cultural competence.
7/17/2015
38
Overview of proposed research
activities



Interview/assess graduate students in their first
year of training pre-exposure to cultural
competence and in their final year of training
post-exposure to cultural competence.
Interview alumni currently in the field re:
relationship of cultural competence training to
performance.
Interview internship and residency preceptors
before and after cultural competence training.
7/17/2015
39
Assessment of managers’ cultural competence
includes effectiveness and facility in the
following areas
Managing cross-cultural
conflict (Among staff,
between patients and
providers)
 Responding to regulatory
environment
 Community outreach
 Managing data collection
 Dealing with language
barriers

Dealing with new
immigrants
 Dealing with patients
whose religion affects
treatment, whose health
beliefs at odds with
Western medicine, who
distrust US health care,
who use complementary
and/or alternative
medicine


7/17/2015
40
In Conclusion…



There is a link between quality, disparities and
cultural competence.
There are practical, evidence-based strategies to
advance this agenda.
Health administrators play a critical role in
advancing this agenda.
7/17/2015
41