A Continuous Quality Impppprovement Approach to Organizational Cultural … · Impppprovement Approach to Organizational Cultural Competence Thomas LaVeist, PhD & Cheri Wilson, MA,

A Continuous Quality Improvement Approach to p pp

Organizational Cultural Competence

Thomas LaVeist, PhD & Cheri Wilson, MA, MHS, CPHQHopkins Center for Health Disparities Solutionsp p

Johns Hopkins Bloomberg School of Public Health

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Presentation Outline

• Review changing U.S. demographics related to race, ethnicity, and language

• Define cultural competence

• Describe the current federal mandates and regulatory standards related to cultural competency

• Overview of the Cultural Competency Organizational Assessment-360 (COA360)

• Discussion of the Culture Quality Collaborative (CQC)• Discussion of the Culture-Quality-Collaborative (CQC)

• Share COA360 and CQC Satisfaction Results

About Us

“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 DisparitiesNational Institute on Minority Health and Health Disparities

ICHAD ORGICHAD.ORG

Recent Webinar

• “Quality Healthcare for Lesbian Gay Bisexual &Quality Healthcare for Lesbian, Gay, Bisexual & Transgender People: A Four-Part Cultural Competence Webinar Series”

– Part 1: Understanding the Health Needs of LGBT People: An Introduction

Tuesday June 19 2012 3:30 p m 5:00 p m EST– Tuesday, June 19, 2012, 3:30 p.m-5:00 p.m. EST

In collaboration withIn collaboration with

Percentage Resident Population by Race/Ethnicity, U.S. 1950-2000

100%

70%

80%

90%

100%

Hi i

50%

60%

70% Hispanic

Asian/PI

American Ind

20%

30%

40% Black

White

0%

10%

1950 1960 1970 1980 1990 2000

Projected Percentage Resident Population by Race/Ethnicity, U.S. 2010-2070

100%

75%Hispanic

50%

Hispanic

Asian/PI

American Ind

25%

Black

White

0%2010 2020 2030 2040 2050 2060 2070

Changing State Demographics

• In 2008, four states—Hawaii (75%), New Mexico (58%), California (58%), and Texas (53%)‐‐plus the District of Columbia (67%) were already minority‐majority. the District of Columbia (67%) were already minority majority. • In the rest of the U.S., minorities constitute 36.3% of the population.

Source: 2009 American Community Survey and 2010 U.S. Census

Changing U.S. Demographics

• Increased number of foreign born residents– Almost 35 million U.S. residents (11.1%)

• Increased numbers speak a language other than English at home

– Almost 55 million U.S. residents (19.7%)Almost 55 million U.S. residents (19.7%)

• Increased numbers speak English less than "very well" and are considered limited English proficient (LEP)

More than 24 million U S residents (8 7%)– More than 24 million U.S. residents (8.7%)

Source: 2000 U.S. Census and 2009 American Community Survey

Changing U.S. Demographics

• Between 1990 and 2000 15 states experienced• Between 1990 and 2000, 15 states experienced more than 100% growth in their LEP populations.• Arkansas, Colorado, Georgia, Idaho, Kansas,Arkansas, Colorado, Georgia, Idaho, Kansas,

Kentucky, Minnesota, Nebraska, Nevada, North Carolina, Oregon, South Carolina, Tennessee, Utah and WashingtonUtah, and Washington

• In 9 states, more than 10% of the overall l ti i l d LEPpopulation is already LEP.

– California, Texas, New York, Nevada, Arizona, New Jersey Florida New Mexico and HawaiiNew Jersey, Florida, New Mexico, and Hawaii

What is Cultural Competence?

• A developmental process that evolves over an extended period of time.

• Individuals, organizations, and systems are at various levels of awareness, knowledge and skills along the cultural competence continuum.

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: CASSPServices for Minority Children Who Are Severely Emotionally Disturbed. Washington, DC: CASSP Technical Assistance Center, Georgetown University Child Development Center, 1989.


It requires organizations to:It requires organizations to:

1. Have a defined set of values and principles, and p p ,demonstrate behaviors, attitudes, policies, and structures that enable them to work effectively cross-culturally;cross-culturally;



2 Have the capacity to:2. Have the capacity to:(a) value diversity,

(b) conduct self-assessment(b) conduct self-assessment, (c) manage the dynamics of difference,

(d) acquire and institutionalize cultural knowledge and(d) acquire and institutionalize cultural knowledge, and

(e) adapt to the diversity and cultural contexts of communities they serve;communities they serve;



3 Incorporate the above into all aspects of:3. Incorporate the above into all aspects of:(a) policymaking,

(b) administration(b) administration,

(c) practice and service delivery,

(d) and systematically involve consumers key(d) and systematically involve consumers, key stakeholders and communities.


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 CompetencyCompetency

Federal Mandates and Regulatory Standards

• The Joint Commission “Effective CommunicationThe 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)Distinction Program (effective 7/1/2010)

• Meaningful Use of Electronic Health Records (EHR )(EHRs)

Economic Burden of Health Inequalities

• Direct Medical CareDirect Medical Care Costs $229.4 billion for the years 2003-2006.

• Indirect Costs of disability and illness $50.3 billion$50.3 billion

• Cost of Premature Deaths were $957.5 billibillion

• Total $1.24 trillion (in 2008 inflation-adjusted2008 inflation adjusted dollars).

COA360 Overview

COA360COA360TM

COA360 Validation Article

Journal of Healthcare Management 53:4 (July/August 2008): 257-267.

Winner, 2008 Innovation AwardNational Center on Minority Health and

Health Disparities (NCMHD)

COA360 OverviewCOA360 Overview

• Web-based tool

• Assessment of healthcare organizations, not individuals

• Identifies strengths and areas for improvement

• Suitable for any size healthcare organization

• Assesses unique configuration of diversity in the service area (race, ethnicity, language, and religion)

– Plan to incorporate sexual orientation

COA360 Overview

M• Measures:– CLAS Standards

Joint Commission Standards– Joint Commission Standards

– CAHPS patient experience, including health literacy and cultural competency item setsliteracy and cultural competency item sets

360° View of the Organization

Clinical Staff Non Clinical Staff

Organization

Patients/Administrators

Patients/Clients

The COA360/CQC Continuous Quality Improvement (CQI) Cycle

Assess

COA360 IdentifyCOA360 Identify DeficienciesRe-assess

Tailored Inter entionsInterventions

Brief COA360 Demo

• Point of Contact SurveyPoint of Contact Survey• Administrator/Clinical Staff/Non-Clinical Staff

Survey• Patient/Client Survey

Survey Invitation Email

Survey Login PageSurvey Login Page

Participant Home Page

Point of Contact Surveyy

Point of Contact Survey



Administrator/Clinical Staff/Non-Clinical Staff Survey









Patient/Client Survey






COA360 Report

COA360 Report

COA360 Report

COA360 Report

COA360 Report

COA360 Report

COA360 Report

COA360 Report

COA360 Report

COA360 Report

COA360 ReportCOA360 Report

COA360 Certified Consultants

• Andrea Thompson and Michael ThompsonAndrea Thompson and Michael Thompson– Marblestone Consulting Group

• Nadia Sawayay• Amy Wilson-Stronks

– Wilson-Stronks, LLC

• Yolanda Robles– Culturalink

• LaVonna Blair Lewis– University of Southern California

Culture-Quality-Collaborative (CQC)Culture-Quality-Collaborative (CQC)

• A learning exchange of healthcare organizations

• Co-learning

• Participating in the COA360/CQC CQI Cycle• Participating in the COA360/CQC CQI Cycle

– Assess

– Identify deficiencies

– Tailored interventions

– Re-assess

– Share findings

The COA360/CQC Continuous Quality Improvement (CQI) Cycle

Assess

COA360 IdentifyCOA360 Identify DeficienciesRe-assess

Tailored Inter entionsInterventions

Programming through June 2012

Date Event Type Category Topic

March 2011 Webinar Data Collection and Quality Improvement

Collecting and Using race, ethnicity, and language data (ex. stratify patient satisfaction,

quality, and safety data, creating equity dashboards, etc.)

Cultural competency training for clinical staffApril 2011 Webinar Cultural Competency

Training

Cultural competency training for clinical staff (e.g. physicians, nurses, and other direct

patient care providers)

June 2011 WebinarRegulatory

Environment and State laws/regulations and cultural competencyLegislation competency

July 2011 Webinar Health Disparities Appraising the evolving evidence on cultural competency and health disparities

A t 2011 W bi H lth Di iti Culturally competent approaches to August 2011 Webinar Health Disparities y p ppcombating health disparities

September 2011 Webinar New Directions in the

21st CenturyNational best practices and innovations:

AHRQ Innovations Exchange

O t b 2011 W biRegulatory

E i t d J i t C i i St d dOctober 2011 Webinar Environment and Legislation

Joint Commission Standards

Programming through June 2012

Date Event Type Category Topicyp g y p

November 2011 Webinar Language Services Provision of language services and overcoming language barriers

December 2011 Webinar Business Case Putting the Lessons Learned from the CQC in Practice

January 2012 Webinar New Directions in the 21st Century

Harnessing the community to improve organizational cultural competency

February 2012 Webinar Regulatory Environment and Legislation The economic burden of health inequalities

Cultural competency lessons from otherMarch 2012 Webinar New Directions in the

21st Century

Cultural competency lessons from other industries and implications for the health

care system

May 2012 Webinar Language Services Assessing language competency of May 2012 Webinar Language Services bilingual staff

June 2012 Webinar Data Collection and Quality Improvement

Review of CQC Members’ COA360 Results

CQC Founding Members

CQC Founding Members

COA360 AND CQC SATISFACTION RESULTSSATISFACTION RESULTS

COA360 SATISFACTION RESULTSRESULTS

Quantitative Results: Satisfaction with Overall COA360 Experience

5Strongly Disagree/Disagree

22Neutral

73Strongly Agree/Agree 73

0 10 20 30 40 50 60 70 80 90 100

Strongly Agree/Agree

N = 391

Quantitative Results: Satisfaction with COA360 Functionality


18Neutral

77Strongly Agree/Agree 77

0 10 20 30 40 50 60 70 80 90


N = 384

Quantitative Results: Satisfaction with COA360 Usability


18Neutral

79

0 10 20 30 40 50 60 70 80 90


N = 388

Qualitative Results

“The COA360 has given us detailed insight relatedThe COA360 has given us detailed insight related to our cultural and linguistic competency in a variety of domains, and it has allowed us to d t i t t d t t k i d tdetermine targeted steps we can take in order to provide more culturally competent services to our clients.”

Qualitative Results

“Used to determine whether a unit-basedUsed… to determine whether a unit based education approach along with organizational supports leads to improved patient satisfaction,

l t li i l lit demployee engagement, clinical quality, and organizational cultural competence in the Labor & Delivery unit of our hospital.”

“If successful, this intervention could be tailored to th it i th h it l t i f llother units in the hospital to improve care for all

patients.”

Qualitative Results

“ innovative user friendly and easy to…innovative, user friendly, and easy to understand for our patients, staff and leaders.”

“The reports, provided by expert staff, have given us meaningful results, thorough data analysis, and helpful recommendations ”helpful recommendations.

“This information is critically important to our y phospital, given that it serves patients from a wide variety of races, ethnicities and cultural backgrounds ”backgrounds.

CQC SATISFACTION RESULTSRESULTS

Quantitative Results: Overall CQC Satisfaction

0Very Dissatisfied/Somewhat Dissatisfied

11Neutral

89Very Satisfied/Somewhat Satisfied

0 10 20 30 40 50 60 70 80 90 100

N = 19N 19

Quantitative Results: Recommend CQC to a Colleague

5No

95Yes

N = 19

0 10 20 30 40 50 60 70 80 90 100

N = 19

Qualitative Results: Most useful CQC aspects

• Webinars and the opportunity to network withWebinars and the opportunity to network with other health systems.

• Learning from other providers.• Access to the COA360; knowing more about what

other organizations are doing.Webinar subjects• Webinar subjects

• Developing a knowledge base in areas where I do not normally focus my attention. y y

Qualitative Results: Most useful CQC aspects

• Balance between the academic and practitionerBalance between the academic and practitioner examples

• Diversity of topics and frequency • Resources from speakers and other members• Access to seminar information• Identification of barriers

Q & A

Documents

A Continuous Quality Impppprovement Approach to Organizational Cultural … · Impppprovement Approach to Organizational Cultural Competence Thomas LaVeist, PhD & Cheri Wilson, MA,