Cultural competency's

Role in Health Equity

Leslie R. Walker, MD

Professor, Department of Pediatrics

Chief, Division of Adolescent Medicine

Director UW LEAH training program

University of Washington/Seattle Children’s Hospital

Objectives

Define cultural competency at a system,

organization or program level.

Summarize the value of qualitative and

quantitative data on state policy change

efforts.

Describe the value and limitations of

person-to-person relationships as

facilitators to effective collaboration.

Culturally Effective Care and the

U.S. Healthcare System

Separate and unequal administration of health care

Negative acknowledgement of different races, classes

Bias of researchers and clinicians

Little representation of diverse cultures and

groups in Leadership, Research, Education

and Clinical care

U.S. Census Estimates 0-17 yr

0

10

20

30

40

50

60

70

2000 2005 2010 2015 2020 2025 2030 2035 2040 2045 2050

White

African Am

Asian

Other races

Hispanic

2011 more than 50% of children less than

1 year of age were minority.

Percent

Search for Health Equity

Recognized need for health equity

Medical errors not explained fully by socioeconomics

Focus on increasing diversity in workforce

Need for diversity in research

Cultural Competence

Workforce Diversity trend

findings: GAPS Quality measurements are not always included

measuring cultural competence including its

relation to:

patient care outcomes

patient satisfaction

faculty engagement , recruitment and retention

Workplace climate

Cost savings

Health Equity

The absence of :

systematic disparities in health

and

disparities in the major social determinants of health

between

social groups who have different levels of underlying social advantage and disadvantage including racism

Jones CP. Confronting Institutionalized Racism. Phylon 2003;50(1-2):7-22

Braveman PB. Health disparities and health equity: the issue is justice. 2011

Basic Assumption

Culture is an important variable

in determining how people see

and interpret (know) the world

around them and the basis of

how they make decisions.

Implicit Association Test:

Project Implicit

https//implicit.harvard.edu/implicit/

Understanding the divergence between what we would like to think we believe and what we really think

Conscious vs. unconscious

Blindspot 2013 by Mahzarin Banaji & Tony Greenwald

There is no way to speak of a

patient’s culture from a culture-

free point of view.

—N. Aultman, 1995

Steps to becoming a Culturally

Effective Medical Institution

Collect demographic, language, (REAL) data ( faculty, staff, patients)

Identify and report disparities

Provide culturally and linguistically competent care

Steps to becoming a Culturally

Effective Medical Institution

Develop culturally competent disease management programs.

Increase diversity and minority workforce pipelines

Involve the community

Make cultural competency an institutional priority

Health Research & Educational Trust, Institute for Diversity in Health Management. Building a Culturally Competent Organization: The Quest for Equity in Health Care. Chicago, IL: Health Research & Educational Trust. July 2011

Achieving culturally relevant

competence is:

Critical to achieving excellence in patient

outcomes and conducting research

Having measurable skill and ability in the

daily practice of medicine with diverse

populations

Achieving culturally relevant

competence is:

Incorporating cultural competence in all

areas of training and other health care

responsibilities

Understanding the dynamics of a diverse

workplace and being able to manage

individual and institutional unconscious

bias

National Workforce Diversity

Committee trend findings

Need for Workforce Diversity widely stated

as something organizations should do

Not promoted as a way to

1. Improve health outcomes

2. Establish excellence and fiscal health

FOPO Workforce Diversity trend

findings

Evidence shows that attention to cultural competence and workforce diversity increases job satisfaction and patient care outcomes (Coelho, Galan 2012)

Understanding and acceptance and promotion of new metrics in leadership crucial to success

Diversity in Workforce

Can any medically certified health professional be counted on to give unbiased medical care?

How does increasing diversity in the workplace make a difference?

Can a trained provider be a knowledgeable cultural expert with every ethnic person they meet in their community?

Shaping State Policy Change:

Use of Qualitative and Quantitative Data

Making the case with simple data and

stories

1. Effective media relations

2. Using simple descriptive data

3. Survey Data support change in process

4. Translation of academic research into

community practice

5. Shared values shapes legislative policy

Effective Collaboration

Starts with person-to-person relationships

Facilitators can break down barriers

Create a consensus in values and priorities

Each brings something to the table valued by

group

Pitfalls along the way:

Will not automatically create inclusion

Systems may limit actions, productivity

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© Kaiser Permanente - 2013

Leveraging Culture and Systems Integration

to Drive Performance

1

Neighborhood /

Community

Society

Individual /

Family

Home / School /

Worksite

Physical and Mental Health Care

“Body, Mind and Spirit”

Deploying Kaiser Permanente Assets for Total Health

Bringing together Kaiser Permanente’s mission, brand, knowledge and capabilities:

Community Health

Initiatives

Environmental

Stewardship

Clinical Prevention

Access to Social

and Economical

Supports

Health Education

Public Information

Public Policy

Research

and Technology

Walking Promotion

Worksite/

Workforce

Wellness

20 Ronald Copeland, MD, FACS

Language

Medical Errors

How does culturally relevant competency

mitigate medical errors?

Do standard evidence based algorithms

have a role to play?

Personal Story

Clinical

Why do you think someone would

decline recommended medical care?

Do you think responsibility lies with the

patient? The provider? The system?

Medical System

Institutional Barriers

What are the institutional barriers that

contribute to bias and impede culturally

competent, equitable care?

Where do you begin as an individual in

eliminating institutional barriers that

produce bias and medical errors in health

care?

Access to Care

Research

Why do you think some communities are

particularly reluctant to participate in

research?

What do you think are some solutions to

the mistakes made in the past?