dd2012 laveist wilson 101212.ppt - johns hopkins …...10/1/2012 1 a continuous quality improvement...

10/1/2012

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A Continuous Quality Improvement Approach to

Organizational Cultural C tCompetence

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

Johns Hopkins Bloomberg School of Public Health

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 Disparities

Presentation Outline

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

• Define cultural competence

• Describe the current federal mandates and regulatory t d d l t d t lt l tstandards related to cultural competency

• Overview of the Cultural Competency Organizational Assessment-360 (COA360) and the Culture-Quality-Collaborative (CQC)

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

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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Changing U.S. Demographics

• Increased number of foreign born residents

– 12.7% of U.S. residents

• Increased numbers speak a language other than English at homehome


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


• Between 1990 and 2010, the U.S. LEP population increased 80%.

Source: 2010 U.S. Census and 2011 American Community Survey

What is Cultural Competence?

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

• Individuals, organizations, and systems are at , g , yvarious 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: CASSP Technical Assistance Center, Georgetown University Child Development Center, 1989.

CulturalPre‐Competence

CulturalCompetence

CulturalProficiency

Cultural Competence Continuum(Cross, Bazron, Dennis and Isaacs, 1989)

Cultural Destructiveness

CulturalIncapacity

Cultural Blindness

Slide Source: National Center for Cultural Competence, 2008


It requires organizations to:

1. Have a defined set of values and principles, and demonstrate behaviors, attitudes, policies, and t t th t bl th t k ff ti lstructures that enable them to work effectively

cross-culturally;



2. Have the capacity to:

(a) value diversity,

(b) conduct self-assessment,

(c) manage the dynamics of difference(c) manage the dynamics of difference,

(d) acquire and institutionalize cultural knowledge, and

(e) adapt to the diversity and cultural contexts of

communities they serve;



3. Incorporate the above into all aspects of:

(a) policymaking,

(b) administration,

(c) practice and service delivery(c) practice and service delivery,

(d) and systematically involve consumers, key

stakeholders and communities.


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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:• NCQA Multicultural Health Care Standards: Distinction Program (effective 7/1/2010)

• Meaningful Use of Electronic Health Records (EHRs)

Economic Burden of Health Inequalities

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

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

• Cost of Premature Deaths were $957.5 billion

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

COA360TM

Clearview Organizational Assessments-360 (COA360) Overview

COA360 Validation Article

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

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Winner, 2008 Innovation AwardNational 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 i ti (T b l h d N b 2012)organizations (To be launched November 2012)

• PCMH360 – For medical practices (To be launched April 2013)

COA360 Overview

• Web-based tool

• Assessment of healthcare organizations, not individuals

• Identifies strengths and areas for improvementg p

• Suitable for any size healthcare organization

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

COA360 Overview

• Measures:

– CLAS Standards

– Joint Commission Standards

– HCAHPS patient experience

360° View of the Organization

Clinical Staff Non Clinical Staff

Patients/Clients

Administrators

Organization

The COA360/CQC Continuous Quality Improvement (CQI) Cycle

Assess

COA360 Identify Deficiencies

Tailored Interventions

Re-assess

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Brief COA360 Demo

• Point of Contact Survey

• Administrator/Clinical Staff/Non-Clinical Staff Survey

• Patient/Client Survey

Survey Invitation Email

Survey Login Page Participant Home Page

Point of Contact Survey Point of Contact Survey

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Administrator/Clinical Staff/Non-Clinical Staff Survey




Patient/Client Survey Patient/Client Survey

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Patient/Client Survey Patient/Client Survey

COA360 Report COA360 Report


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COA360 Report

COA360 Report

COA360 Report

COA360 SATISFACTION RESULTS

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Quantitative Results: Satisfaction with Overall COA360 Experience

110, 22%

24, 5%

N = 492

358, 73%

Strongly Agree/Agree Neutral Strongly Disagree/Disagree

Quantitative Results: Satisfaction with COA360 Functionality

92, 19%

19, 4%

N = 485

374, 77%


Quantitative Results: Satisfaction with COA360 Usability

90, 18%

12, 3%

N = 488

386, 79%


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 ourprovide more culturally competent services to our clients.”

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 &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 i f l lt th h d t l i dus meaningful results, thorough data analysis, and

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

Assess

COA360 Identify Deficiencies

Tailored Interventions

Re-assess

Programming through June 2012

Date Event Type Category Topic

March 2011 WebinarData Collection and Quality Improvement

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

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

April 2011 WebinarCultural Competency

Training

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

patient care providers)p p )

June 2011 WebinarRegulatory

Environment and Legislation

State laws/regulations and cultural competency

July 2011 Webinar Health DisparitiesAppraising the evolving evidence on cultural

competency and health disparities

August 2011 Webinar Health DisparitiesCulturally competent approaches to

combating health disparitiesSeptember

2011Webinar

New Directions in the 21st Century

National best practices and innovations:AHRQ Innovations Exchange

October 2011 WebinarRegulatory

Environment and Legislation

Joint Commission Standards

Programming through June 2012

Date Event Type Category Topic

November 2011 Webinar Language ServicesProvision of language services and

overcoming language barriers

December 2011 Webinar Business CasePutting the Lessons Learned from the CQC

in Practice

January 2012 WebinarNew Directions in the

21st CenturyHarnessing the community to improve

organizational cultural competency

February 2012 WebinarRegulatory Environment

and LegislationThe economic burden of health inequalities

March 2012 WebinarNew Directions in the

21st Century

Cultural competency lessons from other industries and implications for the health

care system

May 2012 Webinar Language ServicesAssessing language competency of

bilingual staff

June 2012 WebinarData Collection and Quality Improvement

Review of CQC Members’ COA360 Results

CQC Founding Members

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CQC Founding Members Q & A

dd2012 laveist wilson 101212.ppt - johns hopkins …...10/1/2012 1 a continuous quality improvement...

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