© Copyright, The Joint Commission Hospital Accreditation Requirements to Advance Effective Communication, Cultural Competence, and Patient- Centered Care Amy Wilson-Stronks, MPP Project Director, Health Disparities Principal Investigator, Hospitals, Language, and Culture study Division of Standards and Survey Methods The Joint Commission HCIN Conference From Ad-Hoc to Best Practices in Healthcare Interpreting July 16, 2009

© Copyright, The Joint Commission Exploring Cultural and Linguistic Services in the Nation’s Hospitals: A Report of Findings  March 2007  Recommendations for hospitals, policymakers, and researchers  6 Domains –Leadership –Quality Improvement and Data Use –Workforce –Patient Safety/Provision of Care –Language Services –Community Engagement Download the report free: patientsafety/hlc/ patientsafety/hlc/ Source: Wilson-Stronks A, Galvez E. Exploring cultural and linguistic services in the nation’s hospitals: A report of findings. Oakbrook Terrace, IL: The Joint Commission; 2007.

© Copyright, The Joint Commission One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations  April 2008  Thematic framework derived from current practices  Self-assessment tool for organizations to use  Cultural competence is an ongoing journey - hospitals should assess and re-assess the services they provide Download the report free: patientsafety/hlc/ patientsafety/hlc/ Source: Wilson-Stronks A, Lee KK, Cordero CL, Kopp AL, Galvez E. One size does not fit all: Meeting the health care needs of diverse populations. Oakbrook Terrace, IL: The Joint Commission; 2008.

© Copyright, The Joint Commission Current Joint Commission Requirements  Values, beliefs respected  Effective communication  Patient involvement in care  Patient education  Informed consent  Planning for services to meet patient needs  Collection of language and communication needs  NPSG 13 – Patient Engagement

© Copyright, The Joint Commission Developing Hospital Standards to Advance Effective Communication, Cultural Competence, and Patient-centered Care  18-month standards development project –Co-directors: Paul Schyve, MD and Amy Wilson-Stronks, MPP –Supported by The Commonwealth Fund –Based on previous research and standards gap analysis –Hospitals, Language, and Culture: A Snapshot of the Nation study –OMH CLAS/Joint Commission Crosswalk  Timeline: August 2008 through January 2010 –Draft standards May 2009 –Standards implemented in 2011

© Copyright, The Joint Commission Project Goals:  Develop accreditation standards for hospital program –Incorporate issues such as diversity, culture, language, and health literacy into current standards or drafted into new requirements  Develop guidance document for field –Collaboration with National Health Law Program (NHeLP) –Include information on implementation of new standards, existing standards, and best practices Developing Hospital Standards to Advanced Effective Communication, Cultural Competence, and Patient-centered Care

© Copyright, The Joint Commission  Effective Communication –Identification of patient communication needs –Provision of language services and auxiliary aids  Data Collection and Use –Collection of patient-level demographic data –Use of available population-level demographic data for service planning and performance improvement  Addressing Specific Patient Needs –Patient and family involvement in care –Equitable treatment –Cultural, religious, spiritual needs and beliefs Issues to Address

© Copyright, The Joint Commission Proposed Requirements  Staff Training on Cultural Sensitivity (HR , EP 5; HR , EPs 7 and 8)  Staff and Licensed Independent Practitioner Training on the Use of Communication Tools (HR , EP 9; MS , EP 7)  Use of Population- and Patient-Level Demographic Data (LD , EPs 4 and 4)  Identification of Patient Communication Needs (PC.0X.0X.0X, EP 1)  Address Communication Needs Across the Care Continuum (PC.0X.0X.0X, EP 2)  Provision of Language Access Services and Auxiliary Aids (PC.0X.0X.0X, EP 3)  Assessment of Patient Understanding (PC.0X.0X.0X, EP 4; PC , EP 25)  Inclusion of Health Literacy Needs in Learning Needs Assessment (PC , EP 1)

© Copyright, The Joint Commission Proposed Requirements (cont.)  Collection of Patient-Level Demographic Data (RC , EPs 1 and 4)  Documentation of Need for Mobility Assistance (RC , EP 2)  Documentation of the Use of Language Access Services and Auxiliary Aids (RC , EP 4)  Accommodation of Patients’ Cultural and Personal Beliefs (RI , EP 6)  Accommodation of Patients’ Religious and Spiritual Practices (RI , EP 9)  Non-Discrimination in Care (RI , EP 11)  Inform Patients of Right to Receive Language Access Services (RI , EP 4)  Unlimited Access to Designated Patient Advocate (RI , EP 23)

© Copyright, The Joint Commission Staff Training and Education HR , HR , MS  Orientation –Sensitivity to cultural diversity of staff and patient population(s)  Ongoing education and training –Impact of cultural diversity on care –Impact of staff cultural diversity on team communication, collaboration, and care –How to use available communication tools

© Copyright, The Joint Commission Use of Demographic Data for Service Planning LD  Use of population-level data to determine needs of population(s) served –Examples of population data sources –Examples of demographic characteristics that may be considered  Use of aggregated patient-level data to determine needs of population(s) served (see also RC )

© Copyright, The Joint Commission Effective Communication PC.0X.0X.0X  New standard in Provision of Care chapter  Emphasizes need to identify the patient’s preferred method of communicating  Integrates concepts of language access and patient-provider communication  Includes requirement to assess patient understanding

© Copyright, The Joint Commission Health Literacy Needs PC  Inclusion of health literacy needs in learning needs assessment  Assessment of understanding of patient education and training

© Copyright, The Joint Commission Documentation RC  Specification of preferred language  Added requirement to collect patient race/ethnicity and religion/spirituality  Added requirement to document patient mobility needs  Added requirement to collect additional demographic information as necessary for care  Requirement to document use of language access services or auxiliary aids

© Copyright, The Joint Commission Patient Rights RI , RI , RI  Changed “respects” to “accommodates”  Changed spiritual “services” to “practices”  Care provided free from discrimination  Informing patient of right to receive language access services free of charge  Accommodating right to unlimited access to a family member, friend, or other advocate

© Copyright, The Joint Commission Next Steps  Continue to revise proposed concepts to include in draft accreditation requirements –Internal review process –Field engagement –Standards implementation in 2011  Continue to develop guidance document for field –Expert Advisory Panel input –Draft content, review, revise –Anticipated release in 2010

© Copyright, The Joint Commission Field Review To review and comment on the proposed requirements, please visit: Standards/FieldReviews/field_ecccpc Comments will be gathered for six weeks, beginning on June 8, 2009.

© Copyright, The Joint Commission  Please visit our website: Available: Culturally competent patient-centered care standards information Hospitals, Language, and Culture study information Downloadable reports Links to other websites Resources  Amy Wilson-Stronks, MPP For More Information