360 O CARE: REDUCING HEALTH DISPARITIES THROUGH ORGANIZATIONAL CULTURAL COMPETENCE 2012 USPHS Scientific and Training Symposium Wednesday, June 20 th, 2012 Center on Health Disparities Emeobong E. Martin, MPH Marcos Pesquera, RPh, MPH

Cultural Competency in Health Care  WHO: Physicians and other Health Professionals, Administrators, Students, Support Staff, Organization  WHAT: Knowledge, Skills, Abilities, Attitudes and Behaviors  MEASURES:  Patient Outcomes (health status, health care utilization, satisfaction)  Provider Outcomes (cultural knowledge and sensitivity, patient-centeredness, effective communication, satisfaction)

Culturally Competent Care and Improved Health Outcomes  Research shows:  Cultural competency training can be effective and beneficial (Lie et al. 2010)  A few result in positive patient outcomes (e.g., Majumdar 2004, McElmurry 2009)  Some have moderate to no effect on outcomes  None have had a negative effect on outcomes

What is Cultural Competence?  Practitioner’s Guide  “The delivery of health care services that acknowledges and understands cultural diversity in the clinical setting, respects patients’ health beliefs and practices and values cross- cultural communication.” (Kaiser Permanente)  Organizational Application  “A set of congruent behaviors, attitudes and policies that come together in a system, agency or among professionals that enables effective work in cross-cultural situations.” (Health Resources and Services Administration)

Why is cultural competence important?  Patient Protection & Affordable Care Act  Joint Commission Standards, CLAS Standards  Title VI  Changing Demographics of our Communities  Health Disparities are well-documented in the literature  Improve Patient Experience

How do you achieve cultural competence? Organizational Assessment Overview* Organizational Values Governance Planning, Monitoring & Evaluation Communication Staff Development Organizational Infrastructure Services & Interventions Culturally Competent Patient- Centered Care *Seven Domains Courtesy of Health Resources and Services Administration

Organizational Values Culturally Competent Patient- Centered Care  Perspective  Attitude  Commitment  An organization's perspective and attitudes with respect to the worth and importance of cultural competence and its commitment to provide culturally competent care.

Organizational Values Governance  Goals  Policy  Oversight  The goal-setting, policy-making, and other oversight vehicles an organization uses to help ensure the delivery of culturally competent care.

Organizational Values Governance Planning, Monitoring & Evaluation  Mechanisms  Processes  Systems  Activities  The mechanisms and processes used for:  a) long- and short-term policy, programmatic, and operational cultural competence planning that is informed by external and internal consumers; and  b) the systems and activities needed to proactively track and assess an organization's level of cultural competence.

Organizational Values Governance Planning, Monitoring & Evaluation Communication  Exchange of information internally and externally  The exchange of information between the organization/providers and the clients/population, and internally among staff, in ways that promote cultural competence.

Organizational Values Governance Planning, Monitoring & Evaluation Communication Staff Development  Attitude  Knowledge  Skills  An organization's efforts to ensure staff and other service providers have the necessary attitudes, knowledge and skills for delivering culturally competent services.

Organizational Values Governance Planning, Monitoring & Evaluation Communication Staff Development Organizational Infrastructure  Resource availability  The organizational resources required to deliver or facilitate the delivery of culturally competent services.

Organizational Values Governance Planning, Monitoring & Evaluation Communication Staff Development Organizational Infrastructure  Delivery  Facilitation  An organization's delivery or facilitation of clinical, public-health, and health related services in a culturally competent manner. Services & Interventions

Organizational Values Governance Planning, Monitoring & Evaluation Communication Staff Development Organizational Infrastructure Services & Interventions Culturally Competent Patient-Centered Care

Organizational Assessment Applied

 Provider since 1981  Diverse community  Children, adolescents, adults, geriatrics  U.S. born, immigrant populations  Private and public insurance  Services:  Acute  In-patient  Partial hospitalization  More than 780 employees  Five Maryland locations

Adventist Behavioral Health (ABH) Locations ABH-Rockville The Reginald S. Lourie Center (Rockville) ABH at Washington Adventist Hospital (Takoma Park) ABH – Anne Arundel (Crownsville) ABH – Eastern Shore (Cambridge) Location, Location, Location…

38 Leadership Interviews 14 Staff Focus Groups (~10 people/group) 8 Community Interviews ABH Organizational Cultural Competence Assessment Overview

September 2010: Presentation to Organizational Leadership November May 2011: 1:1 Interviews w/Organizational Leadership May-June 2011: 1:1 Interviews w/Community Partners May-August 2011: Staff Focus Groups Phase I

Sample Questions  How do you see cultural competence applied in treating (X) population within your institution?  How do you or your organization currently support the provision of culturally competent care?  What do you think is necessary to:  Provide patient-centered care?  Improve the overall patient experience at ABH?

Assessment Data  >60 hours of audio recordings  ~5 hours of transcription/qualitative session  >600 pages of transcribed text

Assessment Results  Strengths  Opportunities for Improvement  Recommendations  Notable Quotes

Sub-section of HRSA Domain Leadership PerceptionsStaff PerceptionsCommunity Perceptions Strengths Opportunities for Improvement Recommendations HRSA Domain

Phase II September- November 2011: Synthesize & Summarize Data January 2012: Present Summary Report to Organization President February 2012: Present Summary Report to Organizational Leadership March-April 2012: Assist Leadership in Outlining Strategic Planning Process May- September 2012: Assemble and meet w/Task Force to Develop Strategic Plan October 2012: Present Strategic Plan to Organizational Leadership January 2013 & Beyond: Implementation Support

Thank You! 1801 Research Boulevard, Suite 300 Rockville, Maryland