1. Integrating the National Standards on Culturally and Linguistically Appropriate Services into Patient-Center Care (CLAS): A Holistic Approach March 1, 2017
This presentation is provided free-of-charge and is supported by Grant Number 1L1CMS from the U.S. Department of Health & Human Services, Centers for Medicare & Medicaid Services. The contents provided in this webinar are solely the responsibility of the presenters and do not necessarily represent the official views of HHS or any of its agencies.

2. Guadalupe Pacheco, BA, MSW
Speaker
Guadalupe Pacheco, BA, MSW
30 years of senior-level health management policy development and non-profit experience.
Served in areas of health policy, cultural centric service delivery, and public engagement.
Previously served a Project Manager for Lockheed Martin Corporation
Training Director for the AIDs Education and Training Center-Multicultural Center (AETC-MC) at Howard University College of Medicine
Senior Health Advisor/Project Officer to the Director at the Office of Minority Health
Office of Assistant Secretary for Minority Health, and US Department of Health and Human Services.

3. Presentation Objectives
Demonstrate how the CLAS and the Transforming Clinical Practice Initiative (TCPI) drivers can be used to support health care delivery and patient-family engagement;
Highlight how the Three TCPI Drivers can be used to improve clinical workflow and patient outcomes; and
Provide the rationale and examples of patient-family in the delivery of patient-center care.
Speaker Notes:
Afternoon. First, I want thank all of you for taking time off your busy clinical practice to be part of this webinar series on
Transforming Clinical Practice Initiative (TCPI).
I will provide an overview of the National Standards on Culturally and Linguistically Appropriate Services in Health and Healthcare (CLAS) and how the TCPI drivers can be used to support health care delivery and patient-family engagement.
I will also highlight how the Three TCPI Drivers can improve clinical workflow and patient-outs; and finally provide the rationale for engaging patients and family in the process of delivery patient-centered care.
Time permitting, I we will take the opportunity to address any questions that you may have.

4. What Are Culturally and Linguistically Appropriate Services in Health and Healthcare?
Services that are respectful of and responsive to individual cultural health beliefs and practices, preferred languages, health literacy levels, and communication needs of patients and employed by all members of an organization (regardless of size) at every point of contact.
Use CLAS as a tool to eliminate/reduce racial & ethnic health disparities
Source: OMH National CLAS Standards, 2012
The 15 CLAS Standards were developed to provide pathways for delivering culturally and linguistically services to racially and ethnically diverse populations but to promote health equity, improve quality, and help eliminate health care disparities
My premise is that these standards are applicable to all patients regardless of their racial/ethnic background and adaptable to all clinical settings.
The take home messages are: services are respectful/responsive to the cultural health beliefs/practices/preferred languages, health literacy levels, and communications needs of patients.

5. National CLAS Standards
Principal Standard
Governance, Leadership and Workforce
Communication and Language Assistance
Engagement, Continuous Improvement, and Accountability 1
2-4
5-8
The enhanced CLAS Standards Breakdown by Theme:
Principal Standard – Standard 1
Governance, Leadership and Workforce – Standards 2-4
Communication and Language Assistance – Standards 5-8
Engagement, Continuous Improvement, and Accountability – Standards 9-15
9-15

6. Enhanced CLAS Standards
The National CLAS Standards are intended to advance health equity, improve quality, and help eliminate health care disparities by establishing a blueprint for health and health care organizations to: Principle Standard 1) Provide effective, equitable, understandable and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy and other communication needs. Theme 1) 2-4: Governance, Leadership, and Workforce Theme 2) 5-8: Communication and Language Assistance Theme 3) 9-15: Engagement, Continuous Improvement, and Accountability
The CLAS Standards emphasize the importance of promoting health equity, improve quality, and help eliminate health care disparities!
Look at the language in Principle Standard—compliments “Patient-centered care”

7. 1:Principle Standard
Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.
Creates a safe/welcoming environment/appreciation of diversity/focuses on patient-centered care
Individuals receive services in a culturally and linguistically appropriate manner to enable them to meet their communication needs/understand their care & participate in their care
To eliminate health disparities
Providing respectful care that addresses the patients cultural and linguistic needs; cultural health beliefs and practices; preferred languages, and health literacy.

8. 2: Advance and sustain governance and leadership that promotes CLAS and health equity through policy, practices and allocated resources (2-4: Governance, Leadership & Workforce)
Mission statement/core values/vision statement-promoting health equity
Commitment from top board, management leadership,
Management/board set policy/program goals, development of strategic plan of promoting organizational diversity, providing CC care, eliminating health disparities; written policies, practices, procedures, programs, etc.
Provide fiscal, human resources, tools, skills, and knowledge to support a culturally competent organization.
The importance of having a mission statement—what are your core values of your practice
If its going to happen—it comes from the leadership at the top. You’re the leader but you also want to develop your leadership team!
The various components of your infrastructure are also critical to your success.

9. 5-8: Educate and Train Governance, Leadership, and Workforce in CLAS
CLAS education and training for professionals working in health/human services must be ongoing;
Training should be based on sound educational principles (adult learning, pre-test, post-test, knowledge based, skill-based, attitude-based)
Training in the areas of effective communication, health literacy, socio-economic status, race, ethnicity, effects of cultural differences in access heath and other human services;
Applicable civil rights laws, Affordable Care Act of 2010, Title VI of the Civil Rights Act of 1964, HHS Title VI Guidance for LEP Individuals.
Integration of CLAS in agency training to ensure it becomes part of the organizational culture
Standards 4-8 fall under the newly cast “Communication and Language Assistance” Theme
Changing the name of Theme 2 from “Language Access Services” to “Communication and Language Assistance” broadens the understanding and application of appropriate services to include all communication needs and services, including sign language, Braille, oral interpretation, written translation, and others.

10. 9: Infuse CLAS Goals, Policies, and Management Accountability Throughout the Organization’s Planning and Operations (9-15: Engagement, Continuous Improvement, and Accountability)
Establish CLAS appropriate goals and policies for the delivery of cultural competent care based on health equity concepts/ideas
CLAS should be embedded throughout various levels of the organization’s workforce (upper and lower management)
CLAS should be core elements of the organization’s identity, mission, operating principles, service focus, budget/quality improvement activities
Establish accountability mechanisms throughout the organization, staff evaluations, individuals’ satisfaction measures, and quality improvement measures
What are your operational goals for the year? Are they based on outcomes for your patients? Quality improvement, accountability, feedback from your patients (satisfaction measures)

11. 10: Conduct Organizational Assessments
Conduct ongoing assessment (self-assessment) of the organization’s CLAS-related activities;
Conduct a cultural audit using cultural and linguistic assessment tools (structural policies, procedures, and practices—barriers to care; positive/negatives)
Use audit data to Integrate CLAS-related measures into continuous quality improvement activities
Establish feedback “loops,” internally and externally, to continuing monitor and improve on your CLAS activities (service delivery)
How do you assess your successes? Do you conduct audit on your service delivery models? How do address service barriers? Workflow issues?

12. 11: Collect and Maintain Demographic Data
Collect demographic data such as race, ethnicity, sex, language, and disability status;
Use data to identify population groups within service area;
Ensure equal allocation of organization resources;
Use data to monitor/evaluate the impact of CLAS on health equity/outcomes/to inform service delivery.
Data builds the story of your patients. What are their needs, trends, successes, areas to improve on, justified resources to address those needs.

13. 12: Conduct Assessments of Community Health Assets and Needs
Conduct regular assessments of community health assets and needs (needs assessment, resource inventory, gap analysis);
Identify potential disparities in care or services; and
Identify language and other needs of the community
Plan/implement services that respond to the cultural & linguistic diversity of the populations in the service area
Assessing the needs of the community? What are the major health disparities of the community? What are the linguistic needs of the community?
How do you respond or address those needs?

14. 13-14: Partner with the Community
Health care entities should partner w/ the community to design, implement, and evaluate policies, practices, & services to ensure cultural/linguistic appropriateness (vehicle to build trust)
Health care entities should use town hall meetings, hold community forums, and/or conduct focus groups, talking sessions, webinars, etc. to acquire stakeholder input
Sponsor or participate in health fairs with community-based organizations, cultural festivals, and celebrations
Building a relationship with your patient community; being a partner to build trust; using the partnership (s) to acquire stakeholder input on your services.
Good partnerships and relationships result in maintaining your patient base but also expanding it.
All these activities promote public engagement with the community.

15. CLAS Public Engagement
This is what public engagement is all about.

16. 15: Communicating the Organization’s Progress in Implementing and Sustaining CLAS
Communicate to stakeholders, constituents, and general public of CLAS accomplishments;
Helps build and sustains communication on CLAS priorities/fosters trust between community and service setting
Helps meet community benefit requirements
Serves as an accountability mechanism to the community but also part of continuous improvement process

17. TCPI AIMs/Goals Source: CMS, 2016
The TCPI AIMs/Goals serve as the foundation for the primary drivers of this new form of care delivery.

18. Primary Drivers Family and Patient-Centered Care Design:
1.1 Patient and family engagement--CLAS
1.2 Team-based relationships--CLAS
1.3 Population management--CLAS
1.4 Practice as a community partner--CLAS
1.5 Coordinated care delivery--CLAS
1.6 Organized, evidence based care--CLAS
1.7 Enhanced access to care--CLAS
Continuous, Data-Driven Quality Improvement
2.1 Engaged and committed leadership--CLAS
2.2 Quality improvement strategy supporting a culture of quality and safety--CLAS
2.3 Transparent measurement and monitoring--CLAS
2.4 Optimal use of HIT
Sustainable Business Operations
3.1 Strategic use of practice revenue--CLAS
3.2 Workforce vitality and joy in work--CLAS
3.3 Capability to analyze and document value--CLAS
3.4 Efficiency of operation--CLAS
--The 15 CLAS standards compliments all three of Primary Drivers of the TCPI
--Examples: Patient and family engagement; population management; enhanced access to care;
--Continuous, Data-Driven Quality Improvement; engaged and committed leadership; Quality improvement; measurement and monitoring
--Sustainable Business Operations; use revenue to market to new diverse patient base; diversifying workforce; ability to document value based on data and patient outcomes

19. How the Three TCPI Drivers—used to Improve Clinical Workflow/Patient Outcomes
TCPI promotes patient-center care=putting the patient first—medicine is organized around the patient’s needs
TCPI promotes efficient care, with superior coordination, information sharing—use of electronic health records, and teamwork across disciplines to produce value care and improve outcomes
TCPI promotes developing the infrastructure of the private practice—good management/clinical team, fiscal management controls, performance measures, data collecting platforms, and analytics
--The leader in the practice must take charge—it starts from the top to create a culture of patient-center care that focuses on performance and outcomes
--improving processes to reduce errors, waste, and improve outcomes (CLAS use of medical interpreters to make gather patient history, correct diagnosis, and to prescribe right treatment
--care coordination
--lean management—developing a process improvement culture
--use of data to make the case—building the evidence for certain interventions

20. Patient-Family Engagement in the Deliver of Care
Raising awareness and enlisting patients to manage their own health—use of electronic personal health records
Work to increase communication between the patient and provider
Helping patients understand the referral process to specialist
Addressing barriers that may interfere with appointments
Conducting short surveys on patients to identify gaps and/or feedback on their care; areas to improve
Using a team-approach so that everyone is on the same page
Sources: Academy of College of Physicians
Transforming Clinical Practice Initiative Change Package: March, 2016
--encouraging and coaching patients to use personal health records
--listening to their needs—explaining treatment or options
--health literacy/language barriers
--transportation, financial, need for an interpreter or family presents

21. Summary
CLAS Standards promote health equity, effective, understandable, and respective quality care—compliment patient-centered care and three drivers of the TCPI
The Three TCPI Drivers improve clinical workflow and patient outcomes by focusing on putting the patient first
TCPI promotes the importance of infrastructure of the private practice
Patient engagement-coaching the patient to manage their own health
Increasing better communication between patient and the provider
Assisting patients to understand the referral process to specialist
Addressing other barrier of care
Establish a feed-back loop for feedback from patients (conducting short surveys)
Using a team-approach so that everyone is on the same page
--CLAS Standards support patient-centered care and the three drivers of TCPI
--Patient and Family-Center Care Design, Continuous, Data Driven Quality Improvement, and Sustainable Business Operations
--medicine is organized around the patient’s care needs; promotes efficient care coordination, information sharing among clinical staff, and team-approach—produce value care/improve outcomes
--instituting a performance based management/clinical team, fiscal controls, performance measures, data collection platforms, and analytics

22. Resources www.thinkculturalhealth.hhs.gov www.minorityhealth.hhs.gov
--Cultural competency resources specifically e-learning programs for physicians and nurses

23. Presenter Information
Guadalupe Pacheco, CEO/President
Pacheco Consulting Group, LLC
1516 U Street, NW
Washington, DC 20009
(202)