“Cultural Competency”: Healthcare Meeting the Challenges of Diverse Societies “Tools for Change”

1. “Cultural Competency”: Healthcare Meeting the Challenges of Diverse Societies“Tools for Change” Young Lee Director, HR/Training & Development Coney Island Hospital New York City Health & Hospitals Corporation Brooklyn, NY Email: Young.Lee@nychhc.org

2. “Best Wishes!”

3. Webinar Presentation Goals • Define cultural competence in context of healthcare • Examine critical issues for developing cultural competence in healthcare • Provide Tools for Change: Developing “cultural excellence” • Continuing cultural excellence: Moving forward

4. “Cultural Competency”: Healthcare Meeting the Challenges of Diverse Societies 1. Challenge Defined

5. Cultural Diversity is a Fact • The World has some 6,000 communities and as many distinct languages. • Difference leads to diversity of vision, values, beliefs, practice and expression. • Each culture deserves equal respect and dignity. -- Source: United Nations, 2007

6. Cultural Diversity is an Everyday Reality • The international migration rate is growing faster every year • We live in an increasingly heterogeneous society -- Source: United Nations, 2007

7. Reflecting the Respect of Fundamental Rights • Culture is a set of distinctive spiritual, material, intellectual and emotional features of society or a social group • Respecting and safeguarding culture is a matter of human rights • Cultural diversity presupposes respect of all persons to participate in the cultural life of one's choice -- Source: United Nations, 2007

8. Cultural Diversity is our Collective Strength • Rich diversity + collective strength = Quality Healthcare • Cultural diversity is a natural fact that we need simply recognize and respect • It is about plurality of knowledge, wisdom and energy which all contribute to improving and moving the World forward -- Source: United Nations, 2007

9. Best Patients • “(If you) ask staff to describe patients or families they like and do not like, they usually like patients or families who are grateful or people from the same culture or who speak the same language, but beyond that the attributes of popular patients (and) families become pretty grim. The most popular patients never ring their call lights, never ask for help, never ask questions or challenge their nurses and doctors, and never, ever read medical books or use the internet for help. Their families are not present, and they do not have any friends. In fact, they are close to dead as possible.” -- Source: Healthcare Quality Book, 2005

10. “Cultural Competency”: Healthcare Meeting the Challenges of Diverse Societies 2. Critical Issues in Cultural Competency

11. Why is Cultural Competence Gaining Importance? • Meeting the needs on an increasingly diverse society • Reducing health disparities and improving health care quality • Tailoring health care delivery to meet population and individual needs • Meeting federal requirements • Increasing treatment compliance, patient safety; and reducing medical error • Supporting organizational business strategies and objectives • Growing accreditation interest -- Dennis Andrulis, Drexel University, May, 2007

12. “Hospitals, Language and Culture: A Snapshot of the Nation” Exploring Cultural and Linguistic Services in the Nation’s Hospitals - A Report of Findings: A Report of findings from the Joint Commission March 29, 2007 http://www.jointcommission.org/NR/rdonlyres/E64E5E89-5734-4D1D-BB4D-C4ACD4BF8BD3/0/hlc_paper.pdf – The Joint Commission, 2007

13. “Hospitals, Language and Culture: A Snapshot of the Nation” • Providing Culturally and Linguistically Appropriate Care is Challenging • Six research areas studied • Leadership • Quality Improvement and Data use • Workforce • Patient Safety and Provision of Care • Language Services • Community Engagement

14. “Hospitals, Language and Culture: A Snapshot of the Nation” • Coordinate services relating to language and culture as part of part of organization to quality.” • Create uniform data collection mechanism related to providing quality care … Ethnic, linguistic, cultural … – The Joint Commission, 2007

15. “Hospitals, Language and Culture: A Snapshot of the Nation” • “Linguistically and culturally appropriate care has direct impact on quality and safety, and is a growing issue that is not going away.” -- Paul M. Schyve, M.D., Senior Vice President, The Joint Commission

16. “Hospitals, Language and Culture: A Snapshot of the Nation” – The Joint Commission, 2007

17. “Hospitals, Language and Culture: A Snapshot of the Nation” – The Joint Commission, 2007

18. “Hospitals, Language and Culture: A Snapshot of the Nation” – The Joint Commission, 2007

19. “Hospitals, Language and Culture: A Snapshot of the Nation” – The Joint Commission, 2007

20. “Hospitals, Language and Culture: A Snapshot of the Nation” – The Joint Commission, 2007

21. “Hospitals, Language and Culture: A Snapshot of the Nation” – The Joint Commission, 2007

22. Linguistic Competence • Language/Interpretation services: an important part of total communication; • Medically Trained Interpreters • Clinical skills vs. Interpretation skills • Telephonic translations, interpreter services, literacy assistance • “Cultural Liaisons” – M. Schlesinger • Importance of varied approaches to meet diverse needs.

23. Model for Developing Cultural Competence • Change agents: public/private • Organizational culture, structural/systemic realities, everyday interaction with diversity • Education, Modeling, Secret Shopper/Systemic Behaviors, “Push-Pull” factors • Internal/external controls and buy-in from key stakeholders

24. Increasing Cultural Competence in Healthcare • Dearth of research and quantitative data: cultural diversity awareness research is in its infancy. • Need for research, best practice database, systemic maturity, patient-centered care, patient safety, etc. • Measuring Staff competence to deal with cultural diversity • Example: The CMS H-CAHP Survey, in USA

25. Commonwealth Fund “Evidence to support that cultural and linguistic competence would result in decreased system costs, is not currently in the literature.” -- Source: Commonwealth Fund, 2006

26. Joint Commission: Cultural Competence and Communication Joint Commission, March, 2007

27. Institute of Medicine (IOM) • “To Err is Human,” IOM report 1999 • 48,000 to 98,000 preventable hospital patient deaths per year caused by medical errors. • 2007 Updated data – 100,000 preventable patient deaths from Medication Errors alone. • “Ineffective Communication”: Top cause of all errors -- Source: Institute Of Medicine, 2007

28. 2007 Joint Commission: New Standards “Crosswalk” on Cultural Competence • Rights Responsibilities and Ethics • Provision of Care, Treatment and Services • Leadership • Management of Human Resources • Improving Organizational Performance • Management of Information -- Source: Joint Commission, 2007

29. cc IU qd QOD, q.o.d., qod, and QD, q.d., qd U MSO4, MgSO4, MS Abbreviations for Drug Names > or < Apothecary Units @ Q6PM X3D No zero before decimal dose Zero after decimal dose µg -- Source: Joint Commission, 2007 Joint Commission: 2007 “Do Not Use” List

30. Que?????? – Health Literacy "Mr. Smith is 55 years old and was admitted for LUQ pain, which was also associated with maybe EG or CP. Possibly he may have ACS or LLL consolid but the only thing against it is he has NVBS. We did a CE profile which is negative, we may have to do a ABDCT. Put him on ampnafgent to cover for any GNB” -- Source: Coney Island Hospital, 2006

31. Cultural Competence & Health Literacy • Challenges that Broach Cultures • Culture-Unique Health Literacy Challenges: Example: LGBT and Unique needs of patient populations • Healthcare: Comfort within our own “culture of complexity” – Need to re-think our methods • Health literacy & cultural competence • Engaging the Community: a Source of Information and Linkage

32. Health Literacy: “What Did The Doctor Say?” • “The safety of patients cannot be assured without mitigating the negative effects of low health literacy and ineffective communication on patient care.” Source: “What Did the Doctor Say?: Improving Health Literacy to Protect Patient Safety” – Joint Commission 2007

33. 2007 U.S. National Cultural Competence Standards • U.S. National Cultural and Linguistically Appropriate Services (CLAS) Standards • 14 Key Standards in providing quality care • Standardized manner in which to Provide Culturally Appropriate Healthcare Services -- Source: U.S. Department of HHS, 2005

34. “Cultural Competency”: Healthcare Meeting the Challenges of Diverse Societies 3. Meeting the Challenge

35. Coney Island Hospital NYC Health & Hospitals Corporation • 11 acute-care hospitals, 100 different languages spoken • 400K uninsured accessed care, 5 million out-patient visits per year • TEMIS (U.N. Style translation system), on-site interpreters, impact of 9/11 -- Source: NYC Health & Hospitals Corporation, 2007

36. Building Culturally Competent Organizations View from Coney Island Hospital • How adults learn – • Literacy challenges • How organizations learn • “Cultural” challenges • Teaching Healthcare Workers to be Culturally Competent and Sensitive • Reinforcement – Building a Culture of Safety

37. Cultural Diversity and Sensitivity Training: Coney Island Hospital • Organization’s Patient Safety Focus • Leadership Support and Exigence • All Employees & Systems • Mandated In-Service Training • New Employee Orientation Program • Evidence of training effectiveness: Patient Satisfaction Rates, Error Reduction Rates • Department and Team Training

38. “Good  Great” • “Good to Great”: by Jim Collins and the Culture of Excellence • “Good” is the enemy of “Great”? • Is “Cultural Competence” enemy of “Cultural Excellence”? • Are you “On” or “Off” the bus? -- Source: “Good to Great”, Jim Collins, 2005

39. “Good to Great”: Jim Collins Get on the Bus with Culturally Competent/Excellent Care for all Patients

40. “Cultural Competency”: Healthcare Meeting the Challenges of Diverse Societies 3. Tools for Change

41. Awareness of Cultural Diversity Medical/ Healthcare Excellence Culturally Excellent Healthcare Organization Action/ Behaviors that Reflect Awareness Empathy & Sensitivity Critical Awareness and Continued Analysis Teamwork and Customer service “Conceptual Framework for Cultural Excellence” Inter-connections in Cultural Excellence -- Source: Coney Island Hospital, 2007

42. “Tools for Change” • Cultural Excellence Assessment Profile Tool • “DiSC” Behavior Profile Tool • “Secret Shopper Tool” • Patient & Community Involvement Tool

43. Tool #1 Cultural Excellence Assessment Profile Tool for assessing organizational values • Governance • Planning & Monitoring • Communication • Staff Development • Infrastructure & Service http://www.hrsa.gov/culturalcompetence/indicators/default.htm#components -- Source: U.S. HHS – HRSA, 2007

44. Tool #2 “DiSC Profile” • Tool for assessing and highlighting individual health worker behavior patterns • Learning from what we do • Strengths & Weaknesses • Strategies for Behavior Change -- Source: DiSC Profile Program, Carlson Company, 2004

45. Tool #3 “Secret Shopper” • Proactive uncovering of risk areas • Highlights organizational culture and challenges • Identifies opportunities for systemic change and tracking • Proactive involvement of cross-section of organization -- Source: Peak Performance Consulting, 2003 and Coney Island Hospital, 2007

46. Tool #4 Patient & Community Involvement Initiative Partnership Programs: Example: Coney Island Hospital & Shorefront YM-YWHA, Partner: Sue Fox • Interactive Learning Sessions – Learning from “Stories” • Celebration of Diversity and Learning • Personalization of Challenges -- Source: Coney Island Hospital, 2007

47. Trends in Cultural Excellence • Need for more research • Need for measurable impact of cultural competency interventions • Public health response to increasingly diversifying patient base: education & advocacy • Changing competencies for healthcare workers and organizations

48. “Cultural Competency”: Healthcare Meeting the Challenges of Diverse Societies 4. Next Steps

49. Cultural Excellence: What is Needed Now • Role of Advocacy • Active Patient Involvement • Developing hospital-based learning models • Constant pursuit of Excellence in Healthcare • Exchange of ideas for creation of “Best PracticeDatabases” and “Resource Banks” for culturally excellent healthcare delivery • Action Plan for Follow Up

50. Developing Cultural Excellence • Urgent need for research is Not a call for Non-Action • No single “magic bullet” solution • Cultural excellence developed through myriad efforts of many key stakeholders • Enough data to launch innovative projects across our borders • Important ingredients: partnerships, humble service, shared experiences, action based on knowledge, rewarded accomplishments, teamwork, managing change, patient involvement and common ground