How Well are Our Hospitals Doing in CLAS. How Well are Our Hospitals Doing in CLAS Agenda 1.What is...
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How Well are Our Hospitals Doing in CLAS
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How Well are Our Hospitals Doing in CLAS
Agenda
1. What is Cultural Competency and CLAS
2. What is the Big Deal?
3. How do we Measure Performance/Compliance?
4. What have we learned?
5. How do we Build on that Learning?
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Situation: What Hospitals Face • Cost/Revenue Squeeze
-Acuity, Technology, &
Facility
-Employers, Providers &
Payers• Competitive Inflation
-Hospitals & Health Systems
-Physicians
-Other Private Institutions
• Distinction Extinction
-Limited Options
-Commodity Imagery
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Healthcare in U.S. Under Stress• Exponential Growth of Diversity
- Absolute Size
- Education & Spending Power
- Geographic Dispersion• Persistent Impact of Disparity
- Access
- Care
- Outcomes• Serious Threat to Quality
- Diabetes
- Heart Disease
- Cancer
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• Enhance Healthcare Quality
- Rising Tide Theory
- Bigger Boat Theory
• Revitalize Healthcare Institutions
- Revenue/Share Enhancement
- Operational Efficiency
- Risk Management Protection
Addressing Health Disparities: A Two for One Benefit
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Meeting the Need: More than Just a New Positioning
Culturally Competent Care/Service• Extension of clinical care and personal service • Based on the unique characteristics of an
institution’s:– Patients/customers
– Family members
– Guests/visitors
– Caregivers/associates
A new road to quality improvement, market differentiation & profitability.
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Benefits of Organizational Cultural Competence
External• Comfort within Communities• Trust among Families• Compliance by Patients• Satisfaction for everyone
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Benefits of Organizational Cultural
Competence
Internal• Quality for the CNO• Cost Containment for the CFO• Efficiency for the COO• Growth & Market Share for the CEO
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What is CLAS?
• Standards for delivering Culturally and Linguistically Appropriate Service
• Developed by HHS/OMH
• Accepted Broadly
• Basis for CMCHO Products & Services
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Methods for Measuring Cultural Competence & CLAS Compliance
• Testing-Questionnaires
• Observing-On-site examination
• Sampling-Process or Procedural Trial
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Understanding Your Needs
“You can’t get started or go anywhere until you know where you are and how you got there”
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Assessment Options
• Individual or Organizational
• Internal or External
• Paper or Personal
• Remote or On-site
• Self or Third Party
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Individual vs. Organizational
• Individual
- Awareness
- Attitudes
- Behaviors• Organizational
- Global
- Systemic
- Infrastructure
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CMCHO Organizational CMCHO Organizational Assessment/Survey Assessment/Survey
Community Survey
Discharge Data Analysis
Community Mapping
Leadership Conference
Management Conference
Policy/ Document Review
Patient Chart Reviews & Tracking/ Clinical
Interviews
Employee Interviews & Facility Tours
Surveyors’ Pre- Assessment
Closing Session
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The Data-Community Survey Which hospital in your community is most prepared to meet the language, racial, ethnic, and cultural needs of the community?
Most Prepared (First Mention)
4%
6%
8%
11%
17%
0% 2% 4% 6% 8% 10% 12% 14% 16% 18%
Community
Ohio Valley
Presbyterian
University
St. Mary's
Ho
sp
ita
l
Percent
Most Prepared (First Mention)
4%
6%
8%
11%
17%
0% 2% 4% 6% 8% 10% 12% 14% 16% 18%
Community
Ohio Valley
Presbyterian
University
St. Mary's
Ho
sp
ita
l
PercentImplications:
• No hospital is mentioned by more than 20% of consumers.
• Each has an opportunity to become the leader in Cultural Competency.
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Comparative Data-African American
AFRICAN AMERICAN Comparative Analysis
10.52%
6.41%6.81%
7.11%
11.35%
6.18%
0%
2%
4%
6%
8%
10%
12%
Service Area % Admit % Death % Billed Procedure % Readmits % Patient Days %
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Current Population Trends
Native American/Inuit/Aleut (2002)
White (2002)
African American (2002)Asian/Pacific Islander (2002)
Other Race (2002)
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Leadership & Management Conferences
• Ask questions that cover all 14 CLAS standards
• Use both open- and closed-ended question format
• Designed to probe for in-depth discussion
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Document, Policy/Procedures Review
Review– Thorough review by Survey Team of policies/procedures
that relate to cultural competency. – Survey team looks for consistency in understanding and
application.– Survey team interviews random selection of employees and
physicians for understanding of policies and procedures.
Report – Client provided areas in which vulnerabilities exist.
Recommendation– Particular attention is given to areas of potential exposure,
and/or misunderstanding.
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Patient Chart Review & Tracking: Review Assessment
Review– Random selection of charts for review.
– Documentation reviewed in the following categories:• Communicating with patient
• Ability to address needs of culturally diverse patients
• Care/service Decisions
• Continuum of Care/service
Report– Comments provided from survey team provide an
indication of strengths and alerts.
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Employee InterviewsReview
– Random selection of employees and physicians identified for interview.
• Physicians, Nurses• Administrators, sales staff• Technicians• Housekeeping
– Interviews based upon the following categories:• Understanding cultural competency (policies/procedures)• Communicating with patients/customers• Ability to address needs of culturally diverse patients/customers• Care/service Decisions
Report– Attention to “knowledge gaps”– Identify misunderstanding that can lead to unintentional
negative outcomes
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Review Closing Session
• Provide Insights
• Review Observations
• Present Recommendations
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CMCHO Survey/Assessment Insights
• Community Study Perceptions
- Little to no awareness of competitive edge
- Diversity seen as important
- Awareness & ratings lower among diverse
respondents
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Survey/Assessment Insights Continued
• Discharge Data
- Males over-represented in IP & under-
represented in OP & ER
- Blacks & Hispanics over-represented in ER
- Asians under-represented everywhere
- High AMAs among Blacks & Hispanics in IP &
OP
- Readmits for Blacks & Hispanics polarized
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Survey/Assessment Insights Continued
• On-site Assessment/Survey - Awareness/understanding of CC highest at leadership level - Knowledge of CC principles & practices highest at staff level - Little to no awareness/understanding of CLAS at any level - Facilities have either plans or activities, not both
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Survey/Assessment Insights continued
• On-site Assessment/Survey cont.
- Plans, policies & procedures not integrated
- Greatest gaps in language services
- Language/culture focus imbalance
- Lack of awareness or responsiveness to
professional diversity issues
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Building Cultural Competency • Start with Top-Down Commitment - From CEO to Car Lot Attendant• Insist on Full Integration - Strategically (mission/vision/values) - Operationally (policies/procedures/plans)• Insure Complete Accountability - Goals & Objectives - Metrics & Measures - Rewards & Consequences• Maintain Broad View of Diversity & Cultural Competence
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Building BlockExample: Diversity or Cultural
Competence• Commitment
- CEO as champion and chief advocate
• Integration
- One vision, one mission, one plan
• Accountability
- Responsibility, Measurement, Rewards &
Consequences
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What is CMCHO
• A National Consortium
• Diverse Healthcare Thought Leaders
• Assess, Train, Certify & Consult
• Focus on Cultural Competency
• Focus on Organizational Infrastructure
• Focus on CLAS
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Plug Into
A Healthier Future For You,
Your Organization, and the Communities You Serve