Moffitt Diversity

ACCESS to Care:Building a Culture of Diversity & Inclusion

Cathy Grant, DirectorFriday, August 5, 2011

Florida Diversity Council

Objective

• About Moffitt

• Health Disparities

• Cultural and Linguistic Competence

• Diversity & Inclusion at Moffitt

About Moffitt Cancer Center

• Single Mission – The Prevention and cure of cancer• Celebrating 25th Anniversary • Only NCI designate cancer center in FL• Staff –4,287 Total Employees • Moffitt is licensed for 206 beds • From 2009 to 2010

• Admissions grew from 7,742 to 8,616• Outpatient grew from 289,502 to 320,558

• As of October 2010, grant funding at Moffitt increased to $83.8 million

Cancer Programs

• Blood & Marrow Transplantation • Don & Erika Wallace Comprehensive Breast Program • Cutaneous Oncology • Gastrointestinal Malignancies • Genitourinary Oncology • Gynecologic Oncology • Head & Neck Oncology • Internal and Hospital Medicine • Malignant Hematology • Neuro-Oncology • Psychosocial & Palliative Care • Radiation Oncology • Sarcoma • Senior Adult Oncology • Thoracic Oncology

Video : Justine’s Story

Demographics

Source: US Census: http://quickfacts.census.gov/qfd/states/12/12057.html

3.1% 3.4% 16.7% 24.9% 53.7% Hillsborough

County

2.5% 2.4% 16.0% 22.5% 57.9% Florida

2.9% 4.8% 12.6% 16.3% 63.7% United States

MulticulturalAsianBlackLatinoWhite

(Not Hispanic)

24% speak a language other than English at home

� 77% speak Spanish � 23% other language� 40% reported not speaking English “very well”

Language

Source: U.S. Census Bureau, 2005-2009 American Community Survey

Health Disparities

Differences or gaps in care experienced by one population compared with another population which can result in less access to care, a poorer quality of care, and higher death rates from certain diseases.

Prostate CancerAge-Adjusted Death Rates per 100,000 Persons

By Race & Hispanic Origin: U.S. (2005)

24.522.6

53.3

17.6

10.4

18.5

0

510

15

20

2530

35

40

4550

55

60

All Races White AfricanAmerican

AmericanIndian/Alaska

Native

Asian/PacificIslander

Hispanic

Age

-Adj

uste

d D

eath

Rat

e pe

r 100

,000

Per

sons

Center for Disease Control and Prevention, Office of Minority Health and Health Disparities. An Overview. http://www.pitt.edu/~super4/39011-

40001/39961.ppt#259,1,Office of Minority Health and Health Disparities (OMHD)

Breast CancerAge-Adjusted Death Rates per 100,000 Persons

by Race & Hispanic Origin: U.S. (2005)

24.1 23.4

32.8

15.2

12.2

15.0

0

5

10

15

20

25

30

35

All Races White AfricanAmerican

AmericanIndian/Alaska

Native

Asian/PacificIslander

Hispanic

Age

-Adj

uste

d D

eath

Rat

e pe

r 100

,000

Per

sons

Center for Disease Control and Prevention, Office of Minority Health and Health Disparities. An Overview. http://www.pitt.edu/~super4/39011-40001/39961.ppt#259,1,Office of Minority

Health and Health Disparities (OMHD)

Colon, Rectum & Anus CancerAge-Adjusted Death Rates per 100,000 Persons

by Race & Hispanic Origin: U.S. (2005)

17.5 16.9

24.8

12.011.2

12.4

0

5

10

15

20

25

All Races White AfricanAmerican

AmericanIndian/Alaska

Native

Asian/PacificIslander

Hispanic

Age

-Adj

uste

d D

eath

Rat

e pe

r 100

,000

Per

sons

Center for Disease Control and Prevention, Office of Minority Health and Health

Disparities. An Overview. http://www.pitt.edu/~super4/39011-

40001/39961.ppt#259,1,Office of Minority Health and Health Disparities (OMHD)

Trachea, Bronchus & Lung CancerAge-Adjusted Death Rates per 100,000 Persons

by Race & Hispanic Origin: U.S. (2005)

52.6 53.1

58.4

34.1

25.722.4

0

510

15

20

2530

35

40

4550

55

60

All Races White AfricanAmerican

AmericanIndian/Alaska

Native

Asian/PacificIslander

Hispanic

Age

-Adj

uste

d D

eath

Rat

e pe

r 100

,000

Per

sons

Center for Disease Control and Prevention, Office of Minority Health and Health

Disparities. An Overview. http://www.pitt.edu/~super4/39011-

40001/39961.ppt#259,1,Office of Minority Health and Health Disparities (OMHD)

Racial/Ethnic Disparities in Health Care

Differential utilization based on race for within Medicare:

� Mammography (Gornick et al.)� Amputations (Gornick et al.)� Influenza vaccination (Gornick et al.)� Lung Ca Surgery (Bach et al.)� Renal Transplantation (Ayanian et al.) � Cardiac catherization & angioplasty (Harris et al, Ayanian et al.) � Coronary artery bypass graft (Peterson et al.)� Treatment of chest pain (Johnson et al.)� Referral to cardiology specialist care (Schulman et al.)� Pain management (Todd et al.)

Potential Reasons for Disparities in Care

Source: Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, March 2002.

Patient Level• Patient preferences• Treatment resistance /

compliance• Health perceptions• Care seeking behaviors and

attitudes• Clinical appropriateness of

care

Provider Level• Bias• Stereotyping• Clinical uncertainty• Poorer quality of care • Lack of patient-centered care• Unconscious and automatic

Health Care Organization / Systems Level

• Lack of access to care

• Lack of interpretation and translation services

• Time pressures on physicians and other clinical staff

• Geographic availability of health care institutions

• Changes in the financing and delivery of health care services

Minorities Less Involved in Their Health Care Decisions Than They Would Like to Be

75% 78%73%

65%

56%

0%

40%

80%

Total White AfricanAmerican

Hispanic AsianAmerican

Source: The Commonwealth Fund 2001 Health Care Quality Survey.

Percent of adults involved in health care decision as much as they wanted

Hispanics and African Americans More Likely to Feel Treated with Disrespect

11%9%

16%18%

13%

0%

10%

20%

Total White AfricanAmerican

Hispanic AsianAmerican

Source: The Commonwealth Fund 2001 Health Care Quality Survey.

Percent of adults who felt they were treated with d isrespect

Focus of Efforts

A.C.C.E.S.S. to Care• Enhance Moffitt Cancer Center’s image among at-risk and

underserved communities through delivery of culturally and linguistically competent care, prevention education and mutuallybeneficial partnerships;

Culture of Diversity & Inclusion• Serve as a resource, as well as, identify opportunities to increase

Moffitt’s preparedness when serving diverse communities.

A.C.C.E.S.S.

• Awareness and Education

• Community Outreach

• Cultural and Linguistic Competence

• Equity and Inclusion

• Support Other initiatives (Technical Assistance)

• Strong Partnerships

Integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values, roles, relationships, and institutions of racial, ethnic, religious, or social groups

Definition of Culture

Cultural Competence is defined as “a set of behaviors, skills, attitudes, knowledge, practices, policies, and strategies that together enables the Moffitt workforce to work effectively in cross-cultural situations to improve:

(1) Patient safety; (2) Patient satisfaction; (3) Access to and utilization of care; and(4) Quality of care(5) Workforce diversity; and(6) Participation in clinical trials and research

Cultural Competence

• Beyond the “right thing to do”………..

• Changing demographics

• Health care services that are respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of diverse patients can help bring about positive health outcomes .

•• Growing evidence as an important strategy for reducing

health disparities

• Legal and regulatory mandates

Why CLC?

Improving Quality of Care

• Diverse and Limited English Proficiency (LEP) patients are less likely than others to receive the most effective, evidence-based treatments for certain conditions

• Diverse populations report more communication difficulties with their physicians, less involvement in clinical decisions, more difficulty understanding instructions on prescriptions, and instructions from physician’s staff

Improving Patient Safety

• Diverse and Limited English Proficiency (LEP) patients suffer more medical errors with greater clinical consequences

• Communication problems may lead to misdiagnosis, inappropriate treatment, and limit authentic informed consent

Improving Patient Satisfaction

Good patient/provider communication is linked to better patient satisfaction, adherence to treatment

recommendations, and improved health outcomes

Reducing Liability

Communication issues are a key component of claims filed by patients whose culture, ethnicity, religion and/or English language ability differ from that of the healthcare provider

27

• Value Diversity

• Have the capacity for cultural self-assessment

• Be conscious of the dynamics inherent when cultures interact

• Have institutionalized cultural knowledge

• Have developed adaptations to diversity

Five Essential Elements of a Culturally Competent System

Lost in Translation…

Readily available and culturally appropriate communication and language services and supports, and vital documents and informing materials, for patients and family members through such means as bilingual/bicultural staff, and professional medical interpreters and translators

Linguistic Competence

Impact of Language Barriers

• When Lacking Language Assistance

• Less likely to have a Primary Care Physician (PCP)

• More likely to not go to follow up appointments

• More like to be in fair or poor health

• Medication instructions errors

• Less satisfied with the health care received

• With available Language Assistance

• Successful patient-provider relationship

• Standard medical interview techniques – complete exchange of information

• Empathic connection

It’s the Law!

Title VI of the Civil Rights Act of 1964

“No person in the United States shall, on ground of race, color, or national origin, be excluded from participation in, or be denied the benefits of, or be subjected to discrimination under any program or

activity receiving Federal financial assistance.”

• Who is covered?

• Extent of obligation: Four-factor analysis

• State requirements

www.os.dhhs.gov/ocr/civilrights/resources/specialtopics/lep/

Awareness and Education

Focused on each person’s role in reaching the center’s Diversity-related mission and goals

• Diversity Unplugged• Employee Networks – GLAAM• New Hire Orientation• Diverse Voices – E-Newsletter• National Minority Cancer Awareness Week

Increase visibility and knowledge by providing information about the importance of cancer prevention, healthy lifestyles, and early detection of cancer to our most at-risk, under-served and under-insured communities.

• Capacity – Building Programs• Lay Health Advisors• Cancer Education Toolkits

• Health Education Workshops• Culturally relevant; low literacy• Prostate; Breast; Cervical; Colon; Healthy Lifestyles• Haitian Initiative / Witness Project (Komen)• EmpowerMENt Project• Moffitt Healthy KIDZ• ¡Salud!

• Access to Mammography Screening

Community Outreach/Relations

Community Outreach/Relations (cont.)

• Annual Men’s Health Forum(English / Spanish)

• Community Benefit

• National Minority Cancer Awareness Week (NMCAW) - 3rd Week of April

• Micro Award for Cancer Community Health Initiatives (MACCHI)

Language Services

• Staff• Two Translators

• Five Spanish Interpreters• One Spanish/American Sign Language interpreter

• Pacific Interpreters - 180 languages and dialects• Video Remote Interpreting (VRI)

Other Inclusion Efforts

• Supplier Diversity

• Recruitment & Retention� Diversity Scholarship� School at Work� Candidate pool

Ongoing Challenges

• History• Resistance to change: internal and external• Competing priorities• Culture: internal and external• Trust• Resources / Money: Internal and external

THANK YOU!

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