A Continuous Quality Improvement Approach to Organizational Cultural Competence
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1 A Continuous Quality Improvement Approach to Organizational Cultural Competence Cheri Wilson, MA, MHS, CPHQ Faculty Research Associate, Department of Health Policy and Management Project Director, COA360 and CQC Hopkins Center for Health Disparities Solutions
2 About Us Exploration and Intervention for Health Equality Designated a National Center of Excellence by the National Institutes of Health, National Institute on Minority Health and Health Disparities
3 Clearview Organizational Assessments-360 (COA360)
4 The Clearview360 Suite of Tools COA360u For departments or units of a healthcare organization (Launched 2010) COA360h For hospitals or healthcare organizations (To be launched March 2013) PCMH360 For medical practices (To be launched March 2013) BHSS360 For behavioral health and social service settings (TBD)
5 COA360 Overview Web-based tool Assessment of healthcare organizations, not individuals Identifies strengths and areas for improvement Suitable for any size healthcare organization Assesses unique configuration of diversity in the service area (race/ethnicity/nationality, language, religion/spirituality, and sexual identity)
6 COA360 Validation Article Journal of Healthcare Management 53:4 (July/August 2008):
7 Winner, 2008 Innovation Award National Center on Minority Health and Health Disparities (NCMHD)
8 Measures: COA360u/COA360h CLAS Standards Overview Joint Commission Standards HCAHPS patient experience Human Rights Campaign Foundation Healthcare Equality Index Core Four
9 360 View of the Organization Clinical Staff Non Clinical Staff Organiza.on Pa.ents Administrators
10 The COA360/CQC Continuous Quality Improvement (CQI) Cycle Assess Re- assess COA360 Iden(fy Strengths/ Improvement Opportuni(es Tailored Interven(ons/ Solu(ons
11 Sample Tailored Interventions/Solutions Hospital 1 Education 3-hour skills based cultural competency course for nurses 1-hour culturally competent customer service training for support staff front desk staff, techs, assistants, dietary and housekeeping staff Grand Rounds focused on residents and physicians
12 Sample Tailored Interventions/Solutions Hospital 1 Structural Enhancements to Language Access Services Replaced non-working telephones and those without speaker phones or dual handsets To improve communication with telephonic interpreter services vendor Identified and several frequently used documents and translated into Spanish, Arabic, and Bengali.
13 Sample Tailored Interventions/Solutions Hospital 2 Health Equity Task Force in existence for several years prior to conducting COA360 Subcommittees Language Services, Communication, Education, IT/Quality
14 Sample Tailored Interventions/Solutions Hospital 2 Better education and more utilization of telephonic interpretation phones Educate more broadly about concept of health equity Considering a screening of Unnatural Causes: Is Inequality Making Us Sick? to jumpstart the educational component Reviewing availability of telephonic language access services
15 Sample Tailored Interventions/Solutions Hospital 2 More utilization of language access services Completed inventory of availability of language access telephones Increasing staff awareness of the availability of the language access telephones More signage posted on the availability of language access services Tracking usage of the language access telephones
16 Sample Tailored Interventions/Solutions Hospital 3 Interdisciplinary implementation team Patient Safety, Service Excellent, Quality, and Management Increased language access supports Creation of a Hispanic/Latino Patient and Family Council
17 Brief COA360 Demo Point of Contact Survey Staff Surveys Patient Survey
18 Survey Invitation
19 Survey Login Page
20 Participant Home Page
21 Point of Contact Survey
22 Point of Contact Survey
23 Staff Survey
24 Staff Survey
25 Staff Survey
26 Staff Survey
27 Staff Survey
28 Staff Survey
29 Patient Survey
30 Patient Survey
31 Patient Survey
32 COA360 Report
33 COA360 Report
34 COA360 Report
35 COA360 Report
36 COA360 Report
37 COA360 Report
38 COA360 Report
39 COA360 SATISFACTION RESULTS
40 Quantitative Results: Satisfaction with Overall COA360 Experience 24, 5% 110, 22% 358, 73% Strongly Agree/Agree Neutral Strongly Disagree/Disagree N = 492
41 Quantitative Results: Satisfaction with COA360 Functionality 19, 4% 92, 19% 374, 77% Strongly Agree/Agree Neutral Strongly Disagree/Disagree N = 485
42 Quantitative Results: Satisfaction with COA360 Usability 90, 18% 12, 3% 386, 79% Strongly Agree/Agree Neutral Strongly Disagree/Disagree N = 488
43 What Are People Saying about the COA360? The COA360 has given us detailed insight related to our cultural and linguistic competency in a variety of domains, and it has allowed us to determine targeted steps we can take in order to provide more culturally competent services to our clients.
44 What Are People Saying about the COA360? Used to determine whether a unit-based education approach along with organizational supports leads to improved patient satisfaction, employee engagement, clinical quality, and organizational cultural competence in the Labor & Delivery unit of our hospital. If successful, this intervention could be tailored to other units in the hospital to improve care for all patients.
45 What Are People Saying about the COA360? innovative, user friendly, and easy to understand for our patients, staff and leaders. The reports, provided by expert staff, have given us meaningful results, thorough data analysis, and helpful recommendations. This information is critically important to our hospital, given that it serves patients from a wide variety of races, ethnicities and cultural backgrounds.
46
47 Culture-Quality-Collaborative A learning exchange of healthcare organizations Co-learning Participating in the COA360/CQC CQI Cycle Assess Identify strengths/improvement opportunities Tailored interventions/solutions Re-assess Share findings (CQC)
48 The COA360/CQC Continuous Quality Improvement (CQI) Cycle Assess Re- assess COA360 Iden(fy Strengths/ Improvement Opportuni(es Tailored Interven(ons/ Solu(ons
49 Programming through November 2012 Date Event Type Category Topic March 2011 April 2011 June 2011 Webinar Webinar Webinar Data Collection and Quality Improvement Cultural Competency Training Regulatory Environment and Legislation July 2011 Webinar Health Disparities August 2011 Webinar Health Disparities September 2011 October 2011 Webinar Webinar New Directions in the 21st Century Regulatory Environment and Legislation Collecting and Using race, ethnicity, and language data (ex. stratify patient satisfaction, quality, and safety data, creating equity dashboards, etc.) Cultural competency training for clinical staff (e.g. physicians, nurses, and other direct patient care providers) State laws/regulations and cultural competency Appraising the evolving evidence on cultural competency and health disparities Culturally competent approaches to combating health disparities National best practices and innovations: AHRQ Innovations Exchange Joint Commission Standards
50 Programming through November 2012 Date Event Type Category Topic November 2011 Webinar Language Services December 2011 Webinar Business Case January 2012 February 2012 March 2012 Webinar Webinar Webinar New Directions in the 21st Century Regulatory Environment and Legislation New Directions in the 21st Century Provision of language services and overcoming language barriers PuHng the lessons learned from the CQC in prac.ce Harnessing the community to improve organizational cultural competency The economic burden of health inequali.es Cultural competency lessons from other industries and implications for the health care system May 2012 Webinar Language Services Assessing language competency of bilingual staff June 2012 Webinar Data Collection and Quality Improvement Review of CQC members COA360 results
51 Programming through November 2012 Date Event Type Category Topic July 2012 August 2012 September 2012 November 2012 Webinar Webinar Webinar Webinar Data Collec.on and Quality Improvement Data Collec.on and Quality Improvement Data Collec.on and Quality Improvement Cultural Competency Training Review CQC Member Survey Results and Next Steps for Developing Interven.ons Post- COA360 Assessment Ac.on Plans: Part 1 Post- COA360 Assessment Ac.on Plans: Part 2 Cultural Competency Training for Non- Clinicians
52 CQC Founding Members
53 CQC Founding Members
54 Newest CQC Members
55
56 For additional information: Cheri Wilson, MA, MHS, CPHQ
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