July 25, 2015 Health Forum and Leadership Summit San Francisco, California An Illustration in CLAS Bringing the Cultural and Linguistic Service Standards to Life Juana S. Slade, CDM, CCF, Chief Diversity Officer and Director of Diversity and Language Services, AnMed Health, Anderson, South Carolina Suzanne Wilson, RN, MBA, ACM, Director of Care Coordination and Resource Management, AnMed Health, Anderson, South Carolina
AnMed Health Quick Facts 690 Bed Acute Care System Level II Trauma Center Emergency Department visits: 112,329 Medical Staff: 466 Employees: 3,600 2
2001: Setting the CLAS Standard Applicable law or comprehensive vision? Compliance or cultural and linguistic competence? Executive authorization or executive leadership? Functional accountability or system integration? In December 2000, The US Department of Health and Human Services Office of Minority Health (OMH) in collaboration with the Office of Civil Rights (OCR) issued the Fourteen National Standards for Culturally and Linguistically Appropriate Services (CLAS) Disparity in the delivery of health care to certain racial, ethnic and linguistic groups Requirements and recommendations providing guidance on how to prepare for, or respond to culturally sensitive or linguistically challenging situations. Prior to CLAS, federal, state and local entities independently developed standards: language programs to comprehensive diversity programs. 3
A 14 Year PDSA Cycle 2001 2002 Plan (Infrastructure) 2003 2008 Do (Implementation) 2009 2013 Study (Competence and Quality) 2014 Act (Audit and Monitor) 4
2002: The Point of No Return Unequal Treatment The Institute of Medicine 5
2001: Chief Collaborative Officer Administration, Human Resources, Medical Staff, Quality/Safety Nursing/Patient Care Services, Emergency Department, Women s Health, Children s Health, General Counsel, Community Relations, Public Relations, Internal and External Advisors, Patients, Families, Medical Records, National and International Corporate Community, Training and Organizational Development, Physician Network, Local Colleges and Universities, etc. 6
The best care for the whole population at the lowest cost The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. It is IHI s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the Triple Aim: Improving the patient experience of care (including quality and satisfaction); Improving the health of populations; and Reducing the per capita cost of health care. Improving Health and Health Care Worldwide 7
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The Perfect Cultural Competency Storm! 9
Call to Action! Addressing disparities is no longer just about morality, ethics and social justice: It is essential for performance excellence and improved community health. Association of American Medical Colleges American College of Healthcare Executives American Hospital Association Catholic Health Association of the United States National Association of Public Hospitals and Health Systems 10
Fundamental Premise From the standpoint of hospitals it s really critical that they begin to measure quality by race and ethnicity. And to do that they will need to create race and ethnicity data, and that links to the communication piece. If you look at race and ethnicity, you can look at where the gaps are and where you might intervene. Joseph Betancourt, MD, MPH Director, The Disparities Solution Center 11
Our Project AnMed Health: Disparities Dashboard Abstract The goal of our project was to research and develop a disparities dashboard to identify and strategically address AnMed Health s most vulnerable, underserved and costly patient populations. The disparities dashboard is adjunct to our system-wide quality measures and management strategies. 12
Project Considerations Relevant to the Triple Aim Capitalized on system s cultural competence Compatible with existing clinical and quality priorities Accuracy (reliability) of Race Ethnicity and Language (REaL) Data Collection Organizational timing and resource availability Flexibility 13
Dashboard Framework AnMed Health Disparities Quality Dashboard CY 2013 Diversity Snapshot White Hispanic African American American Indian Asian Unknown/ Other National Hospital Quality Measures 1- White 1-Hispanic 2- African American 3- American Indian 4- Asian 7- UTD Total Setting Percent Heart Failure Inpatient Discharges Evaluation of LVS Function Emergency Department ACEI or ARB for LVSD Child Health HF Appropriate Care Score (ACS) Family Medicine AMI Type of Care White Hispanic African American American Indian Aspirin at arrival Aspirin Prescribed at discharge ACEI or ARB for LVSD Beta Blocker prescribed at Discharge Service Percent of Admissions Primary PCI received w ithin 90 minutes of hospital arrival Inpatient Adult Statin at discharge Inpatient Pediatrics (<18) AMI Appropriate Care Score (ACS) AnMed Health Business Line Pneumonia Cardiac Surgery Blood cultures w /i 24 hours of hosp arrival-pts transferred/admitted to the ICU Cardiology Initial antibiotic selection for CAP in immunocompetent - ICU patient Cath & EP Initial antibiotic selection for CAP in immunocompetent - Non ICU patient Dentistry PN Appropriate Care Score (ACS) ENT Surgical Care Asian Unknown/ Other Gastroenterology On-time prophylactic antibiotic selection General Surgery Appropriate selection of prophylactic antibiotics Gynecology Discontinuation of prophylactic antibiotics w ithin 24 hours after surgery Internal Medicine Cardiac surgery patients w ith controlled 6 a.m. postop serum glucose Medical Oncology Appropriate hair removal Neonatology Urinary catheter removed on POD 1 or POD 2 w ith day of surgery being day zero Nephrology Beta blocker prior to admission and perioperative period Neurology Venous thromboembolism prophylaxis timely Neurosurgery SCIP Appropriate Care Score (ACS) Normal New born Stroke Obstetrics Stroke patients w ith VTE prophylaxis Opthalmology Discharged on antithrombotic therapy Orthopedics Anticoagulation for atrial fibrillation Psychiatric Thrombolytic therapy Pulmonary Antithrombotic therapy by end of hospital day 2 Thoracic Surgery Discharged on statin medication Trauma & Burns Stroke education Urology Assessed for rehab Vascular Surgery Stroke Appropriate Care Score (ACS) VTE VTE prophylaxis Language Services Outpatient Services Inpatient Services Total ICU VTE prophylaxis Other VTE patients w ith anticoagulation overlap therapy Spanish VTE patients receiving unfractionated heparin w ith monitoring by protocol Vietnamese VTE discharge instructions Sign Language VTE Appropriate Care Score (ACS) Arabic Immunization Chinese/Mandarin Influenza Rate German Russian Farsi (Persian) 30-Day Readmissions Overall Rate ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% Overall Volume # # # # # # # Patient Experiences with Care Hawaiian/ African American Puerto Heart Failure Rate ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% White Hispanic Mexican Pacific Asian American Indian Rican Islander Heart Failure Volume # # # # # # # % of Responses in Best Category (9-10 Rating) AMI Rate ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% H-CAHPS Experience 9-10 (Inpatient) AMI Volume # # # # # # # White Hispanic African American American Indian Asian Unknown / Other Overall 14 Overall Rating ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% Pneumonia Rate ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% Pneumonia Volume # # # # # # # COPD Rate ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% COPD Volume # # # # # # #
Flexibility! Patient Experiences with Care White African American American Indian Hispanic Mexican Puerto Rican Hawaiian/ Pacific Islander Asian H-CAHPS Experience 9-10 (Inpatient) % of Responses in Best Category (9-10 Rating) Overall Rating ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% 30-Day Readmissions White Hispanic African American American Indian Asian Unknown / Other Overall Overall Rate ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% COPD readmission rates added in Q3 2013 Overall Volume # # # # # # # Heart Failure Rate ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% Heart Failure Volume # # # # # # # AMI Rate ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% AMI Volume # # # # # # # Pneumonia Rate ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% Pneumonia Volume # # # # # # # COPD Rate ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% ##.#% COPD Volume # # # # # # # Language Services Outpatient Services Inpatient Services Total 15 Other Spanish Vietnamese Sign Language Arabic Chinese/Mandarin German Russian Farsi (Persian)
Emerging Opportunities Internal Strategies/Collaborations Care Coordination High Reliability Patient Perception Patient / Community Engagement State Collaborations Healthy Outcomes Plan Alliance for a Healthier SC SC Call to Action 16
Internal Strategies and Collaborations 17
Care Coordination Emergency Department case management and discharge planning Transitional Care Coordinator Follow-up phone calls and appointments Population health strategies Heart Failure COPD End Stage Renal Disease Post-acute clinic Ambulatory case management 18
High Reliability 5 Traits of High Reliability Organizations 1. Sensitive to operations 2. Reluctant to accept simple explanations for problems 3. Have a preoccupation with failure 4. Defer to expertise 5. Resilient HRO in Action VPP Designation Safety Calendar Safety Coordinating Council Daily Safety Huddle Good Catch Recognitions Gold Standard Leadership Molly Gamble Becker s Hospital Review April 29, 2013 19
20 Patient Perception
Patient and Community Engagement Patient Advisors Foundation Ambassadors Community Diversity Advisory Council 21
22 External Strategies
Healthy Outcome Plan (HOP) South Carolina Department of Health and Human Services Medicaid Expansion Strategy (Proviso 33.34) Participating hospitals proposing service delivery models to coordinate care for chronically ill, uninsured, high utilizers of emergency department (ED) services Critical Success Factors and Benefits: Care Coordination Population Health Management Improved Outcomes Lower Care Costs 23
Alliance for a Healthier South Carolina Transforming the health of all South Carolinians by forging common ground and coordinating action on shared goals Established in 2011, then known as the SC Health Coordinating Council. CEOs, state directors, and executive leaders from 48 organizations in the state representing: academics, business, consumers, government agencies, health care providers, insurance companies, philanthropy, and policy analysts. Committed to Improving the health of babies Improving the health of children Preventing chronic disease Improving access to primary care Improving access to holistic behavioral health services For all, and at a lower per capita cost. 24
SC Call to Action A. Collect and use data to identify and guide decision making regarding the health equity challenges in South Carolina Collect data to identify health equity challenges experienced by our employees and clients and use it to design and implement targeted interventions. Use secondary data to identify health equity challenges in the geographic areas of influence of our organizations and use it to design and implement targeted interventions. 25
SC Call to Action B. Develop and maintain a culturally competent and responsive organizational culture for employees, clients, and partners C. Ensure our organizations are designed to guarantee inclusive decision making. This, through enhanced emphasis on the recruitment of highly qualified minorities for leadership positions, and the investment in filling the pipeline with diverse leaders for this and future generations. D. Engage the community as partners in the design and delivery of sustainable health solutions. 26
Harry S. Truman, 33 rd President of the United States Men make history, and not the other way around. In periods where there is no leadership, society stands still. Progress occurs when courageous, skillful leaders seize the opportunity to change things for the better. 27
28 Q&A