Adapting health systems to the challenge of diversity in the US and Europe

Adapting health systems to the challenge of diversity

in the USA and EuropePractice, policy and

politics

Julia Puebla Fortier Executive Director

Key messages

Good models drive policy

Policy drives institutionalization

Integration with mainstream health agendas

Social and political support is key

Early practice models

Organizational settings community clinics, public health departments, public

hospitals

Interventions Ethnic-specific practices/hours Bilingual/bicultural staff Interpretation/translation Community health workers/cultural liaisons Cultural competence training

Some advanced practices

Institution-wide cultural competence plans

Race-ethnicity-language (REL) data collection

Video medical interpreting – internal and multi-institution

Mentorship-quality improvement projects

Certification and practice standards

The policy ladder – U.S.

Title VI of the Civil Rights Act

State activity: CA, WA and MA

Federal demonstrations and program requirements Office of Minority Health HRSA (Community and migrant health centers)

CLAS Standards: Categories of interventions

Culturally Sensitive Interventions Cultural competence education Race, ethnic and linguistic concordance Community health workers and culturally

competent health promotion

Language Assistance Bilingual services, oral interpretation,

translated written materials

CLAS Standards: Categories of interventions

Organizational Supports for Cultural Competence Management and policy strategies Community engagement Information and data for planning and

evaluation Appropriate ethics and conflict resolution

processes Public reporting

A foot in the door and the power of perception

Recommended standards, not regulations

Something to point to

Leverage to move forward

Plethora of voluntary ‘compliance’ efforts

Picking up the ball

Initiatives from key health care quality and accreditation organizations: The Joint Commission National Committee for Quality Assurance The National Quality Forum

The Joint Commission

Required accreditation process

Early interest in cultural, linguistic issues

Crosswalk of CLAS standards and JC standards

Hospital, Language and Culture study

Standards and implementation guide released this year

National Committee for Quality Assurance

Voluntary standards and accrediting body for managed care plans

Test waters with CLAS awards program – highlight best practices

Multicultural Health Standards released this year

Focus on data collection, staff diversity/ cultural competence, language services

National Quality Forum

Comprehensive voluntary framework and preferred practices for measuring and reporting cultural competency

45 preferred practices in 6 domains: Leadership Integration into management systems Patient-provider communication Care delivery structures Workforce diversity and training Community engagement

Health care reform

Federal requirements that extend to all health plans related to: Language access REL data collection Disparities reduction

Fitting in to the mainstream

Access to care (civil rights/advocacy)

Legal and quasi-legal (requirements/liability avoidance)

Business case (cost effectiveness, ROI)

Quality improvement (process)

Does it make a difference (outcomes)

Other mainstream agendas

Patient safety

Health literacy

Emergency preparedness

Outcomes, evidence base

Social acceptance

Civil rights movement

Rise of minority group power Political Demographic

Disgrace of disparities

Health professions societies

Political and financial challenges

Anti-immigrant sentiment Interpersonal Political

Financial crisis

New paradigms, new imperatives

Role of foundations and government

The California Endowment, The Commonwealth Fund, The Robert Wood Johnson Foundation

Funding for demonstration projects and research

For more information:

Julia Puebla Fortier, Executive Director

rcchc@aol.com

DiversityRx - Resources for Cross Cultural Health Care

www.diversityRx.org

www.diversityRx.org redesign