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

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  

Clearview Organizational Assessments-360 (COA360)

•  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)

The Clearview360 Suite of Tools

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)

Journal of Healthcare Management 53:4 (July/August 2008): 257-267.

COA360 Validation Article

Winner, 2008 Innovation Award National Center on Minority Health and Health Disparities

(NCMHD)

•  Measures: – CLAS Standards

– Joint Commission Standards

– HCAHPS patient experience

– Human Rights Campaign Foundation

Healthcare Equality Index Core Four

COA360u/COA360h Overview

Clinical  Staff   Non  Clinical  Staff  

Pa.ents  Administrators  

Organiza.on  

360°View of the Organization

COA360  

Assess  

Iden(fy  Strengths/

Improvement  Opportuni(es  

Tailored  Interven(ons/

Solu(ons  

Re-­‐assess  

The COA360/CQC Continuous Quality Improvement (CQI) Cycle

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

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.

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

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

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

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

Brief COA360 Demo

•  Point of Contact Survey

•  Staff Surveys

•  Patient Survey

Survey Invitation Email

Survey Login Page

Participant Home Page

Point of Contact Survey

Point of Contact Survey

Staff Survey

Staff Survey

Staff Survey

Staff Survey

Staff Survey

Staff Survey

Patient Survey

Patient Survey

Patient Survey

COA360 Report

COA360 Report

COA360 Report

COA360 Report

COA360 Report

COA360 Report

COA360 Report

COA360 SATISFACTION RESULTS

Quantitative Results: Satisfaction with Overall COA360

Experience

N = 492

358,  73%  

110,  22%  

24,  5%  

Strongly  Agree/Agree   Neutral   Strongly  Disagree/Disagree  

Quantitative Results: Satisfaction with COA360 Functionality

N = 485

374,  77%  

92,  19%  

19,  4%  

Strongly  Agree/Agree   Neutral   Strongly  Disagree/Disagree  

Quantitative Results: Satisfaction with COA360 Usability

N = 488

386,  79%  

90,  18%  

12,  3%  

Strongly  Agree/Agree   Neutral   Strongly  Disagree/Disagree  

“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.”

What Are People Saying about the COA360?

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.”

“…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.”

What Are People Saying about the COA360?

•  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

Culture-Quality-Collaborative (CQC)

COA360  

Assess  

Iden(fy  Strengths/

Improvement  Opportuni(es  

Tailored  Interven(ons/

Solu(ons  

Re-­‐assess  

The COA360/CQC Continuous Quality Improvement (CQI) Cycle

Programming through November 2012

Date Event Type Category Topic

March 2011 Webinar Data Collection and Quality Improvement

Collecting and Using race, ethnicity, and language data (ex. stratify patient satisfaction,

quality, and safety data, creating equity dashboards, etc.)

April 2011 Webinar Cultural Competency Training

Cultural competency training for clinical staff (e.g. physicians, nurses, and other direct

patient care providers)

June 2011 Webinar Regulatory

Environment and Legislation

State laws/regulations and cultural competency

July 2011 Webinar Health Disparities Appraising the evolving evidence on cultural competency and health disparities

August 2011 Webinar Health Disparities Culturally competent approaches to combating health disparities

September 2011 Webinar New Directions in the

21st Century National best practices and innovations:

AHRQ Innovations Exchange

October 2011 Webinar Regulatory

Environment and Legislation

Joint Commission Standards

Programming through November 2012

Date Event Type Category Topic

November 2011 Webinar Language Services Provision of language services and overcoming language barriers

December 2011 Webinar Business Case PuHng  the  lessons  learned  from  the  CQC  in  prac.ce

January 2012 Webinar New Directions in the 21st Century

Harnessing the community to improve organizational cultural competency

February 2012 Webinar Regulatory Environment and Legislation The  economic  burden  of  health  inequali.es  

March 2012 Webinar New Directions in the 21st Century

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

Programming through November 2012

Date Event Type Category Topic

July 2012 Webinar Data  Collec.on  and  Quality  Improvement  

Review  CQC  Member  Survey  Results  and  Next  Steps  for  Developing  Interven.ons  

August 2012 Webinar Data  Collec.on  and  Quality  Improvement   Post-­‐COA360  Assessment  Ac.on  Plans:  Part  1  

September 2012 Webinar Data  Collec.on  and  Quality  

Improvement   Post-­‐COA360  Assessment  Ac.on  Plans:  Part  2

November 2012 Webinar Cultural  Competency  Training  

Cultural Competency Training for Non-Clinicians

CQC Founding Members

CQC Founding Members

Newest CQC Members

For additional information:

•  Cheri Wilson, MA, MHS, CPHQ •  chwilson@jhsph.edu •  443-287-0305 •  http://www.clearview360.org