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A review of how cultural and linguistic competence in health care has advanced in the US, and lessons for Europe
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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
DiversityRx - Resources for Cross Cultural Health Care
www.diversityRx.org
www.diversityRx.org redesign
