Where do we need to go?

The AHA published an article on health disparities and its statement that was recently submitted to the House Ways and Means Committee. You can check it out an excerpt from their solicited statement at the link below.

http://www.hospitalconnect.com/ahanews/jsp/display.jsp?dcrpath=AHANEWS/AHANewsArticle/data/AHA_News_080707_AHA_racial_ethnic&domain=AHANEWS

Of course, the statement was well written and supported by thorough data and as practitioners, we can all stand up from the choir and deliver a resounding "AMEN". What I am left with in the process of a long standing need for health care transformation is a "where do we need to go?" question. This question is not new for anyone either. What has not surfaced however, are long-term strategies that can be adopted not just for public health practitioners, clinicians, and hospitals, but by every institution that is affected by disparate treatment and disparate outcome. Translation--everyone!

I am going to speak to this in more depth later; however, the premise is that our strategic hats need to be collectively worn more often than our execution hats. We have a great deal of data and we still need to collect it. In addition, we as practitioners dedicated to health equity need to be strategic on what each data point collected represents and how it can fit into a bigger framework that leaves us with a body of information that can longitudinally clarify what is working with whom and how and how can we duplicate, systematize, and hone it for long-term success. What is our success strategy as a body of health care folks who want to see our bottom-line for health care in this country improve while our top line of people rises it with it? Can it be done? You bet it can!

We will discuss more in the near future about this possibility.

Joint Commission Releases Revised Restraints Standards for Behavioral Healthcare--The Role of Culture

The Joint Commission released new standards in behavioral care in May that will go into effect January 1, 2009. Now, I don't need to go into the details of the new standards, but I did want to highlight one particular piece that was intriguing from a culturally competent care perspective.

The standard includes (paraphrased):
staff must demonstrate an understanding of the factors that influence behavior and may result in the need for restraints and seclusion.

What was intriguing is that many behavioral factors as we know are related to culture. For example, in my work with hospitals a client once told me that there was situation where a young 36 year old man was told that he had cancer and it was aggressive and then basically left there without the care of someone who would communicate with him. He was black and in a predominantly white staffed hospital facility. Upon being told he began to talk very loud and forcefully and demand some answers. His escalating tone and demands prompted the care staff to call security who immediately called the police. He was put into restraints which made him become more irate.

Later a black nurse came to him (after being requested) and he explained that he was scared, felt all alone, and no one was answering any of his questions. The less they responded, the angrier he became. He was released from the restraints almost immediately after the black nurse arrived and began to get his questioned answered.

Culture and behavior go hand in hand. If your cultural competency and cross-cultural communication skills are on par to where you want them to be this new standard the Joint Commission is putting into effect will be taken care of in the course of how your organization operates each and every day. Patient-centeredness and this new standard are very much in alignment; as such there is no patient-centeredness without cultural competence.

If you want to learn more about tools for Cross-Cultural Communication, email me at amrijohnson@gmail.com.