tag:blogger.com,1999:blog-65274770639533952612024-03-05T13:10:25.594-05:00Cultural Competency and Diversity in HealthcareAmri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.comBlogger84125tag:blogger.com,1999:blog-6527477063953395261.post-66740690483560779722011-10-24T20:17:00.007-04:002011-10-25T00:06:38.094-04:00Identity-Based ERGsA couple weeks ago on a list serve/linkedin group, there was a debate about Employee Resource Groups. My personal sentiments at times differ from the standard practice of the majority of corporations and their diversity teams. Other times, it may be me simply being difficult. In this instance, my thinking about ERGs that identify by an exclusive group (i.e. African-American, Latino, LGBT, particular religion, etc.) is that representation of those identities in and of themselves in organizations are important, but less and less lead to believe that most ERGs (a.k.a. affinity groups) focused on a single identity are helpful in the long run for organizations or for those engaged.<br /><br />My responses to the inquiries and reactions are in italics.<br /><br /><span style="font-weight: bold;"><br />In response to a member asking about starting an LGBT ERG.</span><br /><span style="font-style: italic;"><br />It is not a secret how I personally feel about identity-based ERGs. By their nature, I think they are exclusive and have spotty effectiveness in the strategic sense. People will naturally gravitate towards that which is like them at some point or another. Reinforcing this actually can set people up for challenges (i.e. Asians (particularly Chinese) being promoted proportionately to upper management/leadership in technical organizations where they well-represented overall). Of course, marketing segmentation, product differentiation, etc. make sense to me. At the same time I always wonder about the ability of a particular group ERG to engage outside of their group beyond situational engagement that is, in a way, artificially constructed. The key ingredient to whether decisions get made based on particular input--trust--is missing in the equation. It is missing primarily because the out-group (e.g. non-LGBT and perhaps A, in this case) is rarely intimately embedded in the foundational conversations of group establishment. Consciously or unconsciously in-group bias on both sides is reinforced. Further, we get these ERG leaders focused on themselves more than the strategic direction of the company, again setting them up for missing opportunities in the long-term as they don't see the bigger possibilities and responsibilities that their role as a member of an ERG entails (or at least could/should/potentially might entail).<br /><br />So, the intention is good. On the other hand, where long-term impact is concerned (so-called measurement or data supported justification or not) I am not convinced that in the times we are in now that newly established identity-specific ERGs can have the impact that a broader concept (i.e. inter-generational groups) can. </span><br /><br />The responses ranged from people defending the position of ERGs in general to letting me know that, for all intents and purposes, "You are wrong." A summary statement that I thought spoke for most respondents was the following: "Creating these identity based groups creates a sense of place in the company for people who fit a particular affinity. It allows them to have a safe place in a company where most do not look like them and don’t understand their experience. It is a message from the company that they are “present” and that the company understands the uniqueness of their experience. This is very affirming for employees who are not part of the majority. This I can stomach and they in fact could be right." Again, point taken.<br /><br />Thing is, when we look at the stats and articles such as this:<br /><a href="http://management.fortune.cnn.com/2011/10/07/asian-americans-promotion-us-companies/">Is there a bamboo ceiling at American companies?</a> what do we conclude?<br /><br />One is left wondering how affective these ethnic and other identity-focused ERG really are? Answer is, we really only know by anecdote. And in many instances the ERG has not made much of a dent in dynamics such as these. They either are not tasked to or have not made it a priority. People are more comfortable around other folks like them and very little changes. Perhaps when people are too comfortable, very little changes for individuals or the organizations they serve?<br /><br />The conversation ended with the potential of an academic study of ERGs. Great outcome!<br /><br /><span style="font-weight: bold;">My conclusion was the following:</span><br /><span style="font-style: italic;"><br />Know that there is little in the world that I am flat out opposed to. LGBTA ERGs and ERGs in general included. ERGs make sense, we should have them, we also should be tasked to take the idea of them deeper, this is my intention.<br /><br />One thing I am allergic to is doing the same things over and over and even when evidence of effectiveness is limited, justifying that which we are attached to for lack of a viable alternative.<br /><br />This is the situation with ERGs in many cases. There are some great identity-focused ERGs in companies. Some contribute a lot to all of the areas that were shared from 'engagement to safe spaces'. I am less sure of their collective, long-term, impact across the board. . .This is not something "I know" but intuitively and experientially I sense and have seen limited impact other than the generic anecdotal statements that "ERGs are good, they help underrepresented people" and perhaps some ROI anecdotes on a limited basis; yet, have not seen anyone challenge the notion that this is "true" beyond anecdote alone. Are we capable of assessing broad impact beyond a few isolated cases? "Its like a jungle sometimes it makes me wonder. . ."<br /><br />So, ERGs get a thumbs up in theory! Our collective willingness to question that which we are convinced of or explore alternatives to, gets a "so-so (with the hand vs. a thumbs up)" in practice.</span><br /><br />Hopefully, the result of this conversation is another avenue to test hypothesis about this work we call diversity and inclusion. The urgency of our politico-economic situation requires us to go deeper. No time to waste.<br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com0tag:blogger.com,1999:blog-6527477063953395261.post-84508659515510625012011-09-27T09:52:00.005-04:002011-09-27T15:32:36.673-04:00NIH Uncovers Racial Disparity in Grant AwardsIt has been a while, but I am back and hopefully consistently so. Thanks to all of you who have encouraged engagement during my hiatus.<br /><br />Let's explore the impact of disparate funding for black scientists. While studies like this can always be questioned as to method and reliability with over larger sample populations, the fact that the study was published in a reputable journal says that this issue is bigger than one of one race vs. another. This is an American problem. Disparity exists just like diversity does.<br /><br />The questions are numerous: How well do we understand the impact of these disparities on our ability to compete globally? What is the impact of disparities such as those described in the study to our healthcare system overall?<br /><br />As we examine the future of health, how science gets done and who does science is critical to our success in the U.S. and in a way globally given the historic impact of U.S. scientists. The conversation has to start even as far back as elementary education. This is significant, let's treat it as much bigger than we can see at present. <br /><br /><br />Biomedical Research Funding<br />NIH Uncovers Racial Disparity in Grant Awards<br /><br /><span style="font-weight:bold;">by Jocelyn Kaiser</span><br /><br />It takes no more than a visit to a few labs or a glance at the crowd at a scientific meeting to know that African-American scientists are rare in biomedical research. But an in-depth analysis of grant data from the U.S. National Institutes of Health (NIH) on page 1015 in this issue of Science finds that the problem goes much deeper than impressions. Black Ph.D. scientists—and not other minorities—were far less likely to receive NIH funding for a research idea than a white scientist from a similar institution with the same research record. The gap was large: A black scientist's chance of winning NIH funding was 10 percentage points lower than that of a white scientist. <br /><br />For whole article <a href="http://www.sciencemag.org/content/333/6045/925.full?rss=1">Click Here</a>:Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com0tag:blogger.com,1999:blog-6527477063953395261.post-47703565951979671352011-02-26T08:07:00.001-05:002011-02-26T08:08:55.056-05:00Medical News: Pro-Bowl Player's Suicide Renews Head Trauma Debate - in Orthopedics, Sports Medicine from MedPage TodayVery interesting article. What stood out was the statement that people responded to Dr. Omalu in a way that immediately tried to discredit him based on his ethnicity: <span style="font-weight:bold;">"The National Football League reacted with outrage, demanding a retraction of the paper. "They said I was Nigerian -- what I was doing wasn't science, I was practicing voodoo medicine,"</span> he recalled." This is not uncommon and speaks to the lack of consciousness that we exhibit when emotional threats (attachment to the sport of American football) or financial threats (NFL, vendors, broadcasters) are perceived. Dr. Omalu's emotional connection to the sport is likely to be less than mine or if you are a fan, yours. Scientifically, his seemingly extreme statements have to be put into context and examined as the problem is a clear one. Given the escalating dialogue about it over the past few years, it is probably bigger than we think and starts when simple aspirations of a professional sports career germinate.<br /><br /><a href="http://www.medpagetoday.com/Orthopedics/SportsMedicine/25064">Medical News: Pro-Bowl Player's Suicide Renews Head Trauma Debate - in Orthopedics, Sports Medicine from MedPage Today</a>Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com1tag:blogger.com,1999:blog-6527477063953395261.post-52821347732377931082010-05-07T22:21:00.004-04:002010-05-07T23:54:19.769-04:00The Risk of Cultural IlliteracyI went to a networking breakfast this morning at the Boston Center for Community and Justice on Diversity: Institutionalizing Diversity as a Business Strategy.<br /><br />A very well done event with a number of business leaders committed to the integration of this thing we call diversity in a manner that connects like "traditional" business staples like lead generation, fulfillment, accounting, etc.<br /><br />It is easy in meetings like this for the default to go straight to workforce representation conversations. Some commented on how some of their companies have gotten executives to fulfill diversity goals and it has increased representation. Others shared that the goals of representation are also tied development. That resonates with me, but it also falls short to me in a way, in that what development means and is are often much different than what those responsible for developing their people do. <br /><br />There was one hospital COO there. She mentioned the ideas of health disparities (quality disparities) and cultural competence. I appreciated her commitment and candor about how far they have come and how far they have to go. Where I wished she could have taken the conversation was into an area that most organizations face on a regular basis: risk.<br /><br />Now, while the idea of risk is one that most leaders have to face, they don't generally think about risks in terms of people not being able to relate to others in a manner that is in alignment with their needs. In healthcare the risks here are obvious. Just speak to any clinician who has had diagnoses compromised due to not having the ability to discern cultural cues. Cues that may have provided additional data for a diagnosis that could have prevented or at least mitigated further suffering on behalf of the patient.<br /><br />In other industries, I hold that the risk of cultural incompetence and what I call "cultural illiteracy" (extrapolated from health literacy) is just as profound. In a global playing field of business, the stakes of cultural navigation matter more than ever before. <br /><br />For many Americans, the lens of the world is narrow and generally has an insular focus. The risk here is that if we are not able to consider the globe as the business environment that we live within; and recognize that the norms of business are as diverse as the world is big, our ability to be competitive in this global economy is mitigated. This is not just true for people from the U.S., this is true for everyone.<br /><br />Consider that we are all culturally illiterate in a way. Now, think about the risk of being illiterate in any other sense of the word.<br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com7tag:blogger.com,1999:blog-6527477063953395261.post-86821974790300631372010-04-11T15:53:00.005-04:002010-04-15T21:34:27.929-04:00Talking Electronic Health Records and Clinical TrialsTwo of my colleagues, Chris Thorman from <a href="http://www.softwareadvice.com/medical/electronic-medical-record-software-comparison/">Medical Software Advice</a> and Avis Williams from <a href="http://www.solarbiomedical.com">Solar BioMedical</a> have written some great articles on the connections between clinical trials and electronic health records. The opinions expressed are their own and not necessarily reflective of the views of Diversity HealthWorks or Amri Johnson.<br /><br />With the changes in health reform, this may be a topic of increasing interest. Thanks to both Chris and Avis for their contribution. Enjoy!<br /><br />Make it a great day!<br />Amri<br /><br /><span style="font-weight:bold;"><br />Electronic Health Records and Clinical Trials: An Incentive to Innovate</span><br />by Chris Thorman<br /><br />As we wait for the federal government to finalize important sections of the Health Information Technology for Economic and Clinical Health Act (HITECH), there is a lot of talk about the financial incentives for implementing electronic health records (EHR). And understandably so. Practices that implement an EHR under the federal government’s guidelines stand to gain nearly $50,000 in incentives over the next five years. (<a href="http://www.softwareadvice.com/articles/medical/medical-news/electronic-health-records-and-clinical-trials-an-incentive-to-integrate-1031910/">More</a>)<br /><br /><span style="font-weight:bold;">Electronic Health Records and Clinical Research: A CRA's Perspective</span><br />by Avis D. Williams, MSPH, CCRA<br /><br />A CRA is the term for anyone involved in monitoring clinical trials. One of the main roles of a CRA is to help ensure timely generation and collection of quality research data. With the advent and popularity of electronic clinical trials (eClinical Trials), CRA’s are seeing a gradual increase in the number of clinical research sites (research hospitals, educational institutions, and private medical practices) opting to use electronic medical records as source documents for their clinical trial data. This article describes some of the benefits and drawbacks encountered by CRAs when monitoring sites that use electronic medical records as source documents for their clinical trials.<br /><br />Benefits<br />During a typical monitoring visit at a site that does not utilize electronic medical records, a CRA can expect to be provided with at least two or three thick medical charts that often take up needed space on the small desk provided by the site to work. A paper medical chart may or may not be organized, legible, or complete. Sometimes, the paper medical chart is not available to the CRA during the monitoring visit because the patient is scheduled to have an office visit on the same day as the monitoring visit. All of these factors can potentially hinder the timely collection of important data, or compromise the quality of the data collected by the CRA. Each day’s delay in getting data collected and analyzed for drug approval can cost more than a million dollars to the pharmaceutical or biotechcompany sponsoring the clinical trial. Therefore, timeliness in collecting quality clinical trial data is very important.<br /><br />However, when a site uses electronic medical records, the CRA experiences a very different scenario. There are no thick medical records to clutter his/her work area. All the medical data are on the computer provided by the site. The electronic medical records tend to be very organized and consistent with the same layout, making it easier to maneuver through the chart and locate the data needed within the chart. The doctor’s progress notes are typed instead of hand written, making the progress notes legible to read. Because the medical records are electronic, more than one person can have access to the record at the same time. The CRA no longer has to wonder if a chart will be available to review during the visit if the patient’s visit happens to be on the same day as the monitoring visit. All of these factors help ensure the timely collection of data, reduce the risk of poor data quality and data analysis delays.<br /><br />Perhaps one of the more important benefits of having electronic medical records from a CRAs view point is the salvation of data during natural disasters caused by hurricanes, tornadoes, tropical storms, fires, earthquakes, etc. The database that stores the information in the medical record prevents the information from being destroyed during these events. Most southeastern and coastal states in the U.S. are prone to these types of disasters. Clinical research associates can often expect delays in collecting data at these sites during the seasonal weather patterns, but the threat of never collecting the data is eliminated due to the use of electronic databases to store the medical records.<br /><br />Challenges<br />Though the benefits of having electronic medical records are substantial, a few important challenges exist at many sites when monitoring clinical data sourced from electronic medical records is required. These challenges include: 1) non-compliance with 21CFR(code of federal regulations) Part 11; 2) defining the difference between research chart and medical chart; 3) Typos and transcription errors; 4) data entry delays.<br /><br />Compliance with 21 CFR Part 11 is very important when sites decide to use electronic medical records as source documents for their clinical trials. This federal regulation requires all electronic records to be electronically signed off with a unique user ID and password that is only known by the person creating the document. The regulation further requires each person who has access to a patient’s medical record to be provided with a unique User ID and password as well, including monitors and auditors. CRAs often find that sites and hospitals are using electronic medical records, but they are not 21 CFR compliant, and therefore cannot be deemed as a true electronic medical records facility for clinical trials. In these cases, the CRA is often unable to view the electronic medical record because the site’s computer network is not secure enough to provide the confidentiality needed for other patients’ medical records who are not participating on the clinical trials. The site is still expected to provide printouts of the unsecured information in a paper medical chart along with a statement confirming that all of the printed medical records are complete, and that not documents are knowingly withheld.<br /><br />A second challenge observed by CRAs is the site’s difficulty in determining the difference between a research chart and a medical chart. Many electronic medical record sites tend to still provide the CRA with a separate paper research chart even though they have electronic medical records. This is often explained by stating that some records are not a part of the medical record, but were obtained from documents developed for the clinical trial, not for the medical record. Therefore, the extra documents were filed in a separate folder outside of the electronic medical record. The challenge encountered here is that a true electronic medical record should contain all documents pertaining to any treatments or clinic visits by that patient. Therefore, the ideal electronic medical system should have the capacity to accept scanned documents from outside sources as well as contain all dictated notes from internal clinic and hospital visits. The purpose for utilizing an electronic system in clinical trials is so that all source data is available and accessible in one working system.<br /><br />A third challenge experienced at sites with electronic medical records is the increased risk of typos and transcription errors of dates, patient identity and treatment information, cutting and pasting. These errors can compromise data quality, and delay timely data collection if not promptly corrected.<br /><br />A final challenge experienced by many CRAs working with electronic medical record sites is the have lag time in which patient visits are posted for viewing in the medical record. Many sites have lag times of 48 to 72 hours before the most recent visit can be available for review. Therefore, if a patient’s most recent visit was completed one or two days before the CRA’s visit, then the CRA will be unable to review the data for that patient’s visit because of the lag time required before the patient’s most recent visit is posted, making it difficult to collect the most current data (serious adverse events, adverse events, conmeds, treatment, etc.) for the patient.<br /><br />Conclusion<br />Though the above challenges of non-compliance with 21CFR Part 11, defining the difference between research chart and medical chart, typos and transcription errors, and data entry delays are significant, they are fixable and will only enhance the benefits of utilizing electronic records once resolved. Sites that are dedicated to providing stellar electronic medical records are already implementing checks and balances in their system to resolve these challenges. Many of the benefits of easy access, less clutter, data storage during adverse weather patterns, legible progress notes, and consistent chart organization discussed in this article are key drivers of productive monitoring visits that will increase data collection and data quality at the site.Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com5tag:blogger.com,1999:blog-6527477063953395261.post-83400342481885538712010-03-27T14:26:00.005-04:002010-03-28T20:54:22.920-04:00Truth Serum"The truth as an offense, but not a sin."<br /> Bob Marley<br /><br />Last week (March 23, 2010), President Barack Obama signed into law Healthcare (insurance) reform after it successfully passed in the United States Congress on Sunday, March 21st.<br /><br />What it means as you have probably read in the paper is that a lot more people will eventually be able to have healthcare coverage and health plans will have a few new restrictions that will aid in them being somewhat more balanced as far as covering people's needs is concerned. Health plans will not suffer, business will not suffer, if you are reading this blog and you make over $200,000 per year (at most about 5% of Americans) you will be required to contribute a little more of your income in taxes. I think this article from MSNBC is one of many that gives a pretty good explanation of what is to come on the surface.<br /><br />With that out of the way, I wanted to see if now that we have something to work with, will those who we have elected to govern choose to govern or will they choose to hide behind one excuse after another so that they can continue to resist their leader. Or should I say the elected leader that some consider theirs?<br /><br />I wrote several months ago that this idea of healthcare reform is a microcosm for American society. My intention was to begin a dialogue about what the realities of this debate really were and until today actually are.<br /><br />So, now that we have a health reform bill signed into law, what is the truth? If we had a truth serum to get into the minds of those who are still living with what is in many ways a violent, and certainly visceral response to this legislation what would they say?<br /><br />Believe me when I say that I get political leanings. It is clear that tilting the balance of power towards the political party that one represents is generally in the goals of a politician. And despite obvious drawbacks of governing on leanings versus principle, I don't expect for that to change.<br /><br />And while I fundamentally believe that the interests of most politicians are consistently biased towards how they can negotiate in a particular direction; I don't believe their intentions are such that they are opposed to things that have the potential to do a great deal of good for a majority of the people that elected them to office.<br /><br />In the case of healthcare insurance reform, I am not so sure that this is about party, position, or the American people.<br /><br />When one hears the rhetoric and refrain of healthcare reform opponents via social media or the news media, I have not heard the whole truth. It is almost like listening to code language.<br /><br />We hear:<br /><br />"It's too expensive, it will break us."<br /><br />"This is a [still] a government take-over of healthcare."<br /><br />"He said he was going to be bipartisan, what happened to that."<br /><br />"We want healthcare reform, but we feel like we simply need to start over, why rush this?"<br /><br />"This bill is not good for the American people."<br /><br />Then of course:<br /><br />"Obamacare is socialized medicine!"<br /><br />and recently from Newt Gingrich:<br /><br />“They will have destroyed their party much as Lyndon Johnson shattered the Democratic Party for 40 years [by passing civil rights legislation]."<br /><br />You have to appreciate Newt's honesty. He spoke as if he had taken truth serum. In fact, he summed up what the unspoken sentiment of many Americans is and has been manipulated to be where reform is concerned: opposition to the idea of President Barack Obama.<br /><br />They are not opposed to the Office of the President, they are not really even opposed to Democrats, or healthcare reform for that matter. I would argue that most Americans don't know enough about the inner workings of health reform or economics to an extent that they even really understand why they feel how they do. In this case of resistance to reform, they are primarily opposed the physical identity of one man.<br /><br />The code language that has been used by resistant politicians and pundits is incrementally becoming more explicit, but in general they have restrained themselves. They have done so because deep down they know that their sentiments are contrary to what they believe is "the right thing". Their anger and resistance is a reaction, in my opinion, to a compromised conscience.<br /><br />When the integrity of one's conscience is compromised, guilt often turns to guile. To mitigate the guilt, many make the object or idea of their guilt to be wrong. They demonize and attack them as a salve to mitigate such a compromise. When the salve doesn't serve its intended purpose, they intensify it.<br /><br />I am still concerned with unilateral thinking and total lack of compromise for anything other than personal benefit. I still feel it could be the downfall of country's integrity and I am hoping that I am wrong.<br /><br />For now, I am pleased that President Obama did <span style="font-weight:bold;">something</span>. With the bill's flaws (there are in my humble opinion several unknowns that could be problematic), challenges to the idea of reform, and vehement resistance towards his character, he persisted. I don't care too much about party, but I do care about principle.<br /><br />What principles will we carry forward in the transition to a new America or for that matter a new world?<br /><br />I think that is one vital question of the future. With all of the unknowns facing us in the future of healthcare and our general prosperity as a country, we can only rise or fall on principles.<br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com3tag:blogger.com,1999:blog-6527477063953395261.post-79970555386360821042010-03-14T19:44:00.002-04:002010-03-14T19:55:19.695-04:00The Idea of MentoringIf there is an idea of mentoring in your mind that is about how one person with expertise and another more "junior" person sit by the fireside while the knowledge seeps in from the "expert". . .think differently.<br /><br />I had the opportunity to hear Dr. Audrey Murrell, Associate Professor at the University of Pittsburgh, speak today. Her approach, depth, and breadth of reach where the idea of mentoring is concerned was phenomenal.<br /><br />She started the conversation getting us clear on the distinctions between mentoring myths and the realities of what mentors are and can be. From there she moved into clearly describing the roles of mentors and how within the role is always a symbiotic relationship. She shared that it is not a paternalistic/maternal parent-child dynamic with a superior-subordinate, helper-helped interaction.<br /><br />This fact that the nature of mentoring is two-way and that both parties should be benefiting from the cultivation of the relationship is, for many, a profoundly different way of viewing mentoring. And even though there are people who have experienced the benefits of having a mentee and have communicated about these inherent benefits, there is still the idea by some that it is a time-sucking, obligatory distraction from "my work".<br /><br />What excited me the most was the clarity she brought to the idea that mentoring is a separate responsibility of the leader/manager vs. an integral responsibility that benefits individuals and organizations in the short and long-term. She said this supported by data and great personal experiences.<br /><br />Dr. Murrell's explanation of the benefits of mentoring led me to reflect on the views that people often have about diversity and inclusion. Inclusion goes naturally hand in hand with development. Being truly inclusive as a leader fosters the manifestation and cultivation of diversity in its myriad dimensions. Developing people is not optional just like cultivating diversity is not optional, especially in certain disciplines and industries. And given the nature of the especially complex problems we are asked to solve in our businesses these days we cannot afford to discount it in any sense.<br /><br />Diverse perspectives are not only valuable, but to be competitive they are essential. All dimensions of diversity from identity to outlook must be considered if innovation and continuous improvement/maintenance of quality are desired.<br /><br />I suggest you pick up Dr. Murrell's book <span style="font-style:italic;"><a href="http://www.amazon.com/Intelligent-Mentoring-Creates-Knowledge-Relationships/dp/0137130848">Intelligent Mentoring</a></span>. Her perspective and insight is a great contribution to any organization or professional who would like to develop this vital leadership competency.Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com1tag:blogger.com,1999:blog-6527477063953395261.post-80026663522266188912010-02-11T22:47:00.005-05:002010-02-12T01:31:35.879-05:00Staying under the radarFrankly, I am not sure what is worse for an organization, especially a healthcare organization: a disengaged employee or a disengaged employer.<br /><br />Both are accountable for each other's circumstance. And if I was a betting man, I would bet that it is very difficult (perhaps impossible), in aggregate to say in which direction the disengagement came/comes from. It doesn't really matter who was the chicken or the egg. What matters is what it creates--individual and organizational suffering.<br /><br />Now, this notion of organizational suffering is not often talked about. As a disengaged employee, why would one care about an organization suffering? In fact, if it is not our company (one we work for) or one we do business with, why would the notion of organizational suffering matter?<br /><br />Individual suffering is a different story. When we can "see" suffering, our feeling is visceral and it summons our compassion which is expressed as an energetic acknowledgement of our connection to the other we are observing. Or, as we have seen in the outreach that many Americans have made in response to Haiti, our compassion is expressed with a financial sacrifice at what ever level one is able or willing to contribute. This is good.<br /><br />On the other hand, there is the suffering that perhaps is much more prevalent in organizations and in individuals. It is hidden suffering. It is blight of commitment, willingness, creativity, desire to be with "the other". It is perhaps the opposite of compassion as it can take even one's individual desire to contribute to self away.<br /><br />A few months ago before I moved to Cambridge, I was talking to a few of my friends and colleagues and I kept hearing a common theme when I asked some of them about their work: "Amri, I am just trying to stay under the radar." They often said this with a bit of an uncomfortable look on their faces as if they were under surveillance and were scared to speak too loudly.<br /><br />I can't say that I know exactly whether or not they were joking or were in part or totally serious. What I can say is that the idea of "staying under the radar" is a suffering idea. It is, joking or not, the idea that you are being targeted and have to assure that the radar cannot detect you. It is not just a suffering idea for an individual, it is as such equally to the organizations that these folks work for as they are getting, at the most, half-rate production and contribution.<br /><br />Just imagine yourself as an employer being able to secretly know all of your "staying under the radar" people and when you walked through the seas of cubicles and past offices you saw 20-30% or more of your people appearing as though they are ducked under their desks working in the darkest part of their workspace. The idea of it is hilarious and utterly depressing at the same time. If I saw this, it would cause me to suffer and it would cause me to act.<br /><br />This conversation is two-sided and employees with the sentiment to disengage have to be as responsible as their employers have to be in making sure they stay engaged. Thing is, not everyone always knows that disengagement is taking place. That is another conversation that we have to have in the near future. <br /><br />It pays to know that all suffering experienced is shared and the responsibility to transcend it is shared, too.<br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com4tag:blogger.com,1999:blog-6527477063953395261.post-27293165595824614552010-01-27T22:44:00.006-05:002010-01-30T09:21:59.170-05:00iPad Launches: Can it Help Healthcare?Greetings All,<br /><br />My colleagues at Medical Software Advice are curious to know if you think a new technology like the iPad, just launched today-A Steve Jobs classic-can assist healthcare providers.<br /><br />They want to know from you. Please share your thoughts in the survey below:<br /><br /><a href="http://www.softwareadvice.com/articles/uncategorized/which-tablet-pc-will-rule-the-halls-of-healthcare-1012610/">Which Tablet Computing Device Will Rule the Halls of Healthcare?</a><br /><br />There is no obligation and neither Amri Johnson or Diversity HealthWorks were compensated for promoting the survey. We simply would like to get your response. For many years there have been a variety of devices that healthcare has used to collect data. Some have been great, others not so functional. Some say the iPad's functionality can be potentially revolutionary.<br /><br />Let <a href="http://www.softwareadvice.com/medical/">Medical Software Advice</a> know what you think and of course. . .<br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com0tag:blogger.com,1999:blog-6527477063953395261.post-76752413516356820502010-01-20T02:22:00.002-05:002010-01-20T02:22:00.405-05:00Passion and ReasonWhen we get down to the business of organizational transformation the road to success is difficult at best. If we desire for the principles of inclusion and cultural competence to be central to transformation the difficulty can be exacerbated.<br /><br />Most people I know have some type of passion in life. This passion is coupled and/or often met with the energy of reason. <br /><br />In the the classic book, <span style="font-style:italic;">The Prophet</span> by Khalil Gibran, the speaker says about Reason and Passion: <br /><br />"Your reason and your passion are the rudder and the sails of your seafaring soul. If either your sails or your rudder be broken, you can but toss and drift, or else be held at a standstill in mid-seas. For reason, ruling alone, is a force confining; and passion, unattended, is a flame that burns to its own destruction."<br /><br />Many of the people I have observed who are committed to this conversation about cultural competency and diversity are very passionate about it. In fact, they have been so passionate, that their reason has been "a flame that burns to its own destruction." Their passion has met with the reason of others and the reason has rationalized away the importance and intrinsic value of the passion. <br /><br />Historically when a person passionate about diversity, inclusion, and cultural competency has had their ideas or budgets minimized, it has in many instances been the result of not doing the diligence of finding the passion(s) of others in the organization. As a result, when there is an opportunity to validate one idea vs. another, the result is often a cyclical resistance of one passion to protect another or to suppress a passion with reason because of a perceived imbalance.<br /><br />I think we are at a crossroads in the evolution of business in this country and perhaps globally. The crossroads is one that lies between passion and reason. Often when there is a crossroads it means that we have to make a choice. The choice for most is seemingly dichotomous. But as Gibran reminds us:<br /><br />"Therefore let your soul exalt your reason to the height of passion, that it may sing; And let it direct your passion with reason, that your passion may live through its own daily resurrection, and like the phoenix rise above its own ashes."<br /><br />So, as we enter into these discussions where a passion for diversity is met with a question about viability, a business case, ROI, a bottom line rationale for why what we do should be done--get excited! Get excited as we are able to meet the reason of one with the passion of another. <br /><br />We are also able to discover the passions of others that we were potentially unable to discern because of our resistance to what we thought was their attempt to suppress our passion. The coupling of reason and passion allows us the space to create something that goes beyond the simplistic rift that we have historically created.<br /><br />When we can understand our passions and use them as impetus for discovering the passions of others, reason when it arises is a gift. It can be seen as a balancing element of a chemical equation; an opportunity to validate something that could be transformational--the beginning of possibility.<br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com0tag:blogger.com,1999:blog-6527477063953395261.post-84408232407060135502010-01-05T23:47:00.008-05:002010-01-12T23:12:06.724-05:00Will short-term thinking's results ever jolt us into reality?When I started this post it was late Tuesday evening January 5th, and I wanted to simply get on-line and finally say Happy New Year to all of you who have been so tremendously supportive of this blog and our network and the mission that Diversity HealthWorks believes is absolutely critical to healthcare being all that it needs to be for this country.<br /><br />Thank you for your support. I cannot fully express my appreciation in a writing, but know that the conversations generated, and the movement made towards creating what I feel is "REAL and ROBUST" healthcare reform (vs. financially-driven political health insurance reform) is greatly appreciated.<br /><br />It was hard to get it all out when I started because I have had a heavier than usual sense that we are moving more and more rapidly away from our capacity to empathize. It is being replaced by blame, fear, and a mindset of scarcity. I understand it and I sympathize because I know that folks are struggling to different degrees. My concern is that the struggle is not making us more progressive as a nation. <a href="http://thinkexist.com/quotation/if_there_is_no_struggle-there_is_no_progress/10807">Frederick Douglass</a> said: "If there is not struggle, there is no progress." My worry is that struggle is resented and as a result progress is thwarted. <br /><br />I expressed in the last post that I am concerned that Americans don't have anything we agree on that connects us. Perhaps my Utopian sensibilities seem unrealistic, but it occurs to me that without any common bond, we are not a United States, we are simply a bunch of individuals focused on, as Janet Jackson stated in her song and Eddie Murphy repeated in a later comedy special, "What have you done for me lately?"<br /><br />We are so wrapped up in the moment that we have no vision beyond "what I get more of" and/or "what they will take more of" and/or "if I get less of anything, it is wrong". Now, this is not a universal sentiment. Some feel blessed to have or have ample amounts and are willing (at least for now) to contribute a little more of what they have for those who have little to nothing. <br /><br />Of course, since I talk about and explore facets of healthcare more than anything, I have seen this response to various health insurance reform bills proposed that suggest that those with more will pay a little more in some cases. So, I applaud those who are okay with this. Personally, I cannot say that they are right or wrong for thinking this way, but I think it is honorable and anyone willing to give gets a nod from me. I dare not question their intention, it is not my job.<br /><br />On the other hand, there are those adamantly opposed to anything that speaks to addressing social issues that seemingly affect a few, but in reality affect us all. There is a belief that "those people" who could be the uninsured in the case of health insurance reform, "don't deserve care if they cannot afford it". <br /><br />There is no consideration of what happens to a society that thinks like this, no consideration of how they are and will increasingly be directly and indirectly negatively affected, no consideration of the future of a nation that does not care for its people. <br /><br />So, why this rant from a blogger that has traditionally been very much committed to presenting as balanced a perspective as I try to have in my consciousness?<br /><br />Well, my conscience is speaking to me. My intuition is clear that where we are going, under the guise of making America strong, has very little to do with preserving the integrity of these <span style="font-style:italic;">not so</span> United States and everything to do with individual preservation and in my opinion, our rapid demise.<br /><br />I feel compelled to simply express my concern that we stand in the space of exploration about who we are choosing to be, more so than perhaps we ever have in our history. And for the most part we are not going too deep in this exploration. In fact, we are not even truly exploring anything beyond short-term dynamics that historically when focused on, have lead us to another short-term dynamic with less than ideal results.<br /><br />Now, I am not saying to stop questioning our political system or the possible draw backs of spending taxpayer money to fix social problems, like health insurance reform, or even the dynamics of the economic recovery. By all means, say what you feel.<br /><br />My issue is that as much as we scream and as much as we disagree because of concerns for self-preservation, is it possible to simultaneously consider a longer-term reality that transcends the individual and speaks to connectivity?<br /><br />The time we are in speaks to a new reality of connectedness that we have not experienced in the world we are in prior to now. What this connectivity speaks to is a necessity to consider that win-loss dynamics in any capacity will no longer work. <br /><br />So, there isn't an environmental policy that is good for one and bad for another. There isn't a healthcare solution that benefits one person and harms another. Yes, there are temporary situations that appear beneficial to one vs. another in a situation with apparently dichotomous variables; however, when we go beyond the short-term we will see that they won't work for long and "for long" is a lot shorter than it once was.<br /><br />The reality of a short-term mindset will jolt us into reality. It is already happening and it will make itself more and more evident moving forward. Will we recognize the effect quickly enough to begin changing the tide?<br /><br />I trust that some won't; I am confident and aware that many will.<br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com1tag:blogger.com,1999:blog-6527477063953395261.post-44851078783203387562009-12-27T01:47:00.002-05:002009-12-27T01:59:28.574-05:00The Logic of What Might BeWe have a healthcare (insurance) reform bill passed in theory and probably soon to be passed in actuality.<br /><br />The next question is: what does this mean? What does it mean, politically, functionally, to you, to me, to many others that don't have the wherewithal, desire, or ability (as a result of no connectivity or not having connectivity, if you know what I mean).<br /><br />Well, if I summed it up quickly, it would go like this:<br /><br /><b>What does it mean politically?</b><br />It means that we have a president and a congress that has been in the position and created the positioning to push something through in about a year that has only been done a handful of times in the short history of the U.S. democracy.<br /><br />It means that there will be attacks that happen any time any individual or group overcomes aggressive political opposition to accomplish something that the opposition vowed publicly and privately to completely derail.<br /><br />It means that implicitly, something that has never been done is being done by a figure that has done something that has never been done.<br /><br />It means that explicitly what we will hear is that when a figure that has done something that has never been done twice, the ultimate outcome is that there will be grave consequences because what has been done can't be that good. "There is no proof."<br /><br /><b>What does it mean functionally?</b><br />Functionally, it means that things are going to shift, some slowly, some within the next year. It means that some of us will pay a little more, some of us will pay a little less. It means that some of those folks with no connectivity or less than functional connectivity will have more opportunity to connect with things they need to feel and be connected.<br /><br />It also functionally means that until we get accustomed to the shifts, that we may feel a little uncomfortable. It means that not everything that certain people wanted will be on the table immediately and in some cases not at all. There is no way this could have been all things to all people.<br /><br />The inevitable consequence is that some companies and individuals that are already making a large sums of money from healthcare, will more than likely continue making large sums despite the varying stances on this dynamic. In fact, I am not sure if that would have changed more than a couple percentages in any direction because in reality, functionally, those making large sums anticipate how they can make money despite political outcomes. If we look at it logically, it is smart business. If a company does not anticipate what could be, they are subject to whatever is when it surfaces without any ability to turn the rudder when the ship requires a change of course.<br /><br />So, that brings me to the title of this post. . ."The Logic of Might Be". This statement comes from Roger Martin talking about "abductive logic" in his book <i><a href="http://www.amazon.com/Design-Business-Thinking-Competitive-Advantage/dp/1422177807" target="_blank">The Design of Business</a></i>. Thinking abductively or proving what might be, asserts that past-based logic is not the only logic that drives our predictions of success. This way of looking at problems doesn't guarantee success. Nothing guarantees "success" where outcomes are concerned.<br /><br />However, what it does is creates a space that allows for exploring possibility. In fact, to me it allows us to validate not just a single possibility but multiple dynamics simultaneously.<br /><br />I can honestly say that I am quite disturbed that in this country that we have become so polarized that there is absolutely nothing that we can rally around as a idea that is good for us all. In fact, it seems that whenever such an idea comes about, we, the media, political parties, whomever, seeks a contrary position and drives that resistance so quickly and aggressively, that most people take a side. They seemingly do so because dichotomous options occur to them as the only options possible. This is the Logic of What Was or What Has Been.<br /><br />In this healthcare insurance reform question or any other critical issue facing us in this current reality: Can we explore "The Logic of What Might Be"? or Will we stay limited by inevitability trapped within the cycle of what has been?<br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com0tag:blogger.com,1999:blog-6527477063953395261.post-48059542148292048712009-12-17T20:34:00.001-05:002009-12-17T20:35:51.615-05:00Predictive Modeling of the MassesMy observation of the healthcare insurance reform debate and the war debate and the Tiger Woods debate and the economy debate and the obesity debate and the. . .is that there a lot of debates. There is little action towards an idea, centrally agreed upon that will move the U.S. and perhaps the world forward.<br /><br />So, I came to the conclusion that all of us have become coffee table, computer desk, bar, stationary bike, recliner, barber shop statisticians as we are all engaged in Predictive Modeling. Let me briefly explain.<br /><br /><b>Predictive modeling</b> is the process by which a model is created or chosen to try to best predict the probability of an outcome. (Geisser, Seymour (1993). <i>Predictive Inference: An Introduction</i>) In many cases the model is chosen on the basis of detection theory to try to guess the probability of a signal given a set amount of input data (Wikipedia).<br /><br />The difference with us armchair statisticians in regard to predictive models for healthcare reform is that our models (for the most part) are not based on "detection theory" as described above. If so, that would mean that there was some level of understanding about how we discern potential outcomes. In most of the situations that we currently face including health insurance reform, the dynamics are completely without discernment.<br /><br />In fact, most predictive modeling going on currently is based on one or a combination of: Self Interest, Fear, Preferred Media Outlet, and in the case of healthcare reform one's general depth (or lack thereof) of knowledge about healthcare.<br /><br />Now, my biggest concern about the entire dynamic that we are facing is that given the circumstances (maybe given any circumstance at any time), speculation about what will happen in the future that is so highly unpredictable is a formula for failure and perhaps a formula for mass paranoia. It is not worth it.<br /><br />What is the alternative? Well, I will stick to what I am most familiar with and what is the subject matter of this blog. . .Moving healthcare forward, in my opinion, will be much less dependent on reform of the system than it is on a paradigm shift in our organizations and individual consumers. The fundamental premise of healthcare is not cost, it's people, quality, and care in that order. I recognize that we have to make money to stay in business, those that know me will tell you I am far from naive in that regard.<br /><br />However, the "money first" strategy has gotten us where we are in healthcare. The heuristic that emphasizes care is grossly compromised by financial considerations. In a model where <i>people come first</i>, efficiency is created through effective communication. Doing things well early in the process and setting the stage for effective self-care will inevitably save money.<br /><br />Let's try this as a premise--1) focus on people/patients; 2) with this focus learn what effective communication is for each patient--make developing cultural competence central to effective communication; 3) resolve that effective communication for a year and the investment into it (not a highly expensive one) will impact quality/core measures more than anything else a healthcare organization can do.<br /><br />Now, this premise is not going to quell the voracious appetites for the predictive tweeters and bloggers, ranting on about how the world is coming to a halt due to the actions of a single leader in one year. Nor will it make those demanding a public option without knowing enough about the pros and cons to do anything more than make an emotional plea.<br /><br />What the premise above or any other premise you suggest can do is move us towards something we commonly agree on with the intent to use this heuristic to prove something or disprove something rather than speculate ourselves stagnant.<br /><br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com1tag:blogger.com,1999:blog-6527477063953395261.post-66377381911192561942009-11-15T21:02:00.000-05:002009-11-15T21:03:01.916-05:00Cynics and PossibilityI often envy cynics. In the midst of change they can so easily begin their critique of the current realities. Or they can take a premise (the central idea of any breakthrough innovation) and dismantle it purely based on their past-based data and understanding alone.<br /><br />In the past my orientation to the cynic went somewhat like this: In scathing displacement they deftly spin their cocoon, a blanket of protection which ironically seems to be woven in resistance to the transformation that deep down, they desperately desire.<br /><br />I am not so sure that this is the case anymore. In fact, it may be that cynics are intentionally playing a role. So, the idea of the devil’s advocate may come to mind, but I think it is more profound than this. For the self-professed and consciously (perhaps conscientiously, too) engaged cynic, their role seems to be one more so that of a constant reminder to look at problems from as many angles as possible. In addition or alternatively their role is also to serve as adviser to the power of intuition.<br /><br />If you feel it strongly in your gut and it is not challenged, the integrity of the idea never stands up to anything strong enough to be for certain that it is anything more than a fleeting good feeling.<br /><br />Let me give an example of why I am learning to appreciate cynics more today than ever and why I think they are the some of the best generators of possibility.<br /><br />Over the past several years my work has led me to generate many premises about human capital dynamics. Most recently, the premise that a focus cultural competence and quality and the components that create and drive the above, are the core of success in any healthcare organization and perhaps in any organization period where quality is valued. The components, especially inclusive leadership and employee engagement have come to be core to the premise in that they are critical in producing sustainable results.<br /><br />So, I have this premise and some of the people in organizations that have agreed that this premise is worth pursing are going about testing hypotheses and questions that relate to the ideas of our model. They are of course leaning heavily on those components that serve their specific needs right now.<br /><br />What the so-called cynics have done for me is inspire me to not be stuck on a single point of possibility. Where before I recognized that the various parts of our model can give organizations a way to connect the often separated components of organizational development.<br /><br />Lately as a result of some of my ideas being challenged and sometimes told to not be practical or feasible, have given me insights towards possibilities that simply were not considered before. I see the value in going deeper into any one component of the model and connecting to the others naturally without having to do 8 other things to legitimize the premise. I questioned a central premise based on a cynical response and in my questioning I discovered a new space to explore and share with you.<br /><br />Now, my envy for the cynic is not envy for their being cynical but appreciation of what they inspire and hopes that I can take on a little more of their characteristic skepticism in order to create and recognize possibilities as they arise.<br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com1tag:blogger.com,1999:blog-6527477063953395261.post-31370587946920015122009-10-29T16:55:00.000-04:002009-10-29T16:56:40.447-04:00Everyone's at Fault-Everybody's at RiskIn the healthcare insurance and healthcare reform debate (I consider the financial side a part of overall reform, but it is not the complete picture of reform) there are obviously sides that have been taken.<br /><br />On one side is the "'we need universal healthcare', 'we need a so-called 'public option'; 'healthcare is a right not a privilege', 'those bad health insurance companies are bringing us all down,'" contingency. You are familiar with this side or you subscribe (at least in part) to it so you understand it experientially. On the other side is the "'this costs too much,' 'I like my healthcare just the way it is,' 'we are turning to socialism,' 'I really don't know what is going on with health insurance reform, but if it is anti-Obama I support it'" crew.<br /><br />The fact is, both of them are creating something that we have seen often in the political process, They are creating an ever-narrowing bottleneck to progress.<br /><br />In 2006, Harvard Professor Robert Putnam, author of the best seller <i><a href="http://www.bowlingalone.com/" target="_blank">Bowling Alone</a></i> and an expert on human/social capital wrote a widely debated paper on social captial, increasing global diversity, its challenges and opportunities. His statements, when taken out of context indicated that he was anti-diversity, when in fact his intention was just the opposite. Writer William Goldsmith of the <a href="http://www.thecrimson.com/article.aspx?ref=515276" target="_blank">Harvard Crimson</a> shares an interview with Putnam:<br /><br /><i>In more ethnically diverse communities, respondents were more likely to “hunker down.” Those results held true even when Putnam controlled his study for a host of other factors that might affect trust levels—including gender, education, and income.<br /><br />“We act like turtles,” Putnam said. In diverse communities, people are not only less trusting of neighbors from different backgrounds, but also of those from their own ethnic and racial groups.<br /><br />Los Angeles, one of the most diverse cities in the world, has the lowest level of trust in the United States, Putnam said. He attributed this to a “socio-psychological system overload,” a type of shock resulting from an influx of heterogeneous newcomers into a generally homogeneous society.<br /><br />But Putnam said people’s turtle-like behavior when first confronted with diversity fades over time.</i><br /><br />What is my point? Like this article by Putnam, interpretation is creating the outcomes vs. facts driving the dialog doing so. People saw all of this change in their surroundings and they began to trust no one, then they began to look to those who were as scared or as vocal as they were or desired to be to connect with.<br /><br />By nature of the topic and historical political factions, the dynamic is inherently emotional. Of course, the emphasis on philosophical differences that has been primarily perpetuated by extreme so-called conservative groups is a much more viable tool in emotional manipulation.<br /><br />However, in the situation the U.S. is in where healthcare (and our overall economy and society) is concerned, the result of creating emotionally-based bottlenecks is that everyone loses.<br /><br />Indeed, there are many things to consider including the idea of increased taxes, how to pay for this whole thing, the dynamics of reform beyond cost: namely cultural competence and quality and all that they entail including health disparities, patient-centeredness, and other essentials to real reform. There is also the cost of perpetuating a self-destructive paradigm for our society that is based in too large a part on financial gain.<br /><br />So, short-term thinking and political jockeying is creating the appearance of something that is dichotomous because the paths to getting where we know we need to be have slight philosophical differences. And of course who will take the credit (negatively or positively, visibly or invisibly) plays a major role, too.<br /><br />The fact is, we are all at-risk of severe consequences as a result of this political cacophony (sounds redundant, huh). Health (insurance reform) is not just about health insurance reform (see <a href="http://network.diversityhealthworks.com/profiles/blogs/parrots-and-protectionism" target="_blank">Parrots and Protectionism</a>). Our response as members of a society that desire to see our country evolve is very much a determinant of eventual outcomes. In fact, while we don't have 100% of the say in how this whole thing goes, our attitudes are being probed for and our ignorance is being preyed upon (and it is not party-centric)<br /><br />I am not talking about whether or not there is a public option. I am not talking about who pays (the bottom line is that regardless of the outcome, we all pay and the cost is not going to be considerably lower. I hope that at the least we can keep it from increasing beyond the cost of inflation) or how much. My concern is that we keep this mindset that someone is taking something away from "me". <br /><br />NEWS FLASH: It has ALREADY been taken away! If we understand this, mentally lying down along political lines will be less restful. If you "sleep" on either line you will be at fault.<br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com0tag:blogger.com,1999:blog-6527477063953395261.post-10350606227187671932009-10-25T01:22:00.000-04:002009-10-25T01:23:38.896-04:00Go Beyond the SurfaceIt has been a minute since I had an entry. It has not been a break from the conversation, just one from my writing about the cultural competence and quality on our blogs.<br /><br />This one will be short. It often occurs to me that we often think about health disparities purely from a deficit model. We approach the prevalence of adverse health outcomes with the notion that our opportunity lies solely in fixing what's wrong.<br /><br />It is natural to try to repair the wrongs, especially when they are driving our intention. The issue with this is that it is a purely past-based approach that inherently leaves us with limits. We are limited in the sense that we begin to look for the root of problem and then spend countless hours and endless conversations about changing the root.<br /><br />The problem is that the root is resistant to change just like we are. In fact, if I were to stretch a little, I would say that where health disparities (aka quality disparities) are concerned, trying to get at the root causes and change them won't work. Of course, I don't think change works all that well either.<br /><br />When we enter into the conversation about health disparities, it is important to do a strengths inventory as well as understand the dynamics of disparate outcomes on the negative side. In example, is the "Chicana effect" with birth outcomes. This term has been used to indicate that interesting fact that low birth weight birth outcomes are similar to that of whites and in some instances have been found to be lower regardless of social-economic status. It has led researchers to conclude that there are things socially and culturally within Latino/Chicano culture that are protective in nature.<br /><br />If research and/or anecdote via our experience gives us insight into a positive health outcome in a particular community, it is vital that we look at the dynamics involved within that outcome. They may be sociocultural, they be structural, they can be a number of things. And it is possible that they can be leveraged in our cultural competence and quality efforts.<br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com0tag:blogger.com,1999:blog-6527477063953395261.post-26899792781780580032009-09-25T13:29:00.001-04:002009-09-25T13:29:46.831-04:00Health Care Reform: Is it all about costs?<b>There is one mystery - yea-ea-eah - I just can't express:<br />To give your more, to receive your less.</b> <b><i>Bob Marley</i></b><br /><br />The conversation about health care reform has lead all of us to ask the question: how much will this cost? It is a very important question and one that has to be addressed every step of the way. What this leads one to think is that the concern that opponents have is purely financial.<br /><br />On the other hand, supporters of health insurance reform, especially those who are supportive of a public option or something resembling universal coverage, speak about the cost of doing nothing or less than the creation of a public option.<br /><br />So, the question is: Is Healthcare Reform all about Cost?<br /><br />My answer: Yes, healthcare reform is all about cost.<br /><br />Now, there is an angle that both those who are worried about cost on the anti-reform side (in the forms being presented currently) and those who are concerned on the pro-reform side have to consider. Fundamentally, in life and in business, you cannot get something for nothing. Or as my hero, Robert Nesta Marley asks: "How can you ever give your more to receive your less?"<br /><br />Fact is that you cannot, not now, not ever. In fact, I could go as far as stating that the problems that we are experiencing in the current economy have been created based on a "give your less to receive your more" mind-set.<br /><br />In its course, some have benefited from the exploitation of this anti-principle. However, the correction that is necessary in a universe based on the natural laws of cause and effect always runs its course. If something is out of balance, correction of the imbalance will occur. It doesn't matter how long it is delayed, it will eventually move back to the even mark.<br /><br />Without a doubt we are in a mode of correction. For such a long time whether it was during the dotcom era when "money was for nothing, and. . ." (you know how the rest of that line from Dire Straits went) or the so-called real estate boom (or was it a cover for the dotcom bust) and now where are we?<br /><br />Over and over, we have created situations that have the inevitable consequence of suffering. Yet, because we think that giving our less and receiving our more is possible, we continue in this cycle, and then we complain.<br /><br />We blame this corporation, and this bank, and this president, and that billionaire, and that job, etc. In many cases, the blame is understandable. There have been many companies and wealthy people that have exploited systems and people to get more for less time after time. This I do believe.<br /><br />What about now? What about health insurance reform? Now our focus returns to the focus on the individual without regard to other humans. Have we truly learned anything about this paradigm? Millions of people have been so very much focused on their financial well-being/abundance that they choose to disregard the well-being of others. In fact, they have created a body of rhetoric that actually classifies their self-concern as patriotic, American, capitalist. They are framing healthcare reform as a threat to their way of life, our freedoms.<br /><br />So, healthcare reform is all about cost, but it is not all about MONEY!<br /><br />Cost transcends dollar and sense. A lack of compassion costs society much more than a few dollars. On a fundamental level it erodes the foundation of who we are as a nation. It compromises what makes one human; and in the final analysis, especially in the times we are in now, determines who we choose to be as a United (or not so United) States of America.<br /><br />We are at a crossroads in the direction we want our country to go. It has little to do with health reform, its costs, or its outcomes. However, it is absolutely reflective of the tenor of the conversation and the desire we have to uplift humanity vs. simply find ways to protect what we (in a very short-sighted understanding) think serves one's individual interests.<br /><br />Healthcare reform is all about costs, yes. Yet, we must consider all dimensions of what costs translate into--all are attached to our pocketbooks--All are attached to our destiny.<br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com3tag:blogger.com,1999:blog-6527477063953395261.post-6260218331869775232009-08-07T15:12:00.004-04:002009-08-08T00:12:59.699-04:00Parrots and Protectionism: Healthcare Reform and American Society<b>"Most people would rather die than think; in fact, most do so"</b><br /><i>Bertrand Russell</i><br /><br />Critical is not something that my closest friends would consider me. Today I will contradict that sentiment.<br /><br />The realities of healthcare reform are still not clear to most Americans. While the factions that have emerged from the each pole from Universal Coverage to Anti-Reform (aka "keep things like they are they are good/comfortable for ME right now") the clarity on either side and even for those who desire a more middle of the road approach has been murky. This morass of confusion has at times been calculated and intentional. More so, it has been the result of many people on Twitter and through various blogs and other social networks and media parroting the sentiments of a faction of people and in some cases a particular person whom they feel is a reflection of who they are.<br /><br />Human nature is what human nature is. We gravitate towards that which makes us feel safe and protects the values that we have come to know as most beneficial to our survival. However, the caveat to this reality is that things inevitably change. If we are lucky and thoughtful, change can be the precursor to transformation; however, transformation is rare. The result that arises when transformation is necessary but is resisted based on an unconscious reaction to that which is beyond the scope of consciousness, is decline.<br /><br />The healthcare reform conversation is reflective of the decline of the United States and it will not cease declining until this conversation and people having it transform, starting with a change (if only for a moment).<br /><br />Changes will need to come in one or two forms. For those who are aware that they are in fact spouting un-truths or half-truths (same thing--see <a href="http://network.diversityhealthworks.com/profiles/blogs/beware-of-half-truths-about" target="_blank">Beware of Half Truths About Healthcare Reform</a>) based purely on self-interest will have to realize that a mind set based on selfishness and motivated primarily by material gain will not be rewarded in the long-term.<br /><br />Of course, some people are aware that it is the case. They are clear that the material growth of the U.S. is in the process of decline and that while we will potentially/eventually get to a place where suffering is mitigated, riches "beyond belief" will rarely be seen and for that matter, valued like many value them currently.<br /><br />The rich will stay rich and what we consider the middle class will shift significantly and the gap between all social-economic strata will broaden. Nonetheless, although they have this awareness they are not willing to do what it takes to consider a broader interest beyond themselves. Some of these voices perpetuating a divide of the people (the "socialist healthcare" "killing off seniors" "making you pay for other people who don't want to work" and "all those immigrants bringing down our country" stuff) will experience severe negative consequences to their fortunes and their lives. This mind-set is dying and if you have a dying mind-set you will eventually. . .well, you get the picture.<br /><br />Now on the other hand, my opinion is that there are droves of people who simply react or parrot the sentiments of others. They liberally react with the "We Are the World" conversation that Universal Healthcare is a must and all people opposed in any fashion are racist, fascist, separatist, selfish humans who don't care about all of those people in need. <br /><br />Or, conversely they parrot the Rush Limbaugh's, Glenn Beck's, Sean Hannity's, etc. of the world and simply repeat their self-interested rhetoric that is so clearly one-sided that one actually has to intentionally not think to believe that their perspective is balanced or even remotely speaking to the entirety of interests of those that they have influenced to duplicate their misdirection and misinformation.<br /><br />So, we are stuck between the selfish, parroting, and extremists. Where do we go from here?<br /><br />First, I think we have to recognize that healthcare reform is about more than just healthcare/health insurance reform. In fact, the topic is simply a microcosm of the dynamics of American society and an opportunity for us to enter into a new era where transformation from an "I" to "We" consciousness is created. I have said and will always say:<br /><br />"The difference between Illness and Wellness is 'I' and 'We'." and I am not just talking about our physical illness and wellness.<br /><br />What is at stake is a reflection of the myriad challenges that face us and that we will have to take on together, not divided to ever have a chance at improving. Whether it is education, energy, the environment, healthcare or any other vital issue, we are now at a time that leads us toward evolution or self-destruction. ALL of us are in this space. Extremes of thought, reaction, and rhetoric in either direction will perpetuate the decline.<br /><br />Second, we can't make this process we are in with healthcare reform about win or loss. If there is win and loss, there is loss--all of us lose. Whether you are affected directly or indirectly, if there are sides and any side is adversely affected by the choices made to the point that their suffering creates greater suffering for others, we all are harmed--the United States is harmed--the world is harmed.<br /><br />If you are considering dismissing what I am saying because it is uncomfortable, so be it. My intention is simply to state what I see and what I think is inevitable if we do nothing or do less than we are capable of as a very capable United States of greatness.<br /><br />The discussion we are in now is VERY very big. Very big conversations lead to very big consequences when subsequent actions or non-actions are taken. This time WE choose. We, the People, are the government and our elected officials are extensions of us. WE choose the rise or fall this time by our words and our thoughts. This has always been the case but the quickening of information exchange and the speed of the times exacerbates it.<br /><br />Third, parrots are some of the most intelligent of animals on the planet. They can be trained, not just to mimic voices and repeat words, but also to speak in context and solve puzzles. The parroting that I am talking about is devoid of real thought and is dominated by emotional reaction, not rational contemplation.<br /><br />Don't be fooled by a small faction stating small-minded perspectives without thoroughly examining all sides of the situation. Otherwise, you will think others are "drinking the koolaid" while you are actually unaware of the reality that the "others" in fact, are you. Voluntarily parroting incomplete sentiments of manipulation is reflective of how deeply one is being manipulated without awareness. Teach/require yourself to think.<br /><br />We are a thinking country, it is what brought forth what we have created, the good, the bad, and the ugly. We have stopped thinking deeply, we rather choose to repeat the thoughts of others. It cannot continue, it will not help you, it will not help your family, it will not help our country.<br /><br />So protect the greatness that we have created in this country. If you must repeat the thoughts of others solely because you are only worried about yourself, let people know. At least we will be clear about your intention.<br /><br />In the space and place we are in now, the time couldn't be more critical. We absolutely must open our minds, deepen our consideration, and learn the intentions and necessity of transformation. Healthcare reform and its dialog can be a platform for us to make this a reality. Let's create what we truly want to see in the world.<br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com0tag:blogger.com,1999:blog-6527477063953395261.post-39802216458225074762009-07-22T13:42:00.002-04:002009-07-22T13:43:50.295-04:00Cultural Competence is a Strategy III doubt that strategy and struggle have a common Latin root.<br /><br />What I don't doubt is that they go hand in hand if success is desired.<br /><br />With any change process, there is resistance. In many instances the resistance can even exist amongst those who want to actually see the change move forward. They may fundamentally believe in the idea of transforming the way their organization gets healthcare (or whatever their business is) done; nonetheless, something they cannot fully understand about their thinking or approach leaves them with results that are less than desired.<br /><br />Why does this happen? It happens because <b>CHANGE DOESN'T WORK.</b><br /><br />Let me explain using a device that I found quite fascinating when I first came across the ad that read: "<i>Drop 2-3 dress sizes in less than 10 minutes</i>." When I first read it and then saw the pictures and read the testimonials on the postcard that was left on my car one day, I began to wonder how long this 2-3 size drop lasted. I was compelled to learn more because I have read about a lot of diets from The Zone to the Master Cleanser, and none of them promised results in such a short period of time.<br /><br />As some of you who watch Oprah probably know (of course it was on Oprah!), this device is not actually a diet. It is in fact a very efficient body compression, girdle-type device that apparently allows one to wrap themselves up thus compressing 2-3 sizes worth of "love handles or other handles" that one has, leaving them visibly thinner under their clothing.<br /><br />I am not discounting this device, it has its place. It creates change and from the outside, if you saw a person with one of these compression devices on, you would naturally perceive them to appear a certain way. They may appreciate your perception as their intention was to present themselves in a particular light.<br /><br />Now, the person wearing this device changed, but how long did that change actually last? What will be required to sustain that change?<br /><br />The answer: it cannot be sustained. It can be repeated and it can be replicated, but it cannot be sustained because CHANGE DOESN'T WORK. It doesn't fail because we are not sincere about our desire to see lasting results. It doesn't fail because the intention is not sincere or carefully considered. Change doesn't work because as long as it is viewed as change it will be resisted and it will be changed again. Change is a tactic. Some tactics have longer-term success than others but in and of themselves, they fall short of creating results that are sustainable.<br /><br />So, change is like the love handle compression device shared above. It is a tactic that creates the appearance of a desired result, but it is not the desired result because its not possible for it to be sustained. 10 minutes to decrease 2-3 dress sizes is akin to doing a 2 hr, 4hr, or two-day "diversity" or "cultural competency" training and expecting that the learning will be sustained and put into practice. I am not saying that it doesn't have a positive effect and given that we deliver training as one of our services, I recommend it. However, I am very clear that it is a tactic in an overall strategy that takes more time and more struggle.<br /><br />Cultural Competence is a Strategy--it is an organizational development strategy. If it is framed as such (and aligned with your overall organizational quality strategy) it can be a transformational strategy. Transformation is sustainable as it implies that the process leads to a place where what your organization is doing tactically transcends the moment of implementation and speaks to practices becoming part of what I call your "Organizational Being". This is in contrast to "Organizational Doing" which speaks to something temporary and consciously or unconsciously viewed as marginal to success.<br /><br />A solid cultural competence strategy takes struggling with current mindsets, norms, and a variety of other conversations that we have become accustomed to that require a shift of perspective to create quality healthcare delivered in a patient-centered, culturally competent manner.<br /><br />Next time I will speak briefly on leading your cultural competence efforts strategically.<br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com0tag:blogger.com,1999:blog-6527477063953395261.post-24386456471113112652009-07-14T12:38:00.004-04:002009-07-15T11:35:27.874-04:00Cultural Competence is a StrategyHuman capital strategy is often considered to be a process that consists of many parts that operate separately. While this is a practical way to get certain things accomplished or checked off of a list, it is not a strategy.<br /><br /><span style="font-weight:bold;">What is a strategy?</span><br />I found many definitions for the term "strategy" when doing a search. Most of them were framed around military strategies. This one from <a href="http://en.wikipedia.org/wiki/Strategy" target="_blank">Wikipedia</a> resonated most:<br /><br /><i>A strategy is a plan of action designed to achieve a particular goal. The word strategy has military connotations, because it derives from the Greek word for general.<br /><br />Strategy is different from tactics. In military terms, tactics is concerned with the conduct of an engagement while strategy is concerned with how different engagements are linked. <b>In other words, how a battle is fought is a matter of tactics: whether it should be fought at all is a matter of strategy</b>.</i><br /><br />As our <i>Cultural Competence-Quality Framework</i> evolves and begins to be adopted by healthcare organizations, one fundamental premise is that the <i>CC-Q Framework</i> is to be leveraged as an integrated human capital strategy inclusive of and dependent upon many parts working in concert, fostering sustainable quality for every individual and organization that you seek to influence through your healthcare organization. <br /><br />For example, in many organizations the focus of the quality efforts are relegated to those responsible for core measures. Occasionally, there will be a report in a leadership meeting and questions will be asked about certain things. However, it is the exceptional organization that is talking to those responsible for cultural competence, diversity, and inclusion about nuances based on individual values, beliefs, and responses that may be confounding core measures, leaving valuable information as a missing variable to ensuring a consistently positive patient experience. <br /><br />This is not to say that every individual is going to be 100% satisfied with their care; however, knowing how certain dynamics play out creates the possibility.<br /><br />Now, from this example there is a chain reaction: While the individual, committee, or outside consultant that is leading the efforts for cultural competence adds to the understanding of the quality/core measures leaders, the knowledge that is gained only has impact if those clinical and non-clinical professionals who are the touch points of patients and their families are made aware of what they can contribute to the fostering sustainable quality. It requires connecting with them, sharing with them, and getting their input in response.<br /><br />Going further (interconnectedness is multi-faceted and inexhaustible but I won't go on and on after this example--maybe in a white paper ;-)) consider that soliciting and getting contributions from myriad areas and levels of employees, community members, volunteers, etc. fosters a level of engagement that creates ownership. Ownership of a thing, process, or idea fosters a relationship to it that engenders not just a good feeling but a level of commitment that leads to a greater contribution to the original idea as well as the many things that one might perceive support the original idea.<br /><br />Jeremy Dean at <a href="http://www.spring.org.uk/2008/04/6-quirks-of-ownership-how-possessions.php" target="_blank">PsyBlog</a> says this about the psychology of ownership:<br /><br /><span style="font-style:italic;">Effort increases perceived value: A table I have bought and struggled to build myself has more value to me than the same table I bought, for the same price, ready assembled. Expending our own effort means we've invested ourselves in an object, so it has more perceived value to us. Other people don't recognize this (and there's no reason why they should).</span><br /><br />The bottom line is that when we leverage cultural competence as a strategy (and/or a core piece of your overall strategy) and we look for mechanisms to connect the dots from tactic to tactic, we naturally find how the pieces are seamlessly linked.<br /><br />This is not to say that this is always easy. When we have been doing things a certain way for a long time change is challenging at its best. Nonetheless, when we truly understand cultural competence as a strategic approach vs. a tactic that speaks to checking something off of a list, the ROI can be tremendous. <br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com0tag:blogger.com,1999:blog-6527477063953395261.post-27598532245412675172009-07-10T10:49:00.002-04:002009-07-10T10:49:55.561-04:00Considering Immigration in Health Reform<i>Mr. Bhargava gives a compelling account discussing health reform and immigration. He points out that illegal immigrants are not driving up the cost of care. He is very much aware of the emotion underpinnings of the immigration debate and the realities of political leanings vs. the reality of situation. The writer clearly is an advocate for immigrants, but is also clear about the bottom line financial impact of this argument.</i><br /><br /><i>Make it a great day!</i><br /><br /><a href="http://www.huffingtonpost.com/deepak-bhargava/dont-enshrine-discriminat_b_227983.html" target="_blank"><b>Don't Enshrine Discrimination in Health Care Reform</b></a><br />by Deepak Bhargava<br /><br />Finally, the country seems serious about reforming health care. But with discussions about a public option, cost control and competition raging, one aspect of achieving true universal coverage is being left out: what to do about immigrants who lack coverage?<br /><br />All of the plans getting serious consideration in Congress would exclude undocumented immigrants. Many proposals would even bar access to community health centers and emergency rooms -- a historic shift from America's humanitarian tradition that in an emergency no one should be turned away. Some proposals would exclude legal resident immigrants who have been in the United States for less than five years. Unless the debate takes a different turn, millions of immigrants will be left out of the system.Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com0tag:blogger.com,1999:blog-6527477063953395261.post-76678780416826000212009-07-04T16:27:00.004-04:002009-07-08T12:00:39.195-04:00Health Disparities are Quality DisparitiesThe 2008 <a href="http://www.ahrq.gov/QUAL/qrdr08.htm#toc" target="_blank">National Healthcare Quality Report</a> and the National Healthcare Disparities Report from the Agency for Health Research and Quality were and are generally published each year at the same time.<br /><br />This is very much appropriate, but it is hard to know if people are making the connection between the two reports. If we have health and/or healthcare disparities, particularly in the sense that with most things equal (SES, access, etc.) there are still disparate outcomes or disparities, what does that speak to?<br /><br />Well, there are few things that we can consider. <br /><br />1) <b>Genetics:</b> While the data on genetic predisposition is emerging there are pros and cons to this variable. A 2005 editorial <a href="http://www.ajph.org/cgi/reprint/95/12/2125" target="_blank"><b>The Role of Race and Genetics in Health Disparities</b></a> Research out of the <i>American Journal of Public Health</i> summarizes the potential role of the human genome mapping in our evaluating causes and approaches to health disparities quite succinctly. <br /><br />My experience is that given the long history of disparate outcome by race coupled with the emerging understanding of disparities in the LGBT, Disabilities, and other communities, genetics may play a role but the role that they play will be at best complementary.<br /><br />2) <b>Social, Environmental, Behavioral Factors:</b> Health behaviors differ from person to person. Some of these behaviors are influenced by cultural health models and beliefs, experiences and responses to the health system and healthcare providers, and environmental circumstances. Behavior has and will always have an influence on health outcomes and behaviors will always be influenced by the behaviors of healthcare providers. So, the dynamic is a two-way street. There is evidence that experiences of healthcare providers (of all ethnic backgrounds) influence how treatments and recommendations for treatment are allocated. One classic study of this is a New England Journal of Medicine Article by Schumann, et. al.: <a href="http://content.nejm.org/cgi/content/abstract/340/8/618" target="_blank"><b>The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization</b></a>.<br /><br />While there were subsequent articles that questioned the authors' findings and the subsequent media attention that was generated, there was no denying the unequal treatment recommendations were prevalent and conclusive from the data collected in the study. This leads me to one last consideration (for now):<br /><br />3) <b>Quality Disparities:</b> What do I mean by "quality disparities"? Let's move outside of healthcare for a minute and consider other industries where quality is vital (assume all industries believe it is). <br /><br />For example, as the president of a company you have been delivering a high-quality product or service for quite sometime. Based on your evaluation and the responses of the customers, you are receiving feedback that what you are producing is consistently good amongst a majority of your customers. You are committed to quality because of your dedication to maintaining integrity but also due to the fact that your competition is fierce and while you are leading the pack, you never take your success for granted.<br /><br />One day, it is brought to your attention that over 25% of your customers (by industry vertical, geography, or some other variable) are experiencing negative outcomes in the utilization of your product or service, yielding on average 2 times more problems than the other 75%.<br /><br />What is your response? What do you think?<br /><br />Well, one response is to say, "we have been delivering quality for so long, what is it with these 25%? <b>We give everyone the same service consistently</b>."<br /><br />Another response is to say, "where is the breakdown?" Followed by, "is there something that we don't really understand about our customers that will help us serve them better?"<br /><br />In an environment of stiff competition, you will do your research to understand who these 25% are, what exactly their challenges are and develop solutions to narrow the outcomes gap. <br /><br />Or, you will decide that these 25% of customers <i>are the problem</i> and let them go, concluding that the 80/20 rule says that they are not necessarily benefiting you that much anyway. This may work or it may take you out of the #1 spot as the industry leader, especially if those segments are fast growing.<br /><br />Back to healthcare. If 20% or more of our patients are experiencing worse health outcomes than the other 80%, obviously there are disparities there. More than likely, this is also what I would consider a quality issue even if we know that "we are treating everyone the same".<br /><br /><b>Why is this a quality issue? In fact, <u>why are health disparities quality disparities</u>?</b> The answer lies not in the fact that hospitals are not delivering quality services. I believe that most facilities and individual practitioners are delivering very high quality services. I also think there are distinctions in what translates as quality.<br /><br />Patient-centered care asks us to treat patients as individuals. It suggests that each patient is functioning and managing their health under a unique set of circumstances and if those circumstances are not understood to as great of an extent as possible, we may miss the mark on their needs short and long term and thus contribute to less than the best outcomes.<br /><br />Missing the mark is reflective of the quality of services delivered for each person based on their unique needs that can sometimes be a result of archetypal dynamics of a particular group identity. <br /><br />If over time, certain demographic segments are experiencing poor outcomes (just like a certain vertical or segment of a non-healthcare company) quality is being compromised. Your integrity is not compromised--you <i>are</i> doing all that you know how to do--but your outcomes are unequal and therefore certain groups are not getting what you intend for them to get and in some cases what you promise them based on previous experiences.<br /><br />The response in healthcare has to be the first response described above for the hypothetical company--understand this population and develop solutions to address their problems. The second option of letting these customers go is not an option in healthcare. While there have been instances in which populations with greatest needs have been met with barriers to treatment because of the challenges they present, this is a response that given the times we are in and the realities of demography, we simply will not and cannot consider. We cannot do it morally nor can we shoulder it economically.<br /><br />Aligning cultural competence with quality, affordable and accessible care is what the DHW <a href="http://network.diversityhealthworks.com/" target="_blank"><span style="font-style:italic;">Cultural Competence-Quality Framework for Healthcare Excellence</span></a> is all about. <b><u>Understanding that integrated efforts towards eliminating health and healthcare disparities (a core part of our <a href="http://network.diversityhealthworks.com/" target="_blank"><span style="font-style:italic;">CC-Q Framework</span></a>) are a critical and central tenant in the quality care that all Americans desire </u></b>is vital to assuring our success in reforming the healthcare system. <br /><br />This post is a very short exploration of health disparities being considered as quality disparities. I would like to explore the idea of health disparities compromising our goal of quality affordable care in more detail. Please share your thoughts with me, the Diversity HealthWorks community and all those visiting our blogs.<br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com0tag:blogger.com,1999:blog-6527477063953395261.post-79907860345342387052009-06-24T00:24:00.005-04:002009-06-24T00:33:24.424-04:00Culture and Quality Part IVA couple months ago (April 4) I began writing a series that I entitled Culture and Quality. As the conversation has evolved a new model has emerged. We have entitled it the: <i><b>Diversity HealthWorks' Cultural Competence-Quality Framework for Healthcare Excellence</b></i>. <br /><br />The premise of the model is based on what we have seen over the past year in the diversity dialogue in all industries including healthcare: contraction and a general lack of cohesion about the future of what diversity and inclusion can be and/or needs to be in our corporations and organizations. We simply have not elevated the idea of diversity to that of a core business function that is unquestionable.<br /><br />Now of course there are exceptions to this rule, but overwhelmingly, most people/companies frame diversity and inclusion as "causes" that they are committed to. Historically, the framing of what I call cause-oriented diversity and what it stands for have been absolutely necessary. To this day, this remains true. Nonetheless, herein lies the conundrum:<br /><br />1. If diversity is more cause-oriented how does it line up next to other core business functions such as marketing, sales, fulfillment, and all related measures assessing core functions?<br />2. What if the "cause" of diversity is not held in at a steady level of urgency like other core business functions?<br />3. Since by their nature causes change--does diversity change or even potentially go away?<br /><br />No matter how we answer these questions, and I am sure we could (and have) discuss each from different perspectives for days, the fact remains that if a cause-oriented diversity leaning is perceived as the norm, inevitably someone or some group can claim or feign that they are not accountable. <br /><br />On the other hand, there is Quality. What about quality? Quality is. . .<br />--Unquestionable<br />--Valued<br />--Measurable<br />--Historical; and<br />--It is ALWAYS in the budget!<br /><br />You will never hear any one say out loud that quality is something that is "nice to have but not a need to have". Quality is at the foundation of every organization in one capacity or another. Even if the ambition of delivering the "highest quality" of this, that, or the other is not yet realized, the ambition and possibility remain prevalent.<br /><br />Healthcare is no exception. In fact, quality is at the core of how healthcare gets done. The President has made this very clear as the conversation about health reform has escalated. In virtually every address he has done around healthcare over the past 2-3 months he has talked about quality. On May 11th, in one of his speeches he said:<br /><br /><i>"I'm also committed to ensuring that whatever plan we design upholds three basic principles: First, the rising cost of health care must be brought down; second, Americans must have the freedom to keep whatever doctor and health care plan they have, or to choose a new doctor or health care plan if they want it; and third, <b>all Americans must have quality, affordable health care</b>." </i><br /><br />This is a mandate that all of us can sign on to. Whether we are conservative or liberal, for or against universal healthcare, feel that healthcare is right or a privilege, quality, affordable, [accessible] care is something we can all agree is a priority.<br /><br />So how does cultural competence fit in? Two answers:<br /><br />1) Many hospital organizations have undergone culture change/quality initiatives driven by the likes of greats such as the <a href="http://www.studergroup.com/home/index.dot">StuderGroup</a> or the work of Fred Lee (<a href="http://www.patientloyalty.com/">If Disney Ran Your Hospital</a>). Some have had tremendous success, while others less so. Few have made culture change and competent culture evolution something they would consider embedded into how they do what they do each day or more so an ongoing discipline that is cultivated by leaders and cascaded down through the organization. <br /><br />I hold that it is not because they don't want to. I fundamentally believe that it is because the culture change and quality efforts are not integrated with and inclusive of all of the facets of the organization. In particular many times the not included is the myriad diversity of employees, patients, families, and the greater community that make up WHO the hospital is as well as performs the functions of what it does.<br /><br />So, I believe that there are cultures within culture change and that we have to develop and evolve our competence in these cultures within an organizational culture to assure continuous quality improvement.<br /><br />2) We have created a model to discuss these dynamics and we want to share with you in a series of free web seminars. On July 1st and July 8th we will host two free web seminars to share the <i><b>DHW Cultural Competence-Quality Framework for Healthcare Excellence</b></i>.<br /><br />The July 1, 2009 event will be for Diversity HealthWorks members only. If you register for this event and you are not a member of Diversity HealthWorks, you will not receive a confirmation link to the event. Membership however is free. So, if you are not yet a member and want to see a demo of the model and have the change to comment, <a href="http://diversityhealthworks.ning.com/main/authorization/signUp?">Join Us</a>.<br /><br />The July 8, 2009 event is open to anyone interested. We look forward to seeing you on-line.<br /><br />To register for the July 1, 2009 Free Web Seminar Click the Link Below:<br /><i><b><a href="https://www1.gotomeeting.com/register/886780793 ">DHW Cultural Competence-Quality Framework for Healthcare Excellence--July 1</a></b></i><br /><br />To register for the July 8, 2009 Free Web Seminar Click the Link Below:<br /><i><b><a href="https://www1.gotomeeting.com/register/288038112">DHW Cultural Competence-Quality Framework for Healthcare Excellence--July 8</a><br /></b></i><br /><br />We hope to see you as we share this integrated framework with all who are interested.<br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com0tag:blogger.com,1999:blog-6527477063953395261.post-88200946110251578592009-06-19T18:44:00.001-04:002009-06-19T18:45:22.124-04:00Draft Summary on Health Reform Bill from the House Ways and Means CommitteeThis summary released June 19, 2009 gives an overview of the provisions intended as part of the bill. Read it and know that the <u>actual</u> draft of the bill will have layers of stuff that is both reflective and not so reflective of the summary. I hope that people actually read it before they go about criticizing it.<br /><br />Transparency has been a mantra out of the Obama administration and we have to consistently hold them accountable to this. So far, I have felt like they have done what they said they were going to do. This means we should trust them to continue, but not depend on it so that we become complacent.<br /><br /><b><i><a href="http://edlabor.house.gov/documents/111/pdf/publications/DraftHealthCareReform-BillSummary.pdf">Draft Health Care Reform Bill Summary</a></i></b><br /><br />Make it a great day!Amri Johnsonhttp://www.blogger.com/profile/02670878496898949165noreply@blogger.com0tag:blogger.com,1999:blog-6527477063953395261.post-29037868467227565112009-06-15T11:38:00.003-04:002009-06-15T11:48:47.456-04:00Expanded Jobs, Streamlined Tools at IMDiversity.comThe IMDiversity.com Career Center and Multicultural Villages network are migrating to a new jobs database and tools format this month, featuring expanded network jobs listings in healthcare and other other sectors, as well as streamlined tools for creating a custom job tools account, searchable resume, and personalized email job alert agents. We invite diverse jobseekers to visit the beta at <a href="http://jobsearch.imdiversity.com">http://jobsearch.imdiversity.com</a>.<br /><br /><span style="font-weight: bold;">Special Note for Existing Users</span>: Please note that those who previously created accounts on IMDiversity's former jobs site will still be able to access their tools, resumes, and application histories for a brief time during the transition at http://jobs.imdiversity.com. However, as of June all new healthcare openings will now be posted on the new job bank, and all users are urged to create a new account at <a href="http://jobsearch.imdiversity.com/jobseeker/create">http://jobsearch.imdiversity.com/jobseeker/create</a> as soon as possible. (Please note that your old username and password will NOT work on the new system.)<br /><br />Following the final release, we will be restoring many of the additional quicksearch tools on the IMDiversity.com Healthcare Careers and Readings Channel at http://www.imdiversity.com/healthcare.asp.Unknownnoreply@blogger.com0