Cultural Competency and Diversity in Healthcare

Identity-Based ERGs

2011-10-24T20:17:00.007-04:00

A 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.

My responses to the inquiries and reactions are in italics.

In response to a member asking about starting an LGBT ERG.

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).

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.

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.

Thing is, when we look at the stats and articles such as this:
Is there a bamboo ceiling at American companies? what do we conclude?

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?

The conversation ended with the potential of an academic study of ERGs. Great outcome!

My conclusion was the following:

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.

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.

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. . ."

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.

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.

Make it a great day!

NIH Uncovers Racial Disparity in Grant Awards

2011-09-27T09:52:00.005-04:00

It has been a while, but I am back and hopefully consistently so. Thanks to all of you who have encouraged engagement during my hiatus.

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.

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?

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.

Biomedical Research Funding
NIH Uncovers Racial Disparity in Grant Awards

by Jocelyn Kaiser

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.

For whole article Click Here:

Medical News: Pro-Bowl Player's Suicide Renews Head Trauma Debate - in Orthopedics, Sports Medicine from MedPage Today

2011-02-26T08:07:00.001-05:00

Very 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: "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," 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.

Medical News: Pro-Bowl Player's Suicide Renews Head Trauma Debate - in Orthopedics, Sports Medicine from MedPage Today

The Risk of Cultural Illiteracy

2010-05-07T22:21:00.004-04:00

I went to a networking breakfast this morning at the Boston Center for Community and Justice on Diversity: Institutionalizing Diversity as a Business Strategy.

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.

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.

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.

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.

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.

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.

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.

Make it a great day!

Talking Electronic Health Records and Clinical Trials

2010-04-11T15:53:00.005-04:00

Two of my colleagues, Chris Thorman from Medical Software Advice and Avis Williams from Solar BioMedical 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.

With the changes in health reform, this may be a topic of increasing interest. Thanks to both Chris and Avis for their contribution. Enjoy!

Make it a great day!
Amri

Electronic Health Records and Clinical Trials: An Incentive to Innovate
by Chris Thorman

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. (More)

Electronic Health Records and Clinical Research: A CRA's Perspective
by Avis D. Williams, MSPH, CCRA

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.

Benefits
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.

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.

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.

Challenges
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.

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.

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.

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.

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.

Conclusion
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.

Truth Serum

2010-03-27T14:26:00.005-04:00

"The truth as an offense, but not a sin."
Bob Marley

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.

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.

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?

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.

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?

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.

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.

In the case of healthcare insurance reform, I am not so sure that this is about party, position, or the American people.

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.

We hear:

"It's too expensive, it will break us."

"This is a [still] a government take-over of healthcare."

"He said he was going to be bipartisan, what happened to that."

"We want healthcare reform, but we feel like we simply need to start over, why rush this?"

"This bill is not good for the American people."

Then of course:

"Obamacare is socialized medicine!"

and recently from Newt Gingrich:

“They will have destroyed their party much as Lyndon Johnson shattered the Democratic Party for 40 years [by passing civil rights legislation]."

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.

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.

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.

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.

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.

For now, I am pleased that President Obama did something. 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.

What principles will we carry forward in the transition to a new America or for that matter a new world?

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.

Make it a great day!

The Idea of Mentoring

2010-03-14T19:44:00.002-04:00

If 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.

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.

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.

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".

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.

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.

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.

I suggest you pick up Dr. Murrell's book Intelligent Mentoring. Her perspective and insight is a great contribution to any organization or professional who would like to develop this vital leadership competency.

Staying under the radar

2010-02-11T22:47:00.005-05:00

Frankly, I am not sure what is worse for an organization, especially a healthcare organization: a disengaged employee or a disengaged employer.

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.

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?

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.

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.

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.

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.

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.

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.

It pays to know that all suffering experienced is shared and the responsibility to transcend it is shared, too.

Make it a great day!

iPad Launches: Can it Help Healthcare?

2010-01-27T22:44:00.006-05:00

Greetings All,

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.

They want to know from you. Please share your thoughts in the survey below:

Which Tablet Computing Device Will Rule the Halls of Healthcare?

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.

Let Medical Software Advice know what you think and of course. . .

Make it a great day!

Passion and Reason

2010-01-20T02:22:00.002-05:00

When 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.

Most people I know have some type of passion in life. This passion is coupled and/or often met with the energy of reason.

In the the classic book, The Prophet by Khalil Gibran, the speaker says about Reason and Passion:

"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."

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.

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.

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:

"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."

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.

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.

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.

Make it a great day!

Will short-term thinking's results ever jolt us into reality?

2010-01-05T23:47:00.008-05:00

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.

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.

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. Frederick Douglass said: "If there is not struggle, there is no progress." My worry is that struggle is resented and as a result progress is thwarted.

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?"

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.

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.

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".

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.

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?

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 not so United States and everything to do with individual preservation and in my opinion, our rapid demise.

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.

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.

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?

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.

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.

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?

I trust that some won't; I am confident and aware that many will.

Make it a great day!

The Logic of What Might Be

2009-12-27T01:47:00.002-05:00

We have a healthcare (insurance) reform bill passed in theory and probably soon to be passed in actuality.

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).

Well, if I summed it up quickly, it would go like this:

What does it mean politically?
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.

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.

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.

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."

What does it mean functionally?
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.

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.

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.

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 The Design of Business. 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.

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.

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.

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?

Make it a great day!

Predictive Modeling of the Masses

2009-12-17T20:34:00.001-05:00

My 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.

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.

Predictive modeling is the process by which a model is created or chosen to try to best predict the probability of an outcome. (Geisser, Seymour (1993). Predictive Inference: An Introduction) 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).

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.

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.

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.

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.

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 people come first, 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.

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.

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.

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.

Make it a great day!

Cynics and Possibility

2009-11-15T21:02:00.000-05:00

I 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Make it a great day!

Everyone's at Fault-Everybody's at Risk

2009-10-29T16:55:00.000-04:00

In 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.

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.

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.

In 2006, Harvard Professor Robert Putnam, author of the best seller Bowling Alone 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 Harvard Crimson shares an interview with Putnam:

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.

“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.

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.

But Putnam said people’s turtle-like behavior when first confronted with diversity fades over time.

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.

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.

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.

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.

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.

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 Parrots and Protectionism). 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)

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".

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.

Make it a great day!

Go Beyond the Surface

2009-10-25T01:22:00.000-04:00

It 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.

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.

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.

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.

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.

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.

Make it a great day!

Health Care Reform: Is it all about costs?

2009-09-25T13:29:00.001-04:00

There is one mystery - yea-ea-eah - I just can't express:
To give your more, to receive your less. Bob Marley

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.

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.

So, the question is: Is Healthcare Reform all about Cost?

My answer: Yes, healthcare reform is all about cost.

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?"

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.

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.

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?

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.

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.

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.

So, healthcare reform is all about cost, but it is not all about MONEY!

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.

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.

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.

Make it a great day!

Parrots and Protectionism: Healthcare Reform and American Society

2009-08-07T15:12:00.004-04:00

"Most people would rather die than think; in fact, most do so"
Bertrand Russell

Critical is not something that my closest friends would consider me. Today I will contradict that sentiment.

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.

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.

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).

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 Beware of Half Truths About Healthcare Reform) 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.

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.

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.

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.

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.

So, we are stuck between the selfish, parroting, and extremists. Where do we go from here?

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:

"The difference between Illness and Wellness is 'I' and 'We'." and I am not just talking about our physical illness and wellness.

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.

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.

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.

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.

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.

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.

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.

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.

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.

Make it a great day!

Cultural Competence is a Strategy II

2009-07-22T13:42:00.002-04:00

I doubt that strategy and struggle have a common Latin root.

What I don't doubt is that they go hand in hand if success is desired.

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.

Why does this happen? It happens because CHANGE DOESN'T WORK.

Let me explain using a device that I found quite fascinating when I first came across the ad that read: "Drop 2-3 dress sizes in less than 10 minutes." 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.

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.

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.

Now, the person wearing this device changed, but how long did that change actually last? What will be required to sustain that change?

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.

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.

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.

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.

Next time I will speak briefly on leading your cultural competence efforts strategically.

Make it a great day!

Cultural Competence is a Strategy

2009-07-14T12:38:00.004-04:00

Human 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.

What is a strategy?
I found many definitions for the term "strategy" when doing a search. Most of them were framed around military strategies. This one from Wikipedia resonated most:

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.

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. 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.

As our Cultural Competence-Quality Framework evolves and begins to be adopted by healthcare organizations, one fundamental premise is that the CC-Q Framework 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.

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.

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.

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.

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.

Jeremy Dean at PsyBlog says this about the psychology of ownership:

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).

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.

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.

Make it a great day!

Considering Immigration in Health Reform

2009-07-10T10:49:00.002-04:00

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.

Make it a great day!

Don't Enshrine Discrimination in Health Care Reform
by Deepak Bhargava

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?

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.

Health Disparities are Quality Disparities

2009-07-04T16:27:00.004-04:00

The 2008 National Healthcare Quality Report 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.

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?

Well, there are few things that we can consider.

1) Genetics: While the data on genetic predisposition is emerging there are pros and cons to this variable. A 2005 editorial The Role of Race and Genetics in Health Disparities Research out of the American Journal of Public Health summarizes the potential role of the human genome mapping in our evaluating causes and approaches to health disparities quite succinctly.

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.

2) Social, Environmental, Behavioral Factors: 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.: The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization.

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):

3) Quality Disparities: 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).

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.

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%.

What is your response? What do you think?

Well, one response is to say, "we have been delivering quality for so long, what is it with these 25%? We give everyone the same service consistently."

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?"

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.

Or, you will decide that these 25% of customers are the problem 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.

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".

Why is this a quality issue? In fact, why are health disparities quality disparities? 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.

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.

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.

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 are 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.

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.

Aligning cultural competence with quality, affordable and accessible care is what the DHW Cultural Competence-Quality Framework for Healthcare Excellence is all about. Understanding that integrated efforts towards eliminating health and healthcare disparities (a core part of our CC-Q Framework) are a critical and central tenant in the quality care that all Americans desire is vital to assuring our success in reforming the healthcare system.

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.

Make it a great day!

Culture and Quality Part IV

2009-06-24T00:24:00.005-04:00

A 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: Diversity HealthWorks' Cultural Competence-Quality Framework for Healthcare Excellence.

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.

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:

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?
2. What if the "cause" of diversity is not held in at a steady level of urgency like other core business functions?
3. Since by their nature causes change--does diversity change or even potentially go away?

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.

On the other hand, there is Quality. What about quality? Quality is. . .
--Unquestionable
--Valued
--Measurable
--Historical; and
--It is ALWAYS in the budget!

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.

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:

"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, all Americans must have quality, affordable health care."

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.

So how does cultural competence fit in? Two answers:

1) Many hospital organizations have undergone culture change/quality initiatives driven by the likes of greats such as the StuderGroup or the work of Fred Lee (If Disney Ran Your Hospital). 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.

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.

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.

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 DHW Cultural Competence-Quality Framework for Healthcare Excellence.

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, Join Us.

The July 8, 2009 event is open to anyone interested. We look forward to seeing you on-line.

To register for the July 1, 2009 Free Web Seminar Click the Link Below:
DHW Cultural Competence-Quality Framework for Healthcare Excellence--July 1

To register for the July 8, 2009 Free Web Seminar Click the Link Below:
DHW Cultural Competence-Quality Framework for Healthcare Excellence--July 8

We hope to see you as we share this integrated framework with all who are interested.

Make it a great day!

Draft Summary on Health Reform Bill from the House Ways and Means Committee

2009-06-19T18:44:00.001-04:00

This summary released June 19, 2009 gives an overview of the provisions intended as part of the bill. Read it and know that the actual 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.

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.

Draft Health Care Reform Bill Summary

Make it a great day!

Expanded Jobs, Streamlined Tools at IMDiversity.com

2009-06-15T11:38:00.003-04:00

The 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 http://jobsearch.imdiversity.com.

Special Note for Existing Users: 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 http://jobsearch.imdiversity.com/jobseeker/create as soon as possible. (Please note that your old username and password will NOT work on the new system.)

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.

Minority Politicians and Health Disparities: The Messenger, the Message

2009-06-11T00:14:00.013-04:00

In 2002 the Institute of Medicine through the actions, concern and political will of the minority caucuses of the U.S. (primarily House Democrats)making a request to the National Academy of Sciences to create a comprehensive report (Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care) on ethnic and racial disparities that has become one of the definitive if not the most definitive report on health disparities that has ever been published.

The publications created a foundational conversation that, as I have shared before in other writings, politicized the issue and raised the level of the conversation. This has been a very good thing.

However, what has not happened is a moving of the health disparities conversation from a single-faceted issue to one that is central to the success of our healthcare system and to the overall success of health reform.

Quality accessible healthcare, cultural competency, eliminating disparities, workforce diversity, patient-centered care and many other aspects of what one would consider successful outcomes of healthcare organizational excellence are all necessary to consistently make successful outcomes a reality.

Now, more so, than perhaps any other period in recent history is time to align our message and enroll messengers to deliver it consistently.

So, on Monday(6/8)there was a flurry of activity in the media announcing that the Congressional Black Caucus (CBC) sent President Obama a letter outlining their desire to assure that health disparities are a core issue in the health reform conversation. They had a meeting about this and subsequently, Health and Human Services Secretary Sebelius published a report (I say a Brief) entitled Health Disparities: A Case for Closing the Gap that outlined some of the pertinent health disparities issues connoting a need for the issue to be addressed comprehensively as part of health reform. It was published on HealthReform.gov.

I agree with the need to focus, who wouldn't. However, I am concerned by two things in particular:

1) The Messenger. Health disparities is a very broad and complicated issue. Even though racial and ethnic disparities are very prevalent and have been central to the issue, what we are facing is much bigger. We are facing the dynamics of access combined with multiple populations that are vulnerable to adverse health outcomes regardless of accessibility of services and not because of their race or ethnicity.

HEALTH DISPARITIES IS AN ISSUE THAT IMPACTS ALL AMERICANS.

So, my concern is that the messenger is generally minority. This is not a bad thing, someone has to say something. The challenge is that when the CBC and other minority caucuses are the predominant leaders in this conversation about how to make health disparities a part of the overall health reform agenda, the issue settles consciously or unconsciously in many of our minds as an issue that they are responsible for. An issue that is all about them.

By not consistently engaging and enrolling a variety of groups such as representatives from the Lesbian, Gay, Bisexual, and Trans-gender communities, the disabled, veterans, non-minority women, and others we miss the opportunity to frame health disparities, health equity, and cultural competency as an issue that simultaneously is inclusive of and transcends "minorities". It is an issue that affects everyone living in the U.S. directly or indirectly.

2) The Message.
--What is framework for the health disparities conversation within the context of health reform?
--What does it need to be?
--As a health professional or other professional, if you believe that addressing health disparities, quality affordable/accessible care, cultural competence, patient-centered care are important: How do you articulate their interdependence? (more)

Beware of Half Truths about Healthcare Reform

2009-06-04T09:53:00.003-04:00

That a lie which is half a truth is ever the blackest of lies;
That a lie which is all a lie may be met and fought with outright;
But a lie which is part a truth is a harder matter to fight.
-- Alfred Tennyson Tennyson

I could write for 2 hours about the many articles that I have read that give a very incomplete, data-lacking, sub-par, politically spun (on all sides) overview of the healthcare landscape along with the possibilities and potential pitfalls of healthcare reform how it is being described to date. I won't bore you or reinforce their political positioning with more links.

This one, I will share because it well represents all that can do harm in terms of the dissemination of incompleteness of information in our society. I wrote a response to one article (there were many half truth/half fiction/anecdotal pieces) and I wanted to share it.

Let's be clear, there is going to be a battle in the reformation of our healthcare system in the U.S. I hope we can at the least share some full truths along the way as we get there.

In response to the blog at Public Plan Facts (loosely used word--"facts")

I am 100% for sharing both sides of a story. From what I have read there is intentionality in the writers for this site, not doing that. The rhetorical argument is one-sided and when citing stats only gives the content that supports your argument "that healthcare reform how we see it is bad for Americans and bad for the country" without presenting information that even edges close to being balanced.

These tactics will not work with the American people any longer. If the 2008 elections have told us anything, the people want to choose not be emotionally cajoled into thinking a particular way or resisting something based on incomplete information.

Say what you feel you need to say. Intentionally omitting important information or spinning the information that is out there is absolutely harmful to people and I hope that your tactics don't cause more harm than good.

Make it a great day!

National Healthcare Quality and Disparities Reports and more. . .

2009-06-03T22:41:00.004-04:00

Over the past month there have been a few reports released that I felt important to share.

The first is from the Agency for Healthcare Research and Quality, their National Healthcare Quality and Disparities Reports.

This is the sixth year for these studies and given our current ramp up of the healthcare reform conversation, they are probably more important than ever. It will be critical for those who have a voice (that means you!) to make sure that we consistently align healthcare quality with eliminating health and healthcare disparities and leveraging cultural competency to see successful healthcare reform.

Quite simply as I have been sharing the past couple months, cultural competency and quality must be aligned and the elimination of healthcare disparities must be addressed if we are going to in earnest make a difference in the transformation of healthcare in this country. I believe it and I will repeat it over and over again as we get deeper into the health reform dialog.

The other report that was phenomenal comes out of the Canada-based Centre for Research on Inner City Health. They are doing such thoughtful and relevant work and have been doing so for some time. <more>

Getting There from Here: A History of Healthcare Reform from the New Yorker

2009-06-01T11:09:00.001-04:00

This is one of the best, if not the best, most well-balanced articles on the realities of healthcare reform that I have read.

It is lengthy, but it hits home as to where we are going, where others have been, and the realities of moving forward with an understanding that there will be necessary hiccups along the way.

Annals of Public Policy: Getting There from Here: newyorker.com

Shared via AddThis

What is your message?

2009-06-01T10:44:00.002-04:00

I am learning to be a better presenter. While I present for a living, when using PowerPoint, I know I can share ideas more effectively.

Learning to present with excellence is vital to organizational success. When selling yourself for a new job, selling an idea internally, or doing a sales pitch or presentation for funding, good slide presentations make a huge difference!

While I am preparing to talk to people publicly about Diversity HealthWorks' model on Cultural Competency and Quality, I have come across many good pieces on how to present effectively. This slide show is just one of many.

Use it, present with effectiveness. Know what your message is and what your audience wants/needs. And as always. . .

Make it a great day!

Good PowerPoint Design - for business presenters

View more Microsoft Word documents from Alexander Osterwalder.

I Determine What is Relevant

2009-05-20T10:10:00.000-04:00

Since May 11th and the President's remarks on May 11th about reforming the healthcare reform, I thought that I needed to write something in context about cultural competency and quality or at the least give my perspective on how health disparities have to be considered if we are going to make any sustainable change in healthcare as a whole.

I pondered what to write and even scratched out an outline of the points I wanted to make sure I explained thoroughly. After pondering and outlining and pondering some more, I realized that I needed more perspective. So, I began to read more blogs and opinions and tweets of those for universal coverage and those against what is being labeled as "socialized medicine".

The amount of information and disinformation and opinion is startling. I have a decent grasp of how the healthcare system works from point of care to process of payment and beyond. Yet, making sense of all the opinions about what health care reform must do, what it will create negatively and positively, to those who believe that the system is fine and that changing it will cause health plans to fail, to those "Good Americans" that simply want everyone to pay their way, is mind boggling to me. I cannot imagine what a person who has not been trained in these dynamics experiences when trying to connect the dots.

My conclusion is that "I determine what is relevant". Now, the "I" in this statement does include, I, Amri. It also includes you, reader. It also include you, pundit, politician, President, Peter, Paul, and Poppins, and potificatoblogwriterspindoctorsincerejournalistpeacemakerparent. (More)

Diversity, Disease Management and the Business Case for Addressing Disparities in Healthcare

2009-05-16T20:49:00.000-04:00

We recently shared a new (actually updated) white paper that we published initially in 2004 and wanted to share it in brief on our blog(s) so that those who did not get the opportunity to see the full paper can be made aware of it and access it if so desired.

For those who are subscribers to Diversity HealthWorks your copy is free. If you have not received a copy, please send me a message through the network.

If you are interested in receiving a complimentary copy of the white paper: Join Diversity HealthWorks or if you would like to purchase a copy please click the link below:

The first few pages are included below for your review. If you have questions, always feel free to contact me, Amri Johnson. You can find our contact info at our website.

Diversity, Disease Management, and the Business Case for Addressing Disparities in Healthcare

____________________________________________

Introduction

The conversation about differences in health outcomes for minorities and whites in the U.S. has been documented in the academic literature, in detail, for many years (U.S. Department of Health and Human Services (DHHS), 1985). Nonetheless, the past 10 years has significantly increased and framed the conversation about differences into the issue of “health disparities”.

Prior to the release of Healthy People 2010, which focused on decreasing (towards eliminating) the differences in racial and ethnic health outcomes, the dialogue was understood and often studied by researchers in the academy; however, mainstream America did not have clarity on the degree of the problem and how to address it. With Healthy People 2010, then Surgeon General David Satcher introduced the term “Health Disparities”.

The introduction of this term allowed for a broader dialogue about the direct and indirect impact of health disparities on multiple players in the health care system. It also created further inquiry as to the causes. In 2002, the Institute of Medicine released its publication Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care that documented the various reasons for disparities as well as offered suggestions on how to address them.

Unequal Treatment was groundbreaking because it opened the discussion up to a more mainstream audience. However, the opening was not exhaustive enough that it could frame the issue in a way that was seen outside of health circles as a bottom line issue that affected all U.S. residents.

As most Americans are aware, the demographics of the country are rapidly changing. For example:

• Currently one-third of Americans are racial and/or ethnic minorities
(Census, 2000)

• By 2020 the Bureau of Census states that over 40% of the U.S. population
will be racial/ethnic minorities

• In the next decade 41.5% of workforce will be racial and ethnic minority
(Bureau of Labor Statistics)

• Over 50% of all U.S. immigrants entered the country since 1990

These statistics translate into a greater necessity to give the issue of health disparities the attention it needs by all who are affected. In particular those affected include: medium and large employers with growing ethnically diverse workforces and taxpayers who pay for the services of the largest employers in the country: federal, state, and local government. As mentioned above health disparities impact all Americans.

By framing disease management, corporate diversity initiatives, and health disparities in a similar context, this paper will illustrate how the business case for addressing each are aligned. In addition it will illustrate how an organization can proactively integrate addressing health disparities into existing practices such as diversity and disease management.

Disease Management and Healthcare Cost

With increasing costs of healthcare, employers (large and smaller), health plans, and healthcare providers have explored and tapped into various methods to address the challenges of managing cost. Myriad programs have been implemented, starting with managed care’s flourishing in the 1970s up to today’s emphasis on Disease Management (DM) which started in the 1990s.

The Disease Management Association Defines disease management as:

A system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant. Disease management:
• supports the physician or practitioner/patient relationship and plan of
care,
• emphasizes prevention of exacerbations and complications utilizing
evidence-based practice guidelines and patient empowerment strategies,
and,
• evaluates clinical, humanistic, and economic outcomes on an on-going basis
with the goal of improving overall health.
Source: (http://www.dmaa.org/definition.html)

While DM is, in theory, indicated as promising where cost savings are concerned, there is very little to no extensive, longitudinal, empirical evidence to indicate sufficiently that such savings are being realized. Al Lewis, Executive Director of the Disease Management Purchasing Consortium and DM ROI expert states, “For the first seven years of the eight year history of DM, nearly every result was tainted by erroneous measurement.” Mr. Lewis has also postulated that understanding ROI for DM is just now starting to gain ground where solid measures and a gold standard are concerned (www.dismgmt.com). Despite sparse empirical evidence supporting DM, DM as an industry has flourished with revenues (primarily paid by health plans) growing from $87 million in 1997 to over $600 million in 2002 with projections of over $1 billion. The Boston Consulting Group has gauged the DM market in 2005 at approximately $1.2 billion. They indicated a 40% compound growth rate of 40% since 1997 similar to the above statistics; and predicted growth to $1.8 billion in 2008. They deduced that the market would reach maturity at around more than $3-4 billion. (“Realizing the Promise of Disease Management Boston Consulting Group 2006)

Corporate Diversity Programs

Corporations have heavily embraced diversity programs over the past 20 plus years. From supplier diversity to employee-focused/workforce diversity programs, most of the Fortune 1000 and many others have specific diversity/inclusion programs being implemented or built into their current HR employee on-boarding/training programs or overall corporate culture.

While most programs were initially developed reactively out of adherence to affirmative action and compliance regulations; currently, many companies are acutely aware of the various positive outcomes and are working proactively to measure diversity’s impact on their corporate bottom line. From employee engagement to measuring ROI through diversity efforts in marketing, recruitment, or other streams of revenue or cost savings, the case for diversity for many has become a part of how business gets done is more and more a mainstream idea for large to medium-sized employers. This emphasis is an evolution as well as a response to some critics that argue against diversity programs being of any bottom line value to an organization. One such critic, Thomas A. Kochan, one of the most respected human resources management scholars in the country from MIT’s Sloan School of Management states, “The business case rhetoric for diversity is simply naïve and overdone. There are no strong positive or negative effects of gender or racial diversity on business performance.” Other arguments are, of course, to the contrary including Luke Visconti, co-founder of Diversity Inc., a leading diversity publication, who states, "It defies gravity and flies in the face of logic," he says. "I can’t even imagine how someone could come up with that conclusion unless there was no diversity among the people doing the study.” In dismissing Kochan’s research, Visconti is stating that anyone who cannot see the value of emphasizing diversity, does not understand the changing demographics of the United States; or, is blind to the anecdotal examples and intangible benefits that companies are experiencing that have yet to be measured empirically.

While these arguments state opinion, more recently authors such as Dr. Scott Page’s book The Difference and Frans Johansson’s The Medici Effect which both suggest that diversity drives better solutions and greater innovation respectively. Many have taken these authors’ research and insights into account as they continue to illustrate how inclusive and diverse work environments are a key to organizational success.

The former comments above have been a part of the diversity industry for a long time, while those of Page and Johansson are more recent. Nonetheless, even though professionals that work in the industry are clear about the need for making diversity a sustainable part of our organizational cultures, we have often seen the commitment by companies to be forsaken. This has especially been the case since the economic recession in 2008-09 has forced corporations to make budget cuts. While diversity is valued, it has still been one of the first places to take budget cuts.

(Interested in receiving a complete copy of this white paper? visit Diversity HealthWorks)

Make it a great day!

Culture and Quality Part III--10 Resources

2009-05-07T16:38:00.000-04:00

In lieu of another article in this part, I decided that sharing resources that will help you frame culture and quality together would be valuable. While I intended to share these resources in the final quarter so to speak, I thought they would be helpful now.

By no means is this meant to be a definitive list. In fact, I welcome suggestions on what should be added to it that allows us to see the connections between cultural competency and quality more clearly. We want (continuing for some and beginning for others) to make this an integral part of our foundation for creating seamless connections of cultural competency, diversity, and inclusion with our collective organizational quality development, mission, and of course, for healthcare reform.

Culture and Quality: Joining the Levers (2002)
Dr. Mark D. Smith, MD, MBA, CEO of the California Healthcare Foundation clearly illustrates the movements of cultural competency and quality and their connection. He frames the presentation around “What are we going to do?” It is important to note that this was 2002 when Dr. Smith presented at the Third National Conference on Quality Health Care for Culturally Diverse Populations. It is 2009, the issue has risen in priority, the presentation is very timely to this day.

The Providers Guide to Quality and Culture
Management Sciences for Health has created a very comprehensive website focused on Quality and Culture for healthcare providers. This site is very comprehensive and frames the quality dynamics with succinct descriptions and a broad grouping of subjects. The site was created with the U.S. Department of Health and Human Services, Health Resources and Services Administration, and the Bureau of Primary Health Care.

National Center for Quality Assurance (NCQA) Efforts
NCQA has taken great efforts to align quality and cultural competency for health plans. In fact, many health plans have been actively making cultural competency and the reduction/elimination of health disparities a priority for years. (more)

Eliminating Health Disparities and Health Reform Go Hand in Hand

2009-05-05T11:53:00.000-04:00

Groups Call on President to Address Health Disparities in Health Reform
The case is building and the time is now to really begin to get a grasp on health disparities. Cultural competency and quality will by their nature be a part of that conversation. Are we ready? What do we need to do to be ready?

Culture and Quality Part II

2009-04-24T16:38:00.000-04:00

The idea of connecting cultural competency to quality is not one that is new. In fact, there are products and people who have been in this mode for a long time. For example Resources for Cross Cultural Health has hosted a conference entitled National Conference Series on Quality Health Care for Culturally Diverse Populations, which they have hosted since 1998.

In addition there are people like Joe Betancourt, MD, MPH who was one of the principal authors of the IOM report Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare published in 2002 who along with his colleagues and leading health disparities researchers, Emilio Carrillo, MD and Alexander Green, MD, MPH created the cultural competency educational tool, Quality Interactions. The name of this product, that teaches health professionals about cultural competency indicates that the creators aligned cultural competency with quality from the beginning of its creation. Thus, as leading researchers and thought leaders in the field they get that cultural competency goes hand in hand with quality healthcare.

So, the idea is not new. However, the idea of aligning quality with cultural competency is not commonly practices. It is not practiced in healthcare where one may consider it to be obvious since the bottom line of healthcare delivery is quality and efficacy. It is why we focus so much on evidence-based practice. Nonetheless, a conscious and consistent conversation aligning the concepts of cultural competency with that of quality has yet to come to light for the majority of healthcare organizations. more

Kaiser Permanente CEO, George Halvorson's New Book

2009-04-18T13:22:00.000-04:00

I saw on one of the blogs (Patient Centric Healthcare) I traverse, that the CEO at Kaiser Permanente is writing a book. I think fondly of Kaiser as a leader in cultural competency, diversity and inclusion. And want to make sure that if you are interested in what a great mind that works with several great minds, (i.e. Ron Knox, Melanie Tervalon, Edgar Quiroz), that IMHO knows the business of healthcare from many angles, and gets the connections between healthcare reform and the responsibilities of healthcare organizations towards both cause-oriented and quality-oriented approaches, pick up the book when it is released!

Upcoming Book By George Halvorson From Kaiser

Check out the blog post and interview.

Visit Diversity HealthWorks I will share the book and a link with members when I pick up my copy!

Make it a great day!

Convergence is Cool

2009-04-14T12:17:00.001-04:00

There is not much to like about an economic recession. There is at least one thing: Innovation expands when other things are contracting. When you don't have a lot to work with you find ways to work more creatively with what you've got.

As I am preparing to write the second part in the series, Culture and Quality, it is amazing (even before April/Minority Health Month came upon us) how much health disparities are being discussed (more)

Will Giving Patients Knowledge of their Physician's Race Reduce Health Disparities?

2009-04-06T21:14:00.000-04:00

The Kaiser Family Foundation website listed an article about the preliminary results of a telephonic study done by Highmark looking at patient preference for having race listed when they are choosing a physician (more)

Culture and Quality Part I

2009-04-04T14:00:00.000-04:00

For many candidates and employers/managers the question of "Where do you want to be in 5 years?" is a common one ask and responded to in interviews and performance reviews. In the work that we are doing to reform/transform healthcare, the idea of where we want/need/have to be in 5 years has been often coupled with the angst people feel about where we are and the past 5-10, 20+ years that has gotten us to where we are today.

I need not rehash the myriad dynamics that face us today. What I want to point out however, for us with a desire to create consistent and sustainable excellence in healthcare, is that we couldn't be in a better position to create something truly transformational. The question here is: Where do we need to go?

Why is the window of opportunity for transformation in healthcare wider now than we may have ever seen before? There are multiple reasons, I will name just a few: more

Patient Centeredness, Cultural Competency, and Health Quality

2009-03-30T11:13:00.000-04:00

Recently, I have been talking more and more about connecting diversity and cultural competency to quality. It is not a new conversation but it is in fact one that has been on-going yet not embraced as a concept that gets healthcare organizations to raise the level of dialogue to that with more inclusive framework or positioning so to speak. Aligning cultural competency and health disparities consistently with quality can lead to what I feel can create a more powerful impact on all those who can affect transformation.

I came across an article out of the Journal of the National Medical Association (JNMA) by Drs. Saha, Beach, and Cooper that speaks to it and I wanted to share it with you today.

Patient centeredness, Cultural Competency and Health Quality from the JNMA

Make it a great day!

Supply, Demand, Universal Coverage as Transformational?

2009-03-27T17:18:00.000-04:00

I saw a blog post from my Twitter stream today that was quite interesting by the Compass Group, Inc. They have great a great blog by the way. I am following it as soon as this posting is completed.

What it stimulated for me was examining the framing of the whole universal coverage conversation as this dynamic of contention as well as the wording. My response to the article which talked about supply and demand. "Supply goes down, prices go up"
the article shared, especially where personnel are concerned.

This theme was in relationship to what health reform would really create as an effect in terms of bringing costs down if there is already a weakened supply. Naturally the economic rule/principle applies and how can we avoid it?: They say greater efficiency and I generally agree.

My feedback to the blog post was as follows:

Great article. What strikes me about what you describe is whether or not we will actually increase those seeking care? If indigent care is costing a public hospital like Grady Memorial Hospital in Atlanta where I live more than $250 Million per year and umpteen billions nationally , what happens if there is coverage? Is it possible that the result of universal coverage is increased employment of healthcare professionals, better preventive measures, and fewer complex procedures that are paid for through premiums of the insured and state and local government intervention? I am not saying that it is going to happen, but is it possible?

What kind of country do we want to live in? One where some are sick and cost those who are well and/or are getting care significant resources and perhaps resentment (like now)? or One where all can be taken care of, not at the expense or resentment of others?

My premise is that a well thought out universal coverage (not universal healthcare control as some interpret or socialized medicine as some fear) system can actually create a healthcare environment that benefits practically everyone, haves and have nots, those currently covered and those not covered, the employed and unemployed, etc. Essentially, we would be on the road in my opinion towards tackling health disparities, addressing cultural competency with a reduced access burden allowing us to really make it a QUALITY dynamic in addition to a moral or regulatory one, etc.

We have a choice, resist change to extent that we see things repeat themselves or start correcting the path we are on, adjust along the way and step into possibility. We all know something has to be done--what are we resisting when we dismiss it other than the notion that as individuals we might get less than we have now? Notions of that nature will do little to transform/reform/elevate our healthcare standing and our standing for being as great as this country is.

Make it a great day!

HCAHPS and Cultural Competency

2009-03-24T21:57:00.000-04:00

Stay tuned for new tools and content related to regulatory cultural competency via Diversity HealthWorks.

Our plan is to share something your organization needs to be aware of and how it to execute what is coming into your overall strategy.

Since Dr. Weech-Maldonado's research in this phase has come to an end, we are already seeing many research-based and tested instruments to measure cultural competency in organizations. There are some good ones, we will share a few and if you know of others, please contact us. Of course, if you share it with me, I will share it and let people know who sent it :-) None of the tools to date, in my opinion, are better than others at this point and you will have to see which one works best for your organization

Stay tuned. . .and Make it a great day!

Development and Testing of the Patient Assessments of Cultural Competency Survey

End Date: February 28, 2009
University of Florida
P.O. Box 100195
Gainesville 32610-0195
Principal Investigator: Robert Weech-Maldonado, M.B.A., Ph.D.

The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys have been used to assess racial, ethnic, and linguistic differences in patients' experiences with care. There are concerns, however, that the surveys do not fully capture aspects of the care experience that are particularly relevant to minority patients, such as access to language services and perceived discrimination. The goal of this project is to test, validate, and disseminate a new survey—the Patient Assessments of Cultural Competency (PACC)—that addresses issues of cultural competency. Once the project team has established the survey's reliability, it will create a short version of the survey to serve as a supplemental module for the CAHPS instruments. The Agency for Healthcare Research and Quality and the National Committee for Quality Assurance have both stated their intention to collaborate on dissemination of the PACC survey.

Kaiser Permanente Ads Call Attention to the Issue of Health Care Disparities

2009-03-20T22:18:00.000-04:00

Kaiser Permanente quite simply is leading healthcare organizations in the direction that I think they absolutely have to go--forward in making health and healthcare disparities a strategic priority. The issue is both political and moral, clinical and organizational. It mirrors societal diversity and inclusion conversations and what are often considered business considerations in that the insured, under insured, and uninsured all work for employers and as employers. Are you part of a healthcare organization looking to share best practices? If so, take Kaiser as an example. . .
Kaiser Health Disparities Ads Call for Action

U.S. Surgeons General Decry Disparities

2009-03-19T11:11:00.000-04:00

We talk and talk and talk about disparities and many (I would say, all) of the Surgeon Generals of the past 20 years have made minority and ethnic disparities a priority directly or indirectly. Dr. Koop focused on smoking and the difference he made was huge. He had help before his platform took root from many public health leaders throughout the country.

As we move towards forward in transforming health care is it worthwhile for us to make health disparities (which affect us all) the leading issue in moving the needle forward? I am talking about doing this in a manner similar to how we approached the tobacco work. Here is the article. . .
Access remains key to health care, surgeons general explain in Orlando

Job-Bias Claims Soar to Record High in 2008, EEOC Says

2009-03-17T22:09:00.000-04:00

This is a well-known fact amongst diversity and inclusion professionals. We have entered a new day, this trend will not go down. Expect at least 100,000 for 2009 if we don't keep our eye on sincere engagement of our workforce and customers.

EEOC Claims Increase
Overall employee claims with the EEOC jumped to 95,402, the most since the agency opened its doors in 1965. Retaliation claims were second in number only to those alleging race discrimination.
http://www.workforce.com/section/00/article/26/24/29.php
from Workforce Management

Make it a great day!

Racial Health Disparities: The Civil Rights Issue of Decade?

2009-03-17T00:42:00.000-04:00

A few years ago, Congressman John Lewis said to me in an interview that "healthcare is the Civil Rights issue of the 21st century". The American Medical Student Association has for a long time been dedicated to address racial and ethnic disparities. This article coming from sessions at their annual conference is reflective of that commitment and what the Congressman declared over four years ago. . .

Racial Health Disparities Called Most Prevalent Civil Rights Issue of Decade
from Diverse Issues in Higher Education

Health Reform and the Medical Home

2009-03-14T19:25:00.000-04:00

I wanted to share a great piece from the blog Practice Improvement: Tony Lembke's site for Improvement, Medicine, Technology, Productivity.

A medical home is a concept that is talked about a lot in the scope of strategies towards the elimination of health disparities. Continuity of care makes a difference in terms of outcomes, prevention, and disease management. Trust is there, consistent dialogue and the ability for a clinician to understand the whole person is there, adherence to treatment is more probable so disease management is more effective. A medical home makes good sense and Mr. Lembke's piece below although focused on Australia is apropos for the US just as well. Patient-centeredness to me is implicitly (at the least) about health equity.

Health Reform and the Medical Home from :PracticeImprovement

Kaiser Permanente Tops Workplace Diversity List

2009-03-13T13:13:00.000-04:00

Under the leadership of Mr. Ron Knox, Kaiser Permanente has consistently been a leader in diversity and cultural competency. Diversity MBA Magazine has recognized them as the No. 1 best place to work for managers from all backgrounds. Congrats to Ron Knox and his team including Edgar Quiroz who heads up workforce diversity and is obviously, along with many others continuing to lengthen the track record of KP in diversity, inclusion, and cultural competency.

Diversity MBA Magazine's 50 Out Front

Electronic Medical Records and the Reinvestment Act of 2009

2009-03-12T18:24:00.001-04:00

For a long time, health professionals have known the value of EMR towards collecting more efficient and useful patient data. The creation of health equity and elimination of health disparities requires greater access to care and a good part of access is clinicians being able to access medical records rapidly to create patient-centered treatment and preventive care plans.

This article gives a good overview for those considering EMRs aquisition as they relate to the Stimulus package approved by Congress. Group practice managers, physicians, and other organizations interested in EMR would find the article very much worthwhile.

The Stimulus Bill and Meaningful Use of Qualified EHRs / EMRs
from Software Advice.com

Study shows UCLA's diversity helps reduce racial bias

2009-03-09T11:46:00.000-04:00

I thought this was interesting. . .I wonder if the small number of African Americans indicates that there is something unconscious in the dynamic that is not accounted for. Most bias these days is beyond conscious understanding. In fact, some argue that this has been the case for a long time especially since civil rights laws in the U.S. Tell me what you think. . .

Make it a great day!

UCLA Diversity Reduces Racial Bias
The face of UCLA has changed dramatically since psychology and political science Professor David O. Sears started teaching at the campus in 1961.

Back then, his students were white, almost without exception. In his first decade of teaching, there were only two African American undergraduates in his classes and almost no Asians or Latinos.

His classes now look extremely different: The majority of his students are non-white. There are Asians, Latinos and African Americans, as well as other nationalities, such as Armenians.

Sears said one might expect such diversity to cause friction, but the transformation he’s seen has taken place without much hoopla. A new study he co-authored — and the subject of a book titled “The Diversity Challenge: Social Identity and Intergroup Relations on the College Campus” (Russell Sage, December 2008) — also confirms that, for the most part, members of the diverse student body are largely accepting of each other.

An Ape, My Conflict with My Cousin

2009-02-19T17:06:00.000-05:00

I did not want to write this blog post. I am tired of these situations coming up and the same cycle playing itself out, but it is what it is and this time I will respond to get it off my chest.

After receiving an email from my cousin in Texas who got a viral email about the New York Post's (Feb. 18th--see below) chimpanzee cartoon that apparently connotes a racial slur against the President of the United States.

So here is how it happens:

Newspaper editor sits around and thinks about content for the February 18th issue. He has cartoonist Sean Delonas, always controversial, publish a cartoon featuring the chimp that was recently shot for attacking its owner's best friend. The caption makes a reference to a the primate writing the stimulus bill. My cousin sends our family including me an email.

My cousin's response to the email she got: Ok Family and Friends! See this cartoon for yourself and tell me if African-Americans should be offended by this or not! Given our history in this country, the Post has the AUDACITY to put this in their newspaper! They knew EXACTLY what they were doing!

This won't be a problem for most of us but, DO NOT BUY THE NEW YORK POST!!!

My response to my cousin and family: Folks, let's move on the path of transcending these types of things. If the artist had ill intent, let them be who they are and pray that someone does not harm them out of anger.

We have the opportunity to embark on the path of transcending pain and healing our communities. Let's not get caught up in the baiting of outside entities distracting us from the work we have to do, we must do, Yes we can do! Get enraged about the distractions and how we have to detach from them in order to move towards enriching and loving one another as our full-time mission.

My cousin (not agreeing in response): Hello. I respectfully disagree. What does it take to get respect in this country?!!!

Because we African-Americans have already came too far and have worked so hard for what LITTLE strides we have made....is ALL the more reason to stop this subtle bigotry in its tracks! If we overlook something like this, they ( the racist right) will just keep on doing these kinds of things!

To me by jumping on this now or "nipping this in the bud" this will help ALL of us heal properly and transcend the pain we as African-Americans only experience in this country. I would think its a travesty if we let these little, subtle racial time bombs get into the heads of our kids and the many millions of other "non African" Americans that come to this country every year and allowed to look down on us.

Its these kind of things that make our kids want "white" dolls instead of "black". Its these subtle statements that help perpetuate the negative stereotypes in our media and in our songs. Why else do we have 75% of African American men marrying outside their race? Do you think that its all for love?

My reinforcement: Still a distraction. We have been trying to "stop things in their tracks" since the beginning of the Civil Rights movement and it has only gotten us but so far.

In fact, when a movement against something like this arises, the media and a paper like this get more exposure and actually make more money. Think about Don Imus. I think he is a decent guy that said something stupid and racist. He lost one show then picked up another out of us being enraged making MUCH more money.

We are not focused enough on re-segregated inferior schools, issues with HIV, our health, growing OUR businesses, etc but we put time in to making this nothing newspaper a viral hit on-line? It doesn't add up for me. They are getting exactly the livid response from the black community that they intended and it is going to make them money and we are putting it in their pockets!

My overall conclusion about things like this: During the political campaign the New Yorker published a cover that was a caricature of the Presidential Candidate Barack Obama and Michelle Obama during what my friends call a "Terrorist Fist Bump."

People were outraged, I suspect Rev. Al Sharpton and Jesse Jackson spoke for all of the black people as they are the ones that get on TV. Now fortunately we have heard the voices of people like Roland Martin (whom I differ in perspective with a little in this posting) who I think are more inclusive in their perspective. Nonetheless, I think there is too much time spent on the ignorance and unconsciously or consciously racist remarks that people make.

Should things be pointed out as to the connotation and impact? At times, yes, other times, no. The nature of many media vehicles attention, coverage, etc. at all cost. The NYPost can have commentary about their cartoon for several more weeks to come. It will be talked about on television news casts, the artist will be invited to speak on shows and interviewed, etc. It is a classic publicity coup that newspapers and many media outlets live for. So, for this reason I say no.

I simply don't think it should get much attention. I understand that if this happened and had a negative connotation for the Jewish community (as in a rat character as Roland Martin described) there would be outrage. I agree. I also think that there would be dollars pulled from advertisers because so many business are owned or operated by people from the Jewish community and they are organized to take that stand. Simply not purchasing the Post does very little and a viral email forwarded to potentially hundreds of thousands does not hurt the Post either--it boosts sales.

We have to acknowledge these racial dynamics, but if we want to begin to embark on the road to change, hold people accountable without promoting their negative actions. So, yes to pointing it out, just not too much.

If we want to come down on vehicles like the NYPost, and request that they contribute to various non-profits working in struggling communities with depressed schools and families. Make them go beyond a defensive stance and engage in a back and forth blaming of leading blacks for their so-called opportunism. Make them say, "we did not intend for this to be offensive". Even if they don't mean it, call for them to back it up and contribute to something that combats the perception if they are sincere. Will they do it, maybe not, but it will give the public insight into what they are all about in earnest and then the outcomes will play themselves out over time.

Don't give them more fuel that helps add to their coffers. There is no progression in that approach and it has not helped race relations and it definitely is not what the diversity conversation should create. In fact, it is the cycle of perpetual sameness that we have seen over and over the more we try to make the "bad people" fess up so that the "good people" can be satisfied that their justice has been served.

I doubt the President cares or has time to care and in fact, he probably shook his head and laughed it off. The stimulus bill is passed and he is off to a great start!

Make it a great day!

Connection is the New Career Economy

2009-02-08T12:46:00.000-05:00

When I make art, I think about its ability to connect with others, to bring them into the process.

Jim Hodges

After a 10+ day trip from coast to coast, connecting, consulting, and collecting stories and learning so much from so many, I returned to see my plants a little irritated with me. In fact, two of them went on strike to the point that they looked as though they were on the brink of death.

I definitely know why I don't have a pet as much as I travel. . .Back to the plants.

After buying new pots, soil, collecting rain water from friends that had it to spare in addition to the small amount that I collected from my deck while away, I went about re-connecting with my plants. Now, they were not altogether neglected while I was away, but they did not (and I could see it) feel connected to or any other human because there was no human presence. As a result, they slowly moved towards a state of being less than they are capable of being.

Traveling is not new for me and my plants are not without their alone time. The difference this time was that I did not leave a key for my neighbor to come buy and spend time with them. I asked a friend who is very good with plants to water them, but he does not have the time to spend with them like my next door neighbor takes the time to do. The difference: watered plants vs. plants that were given the opportunity to interact with an oxygen breathing organism--to connect.

My plants have historically been very healthy and have grown a great deal. Until my previous trip while in Washington, DC for about 9 days in January, they were flourishing. However, the less interaction they have had the less healthy they have been and because I have been gone back to back, I was not able to repair the small issues I noticed they were experiencing. In fact, I said to myself, "they will be okay until I get back."

This was not the best decision. In fact, when I saw the slight wilting and leaves dropping off, I would have served us both better by taking the time to connect, if only for a little while. Assuring them that upon my return, we would spend an extended period of time together renewing our greenness! But I didn't.

Connecting is the new career economy. When I say, "new" I am not implying that we haven't connected in the past and that it hasn't been vital to our careers, recruiting, retention, advancement, etc. What I am saying is that the nature of our connections is now beyond necessity and what is ironic is that the necessity of consciously creating connections evolved to the next level from what some recruiters, candidates, etc. considered as a disconnector--the Internet!

Twitter, Facebook, LinkedIn, and niches like Medical Mingle, and soon Diversity HealthWorks as well as many others are principally focused on connecting people and hearing what they have to say and are up to. People want to connect, these sites allow it to happen.

While traveling, I connected with my best friend from high school, John Dean (our picture is above). John lives just outside of Los Angeles. He doesn't work in healthcare, but he works in social services and there is a definitely connection to some of the things that I am committed to: children, health, diversity, transformation. Possibility lies in the conversation and I know I am better because of it regardless of the future outcomes.

I re-connected with John through Facebook after 15 years. While this example is not one that is directly job-oriented or career building, the connection is about possibilities. The new job economy is about connecting to create possibility. Where in the past, we connect with a particular rationale, now we connect just to connect and out of not knowing what a connection, or a follow, or a poke, or a tweet, or an inMail, or a response to a blog post might create we connect for its sake and then see what happens.

In the James Surowiecki's The Wisdom of Crowds:

He postulates the following about wise crowds and their superior collective wisdom (from Wikipedia):

Diversity of opinion: Each person should have private information even if it's just an eccentric interpretation of the known facts.
Independence: People's opinions aren't determined by the opinions of those around them.
Decentralization: People are able to specialize and draw on local knowledge.
Aggregation: Some mechanism exists for turning private judgments into a collective decision.

In essence, communities or crowds lead us in a direction that allows for connection and connection creates solutions that we could not imagine in a vacuum. This is exciting to me and leads me to know that I cannot neglect my plants as they cannot connect to the internet and connect with you (or me for that matter when I am on the road.)

Likewise, not everyone in our purview desires to connect like we do. Find ways to connect with your colleagues, your friends, family members, employees, etc. in ways that work for them. It will without a doubt be the critical component of success in all relationships business, small to global, and personal from this point on. It always has been and it always will, now lets take it seriously and consciously connect like we never have before!

Make it a great day!

Chain Reactions

2009-02-04T15:45:00.000-05:00

I have been in California for the past week and traveling basically from DC to Chicago, NYC to LA to where I am now in San Francisco since January 14th.

My travels have given me a unique opportunity to compare the dynamics that are happening with the economic realities we are facing from a more intimate local perspective in the cities I have been in.

First off, everyone as expected is concerned about financial realities. It is a part of every conversation and in each business conversation that I have had both healthcare and non-healthcare related, it comes up in context or through more specific content. In each local paper I read, there is some semblance of the economic reality. Hotels are cheaper (good for me) and the appreciation I get for a tip seems to be acknowledged more so than I can recall from past experiences where I have given equal percentages for the service delivered.

Specifically, with my healthcare industry conversations, the over arching theme is the cutting of budgets by hospitals and healthcare systems. In NYC where I visited a hospital in Brooklyn, stretching the dollar for programs related to diversity and cultural competency is not a new thing. However, this particular facility has shown tangible results as far as ROI directly and indirectly through the efforts of its diversity lead; however, the budget to increase initiatives has remained flat and this year has threatened to be cut significantly. What is the rationale?

In Chicago there is a theme of cost cutting as well, but some of the healthcare organizations there are experiencing an increase in Equal Employment Opportunity Commission (EEOC) claims. This is to be expected since the EEOC reports that when the economy is down, discrimination charges go up. A recent Society for Human Resource Management article (January 2009, HR Magazine) quoted The Training Associates marketing director Jeanne Picardi stating that, "Not all senior leaders are familiar with employment law, and may see all training as 'discretionary spending' to be cut. This is a bad idea at any time, and especially in a downturn, because employment law claims increase substantially during a poor economy."

So, while I cannot speak for all of Chicago or all of anywhere for that matter, it is evident that claims will go up and some organizations are taking preventive measures to mitigate the potential circumstances that can result from the current economic reality.

In Los Angeles and in all of California, the talk is on the CA State budget. It is a mess and all Californians are feeling it. From the healthcare industry to retail, jobs are being cut, budgets slashed and consumers are feeling the effects. The effects are coming in decreases in public services (including cuts in public health funding/services), hospital personnel, infrastructure, etc. Not anything different from the rest of the country per se; however, in California there is a conversation in the media that illustrates the dynamics of how the State budget connects to the local economy connects to healthcare that connects to a more profound crisis of deeper, chronic (pun intended) proportions.

Again, I am sure this is happening in most States, but I am not sure about the dialogue being future-oriented given the challenges in the present and the recounting of rationale from the past.

So, where do these chain reactions leave us? First, I think they leave us with a need to turn inward for clarity about what those of us who have the privilege to contemplate the future can do right now to play our role in the collective betterment. This does not exclude concern for our personal and family well-being, but it does require us to look beyond a myopic sentiment of self-interest towards what will create long-term prosperity for many.

Second, we have to stay the course. The money did not "go away". Whatever comes from congress or whatever the banks at some point decide to loan again, we cannot quit moving forward with the focus on growth, not maintenance. Maintenance is death, you grow or you die. If we are maintaining to keep what we have, we will soon see it dwindle. So, whether it be money-wise, health-wise or otherwise, whether we profit, break even, or take a loss, growth has to be at the root of what we do.

If we miss the mark of fiscal profit or better health, we have to sow the seeds and reap profit from our learning about what we missed. If we profit, re-invest in future growth rather than hoard. Gather and store, but let the overflow return to the flow. If it sounds a little Buddhist in nature, so be it. We will see nothing less than the reaping of our labor's fruits of the next 6-12 months. It will seem to arise almost immediately on either continuum. Take note and do what we have to do to not create more suffering from the suffering that we are experiencing individually and collectively right now.

Thirdly, but not last (as I am only sharing snippets) acknowledge that this is temporary and if you act in temporary ways, we will have results based on temporary circumstances. This crisis was created and it can be transformed. It will take the efforts of many to do it. Act based on what you want, not based on what you don't. Either way, we will get what we act upon. Let's act on the greatness that we desire!

Make it a great day!

Foundations' role: Drive Change/Policy vs. Fund Research

2009-01-05T10:14:00.001-05:00

I found this LA Times article compelling and I think the timing could not be better. Folks, the time for transforming health care is NOW. The window of opportunity has never been wider.

Despite "the finance crisis" and "the credit crunch" the conversation that we can enter into is bolstered by the inclusion of myriad perspectives, participation in the process, and hope that the campaign season created.

Regardless of what political affiliation you subscribe to, we all have a physical body and health affects us all. California is taking the lead we can make mistakes and learn towards new innovation with the most populous and arguably the most diverse state in the Union.

Of course, no one really knows "the solution" but we must do something and we must do something together. . .

“Whatever affects one directly, affects all indirectly. I can never be what I ought to be until you are what you ought to be. This is the interrelated structure of reality.”

Martin Luther King, Jr.

Foundations take active role on health policy

January 5, 2009

Reporting from Sacramento — Frustrated that years of financing studies and demonstration projects have not translated into widespread improvement in medicine, California philanthropic foundations and think tanks are shedding their traditionally detached stances to crusade for healthcare reform in the state Capitol and in Congress.

Several of the biggest foundations have established offices in Sacramento and staffed them with experienced former advisors to lawmakers, with the aim of educating legislators to embrace their ideas.

The approach is a notable change in the foundation world, which in the past has maintained an academic distance from the political arena. It is also a delicate endeavor because such nonprofits are barred under Internal Revenue Service rules from lobbying or engaging in partisan politics. With billions of dollars at their disposal, the foundations are seeking to become bigger players.

In November, the California Endowment, a Los Angeles-based foundation with more than $3 billion in assets, announced that it was hiring Daniel Zingale, a senior advisor to Gov. Arnold Schwarzenegger. When he starts later this month, Zingale will encourage policies the endowment favors, including ensuring that all children have health coverage and making doctors and hospitals focus more on disease prevention and the management of chronic ailments.

A onetime AIDS activist and HMO regulator, Zingale led Schwarzenegger's 2007 campaign to expand healthcare to all Californians; that $14.9-billion proposal was rejected by legislators last January.

"We really consider ourselves to be supporting positive change and not just making grants," said Dr. Robert Ross, the endowment's president.

The New America Foundation, a Washington, D.C.-based think tank underwritten by foundations, has crossed even further into policymaking since opening a California office more than four years ago. In 2007, its experts helped Schwarzenegger develop his proposal to expand coverage and promoted it publicly, even appearing at a news conference with the governor. New America's experts can have so much contact with lawmakers that the foundation requires them to keep track of their hours to ensure they do not exceed lobbying limits set on nonprofits.

The California Health Care Foundation, based in Oakland, has taken a less blunt tack since opening its Sacramento office, where it employs a former legislative health expert who helps ensure that the foundation's research topics are relevant to legislative agendas.

"Our view is the Legislature is not facing a shortage of recommendations but a shortage of reliable information," said Dr. Mark Smith, president of the foundation, which has assets of about $640 million.

In 2007, the foundation paid for Jonathan Gruber, an economist at Massachusetts Institute of Technology, to appraise the costs and effects of the healthcare proposals being considered in the Legislature. Lawmakers and their aides relied on those figures in their negotiations.

In an interview, Smith said that the governor and Legislature last year adopted an idea the foundation has supported through grants to ensure that nursing homes and hospitals always know patients' directives about what kind of life-sustaining treatments should be taken when they are seriously or terminally ill.

Sally Pipes, president of the Pacific Research Institute, a conservative think tank based in San Francisco that favors market approaches to healthcare, said foundations risk undermining the credibility of their research by wading into policy deliberations.

"I think that's a bad move for them, because I think they will be really tarred as lobbyists," Pipes said. "I don't think lobbyists have the respect of economists or researchers."

Foundation leaders emphasize they have no interest in direct lobbying and that they promote ideas that are based in evidence, not ideology.

Advocacy is risky for foundations, since most are categorized by the IRS as 501(c) nonprofits, which restricts them from direct lobbying or participation in partisan politics. In the 1990s, Republican senators castigated the New Jersey-based Robert Wood Johnson Foundation, one of the nation's oldest philanthropies, for underwriting a series of forums in which First Lady Hillary Rodham Clinton discussed the Clinton administration's plans for healthcare reform.

But a new generation of healthcare foundations has arisen since then, explicitly charged with advancing more activist missions than those of the older philanthropies started by wealthy families.

"There's been a sea change in thinking," said Leif Wellington Haase, director of New America's California program. "People will realize over time what a big deal that is."

Nationally, 99 new foundations were created when nonprofit healthcare insurers like Blue Cross of California were converted into investor-owned entities, according to the Foundation Center, a New York City-based nonprofit that studies philanthropy. As a condition of regulatory approval, these companies had to set aside a portion of their initial stock sale to endow foundations devoted to improving healthcare.

More than $4 billion in foundation money was devoted to healthcare issues in 2006 by both older and newer philanthropies, according to the Foundation Center

Said Paul Brest, president of the William and Flora Hewlett Foundation in Menlo Park and author of a book on philanthropic strategies: "What I've seen is foundations moving from thinking all we needed to do is support good research in the field and the rest will happen to realizing that unless we are going to support organizations to take the research and try to turn it into policy, then the research is going to sit in the bottom of a pile somewhere."

The California Endowment's entry into Sacramento has been driven by disappointment that many of its pilot projects have shown impressive results yet been ignored by lawmakers, said Ross, its president.

Those include ventures to keep the mentally ill off the streets, extend medical care to children from poor families and help gang members avoid returning to prison.

"We have data and evidence that these programs work," Ross said.

Over the last few years, the endowment has tried to be more sophisticated in how it influences state policy.

Along with four other foundations, including Hewlett, the endowment has financed California Forward, a nonprofit explicitly charged with changing the "outmoded" political structure of the Capitol.

The nonprofit backed Proposition 11, the successful November ballot initiative designed to make legislative elections more competitive and lead to more moderate officeholders.

Now the endowment employs Jason Kinney, a prominent Democratic political strategist, for advice.

In an effort to boost public support for healthcare reform in 2007, the foundation spent more than $10 million on a statewide advertising campaign, community organizing and public forums.

"We are growing weary of experiencing failure on this front," Ross said. He said the employment of people like Zingale "is a trend you'll see more of from our colleagues in the field."

jordan.rau@latimes.com

Are you asking questions for 2009?

2008-12-31T13:47:00.000-05:00

People who ask confidently get more than those who are hesitant and uncertain. When you've figured out what you want to ask for, do it with certainty, boldness and confidence.
Jack Canfield

It is New Year's Eve and as I do every year (and every Lunar New Year, too) along with many others I set a few goals. Although I don't really do New Year's Resolutions any more (too much self-induced pressure and suffering when I miss the mark set because my hopes are based solely on the outcome and not the learning that takes place while getting there so I used to miss all of the opportunities in between) I do set goals frequently and December 31 is as good a time as any to set a few more.

This year, my focus has been on creating solutions and setting goals around solutions that will make my clients' business move with great velocity and operate with clarity and resonate with trust. I began to think about what that would entail and realized that most conversations, research, relationships, great discoveries start not as: "I have a problem, now lets think about solutions. . ." but more so, a: "What if? What's possible when? How do we? How could you? Will you? Can you? Can we? Can I?" So, essentially great ideas and solutions start with questions about what you want.

It occurred to me that most of my goals traditionally set, are not coupled with questions, so this year I am encouraging myself, my clients, and my friends and colleagues to ask questions.

What does it take to formulate the questions that will lead you to where you want to go?

Here is a short list of how things you may consider in formulating your questions:

1) If you ask a closed ended question, it must be followed by an open ended one.
Am I living the life I want to live?; Is my business where I want it to be?; Am I satisfied with things the way they are in the world? The answer to these questions could be dichotomous. Therefore, if you answer them yes or no or maybe, a second question must follow. Respectively, No, I am not living the life I want to live--What will it take for me to live the life I want to live?; Yes, my business is where I want it to be--What have I learned that will allow me to expand my business and create something new for my customers that inspires me?; and No, I am not satisfied with things the way they are in the world.--What is my role in the transformation of my community, my city, our country?

While these examples may lean towards the general vs. the specific the point is to ask questions that you can build on and are oriented towards thinking about things broadly and with little to no limits.

2) After creating and asking the questions, don't begin to answer them immediately. One of the biggest challenges with most human beings is our propensity to want to resolve everything immediately. It goes like this,:your friend or colleague calls and begins to talk about something facing him or her. In some instances they want you to give them advice and in other instances, you want to give them advice. And I do and sometimes they did not want advice, they wanted me to listen and perhaps ask a question or two, but they were not looking for me to solve their problem.

If we can ask a question of ourselves or work with others to generate questions that are pertinent to their goals and dreams, we are not required to nor should we attempt to answer the question(s) at that moment. In fact, limiting the space that is created between the time the question is asked and the time possible answers emerge limits the magic that is created in that space. Without the broadening and deepening of that space, we limit the divine nature of nothingness. Only from nothingness is somethingness created. Ask your question(s) and then let nothingness reside and experience (like most of us have) how the divinity arises out of that space.

3) Ask your questions then ask them in another way and then ask them in another way and then ask them again. No, I am not advocating that you become annoying. What I am saying is that questions, like your goals, evolve. As the process of being with/pondering a question evolves, you begin to construct a new sense of what the deeper question might be. Within every question of significance, there are many more significant questions. After posing what I am naming right now, "the trigger question" (I hope that is not the name of someones book, if soon, I will attribute it to them once I know) there are myriad questions that can arise from it. Like composing a song, you try different combinations and chords and percussion, harmonies, melodies, lyrics, etc. and the different twists and turns lead you to possibilities that the original question just scratched the surface of.

4) When formulating your questions, know that you know everything--the purpose of the question will be clearer. Consider that you are all knowing. Now, I am not saying this to stroke you (I am happy to do that however, as I believe in ample acknowledgement of your greatness) but I am saying it because for you to pose a question, for the most part, I believe there is an answer that given the connectedness entity we are, as a human species, all answers lie within each of us individually and collectively. As the song says "There's not a problem that I can't fix." (Last Night a DJ Saved My Life, performed by Indeep). For both the DJ and for you if you ask the question, it can be answered. There is not a question you don't have the answer to so trust that it will come and as I stated above, let go of "trying" to find a solution. Ponder the question, be assured the answer is emerging from the moment it is asked and let it run its course.

5) You have to ask a question before the answer will be revealed. Here is where most of us miss the mark: We never ask the question. If you have a burning, urgent, question, whatever it may be ask it! Ask it not just silently to yourself, but ask it out loud. If you are not comfortable sharing it with others, ask it out loud with no one around. You need to hear the question in reality almost as if it was not just you who was generating it, but like it came from elsewhere for the answer to come to you to share with the person who asked it. Asking it aloud will generate the energy that will lead to the revelation that you are seeking.

Ask questions out loud that inside you don't feel are even probable, let alone possible. The energy generated from simply asking will blow you away.

Remember, you get what you ask for so ask with clarity and be thankful for what you get. You are going to get what you ask for. When you ask questions, be aware that if you are asking for something specific, you want to be very very clear about your purpose and objective of attaining what you desire. When you get it, in whatever form it comes, be grateful for it. Even if it is not quite what you expected know that what you received is exactly what you needed to learn what you need to learn and move you into a deeper understanding of what you REALLY want. Give thanks for all that comes, there is no good or bad that comes from your questions, only answers. All of them are worth appreciation and all of them open up the next field of dreams and possibilities.

Now, go ask some questions with certainty, boldness, and confidence, and let's make 2009 all we know that it can be. Thanks for all you do and all the beauty that you have revealed and inspiration I have received from you in 2008. I appreciate each and every one of you that are reading this and those who may not have the opportunity.

Make it a great 2009!

Amri

What do you expect BIG or not so big?

2008-11-16T22:22:00.000-05:00

Life is too short to [play] small.
~ Benjamin Disraeli

It came to my attention a few weeks ago that I had been playing small.

No one said to me, "you failed", I didn't get a curt email.
I did not hear it in a book, not a soul gave me a second look.
The result I had was thinking flat, ideas were slow creativity sat
Tucked away in cold dark rooms, wondering about its pending doom.
Dawn then struck, a second look, innovation lying in a crook.
Woke up and saw the time had come, got back on the horse and it started to run.
Giant Steps are double timing, I am playing BIG again and now I'm rising.

Thanks for indulging me. Have you thought about whether you are expecting big things consistently vs. having a fleeting thought about something BIG, potentially happening for you then as quickly as it came it went?

I have had both and I have observed and began to talk to colleagues and clients about the nature of the phenomena. There are plenty of books about playing big and thinking big. One of favorites and where I got the Benjamin Disraeli quote is from the David Schwartz The Magic of Thinking Big. The premise is that you can only go as far as your thoughts take you. Many people that I have spoken to, said they never really thought about how big they were being in their work or in their lives.

So a couple questions for you:

Are you in a job expecting that you will only go so far?
Are you a manager that is concerned that your team is not doing things that will make you look good for your boss?
Do you see your relationships growing powerfully?

If you are a yes to any of these situations or any other situation that is leaving you in a place where you feel that you have limited power, you are probably thinking, playing, or living in smallness. Trust me, you don't want to live there and that is not who you are.

I just put together a talk on inclusive leadership in health care and across all industries, and I illustrated that playing small as I will share with the audience--meaning not giving the people that you interact with every training and development opportunity, piece of information, freedom to share ideas, acknowledgement, and appreciative bit of coaching you can--leaves you smaller than you truly are. It has an impact on you and on those you interact with in an even more dis-empowering manner.

If you don't find ways to give people around you every opportunity within your power to be fulfilled, particularly those you manage or supervise, you are a leader limiting both your potential for greatness and that of those around you. The best surround themselves with the best and they do so by giving them every opportunity, every day to get better while they develop themselves to get better, too. They do this by listening to great people that they work for, work with, and those that work for them (especially the later).

In doing so, you will get more than you imagined!

What I am seeing in many so-called diversity problems where people are managing across difference whether it is generational, disabled vs. non-disabled, or situations with appararently little to know differences, is that managers are not challenging their teams to play bigger than they think they are able to. As a result instead of being inclusive managers pulling for their folks to grow and expand each and everyday with the result being innovation, fun, and mind-blowing results; they are finding their people constricting and holding back.

Whether it is a since of fear given the economy or fear of retribution, I guarantee it is costing your company money now or it will cost you later.

As an employee in this situation (and yes, you are part of the cause, too) not contributing ideas and insights for whatever reason will leave you overlooked and your contribution bundled up and sent to the Twilight Zone that no one will ever from again.

So, the anecdote: choose BIG! Contribute to your teams, your bosses, your families, your friends, your bowling partners, think BIG on their behalf or even better with them, and watch yourself develop the habit for yourself in the process. You will never feel more free and never accomplish more in every area of your life.

Make it a BIG day!

Strong Finishes

2008-11-12T00:38:00.001-05:00

My observation the other day about finishing strong stands true.

What occurs to me though is a reason that may stand out beyond all other reasons to finish strong. I got this insight while weight training with my friend and stress management advisor Juju Poogie (http://www.jujupoogie.com/) and his brother and another long time friend of mine, John.

We were in the process of finishing our last few sets. We began to discuss a workout we did about a week ago doing lunges on a football field near our homes in Atlanta. We lunged the field and immediately lunged back and then did it once more. . .It wore me out. What I recall however, was how actually going harder at the end made it easier to finish. Juju said, push harder when he sensed me feeling fatigued.

Interestingly, I also recently heard a triathlon coach talk about the phenomena of "hitting the wall" in a race. He actually said rather than slowing down--SPEED UP! He instructed his athletes to do this and stated that 95% of them that in earnest speed up vs. slow down experience a greater ability to get past or over the wall better than when they slow down.

So today we are closing in on our second to last set with the weights and I determined that I would actually push harder on the second to last and last set than I had throughout the workout. (Don't get me wrong, I was working hard the whole time, I just stepped it up a little ;-))

In putting that idea into my mind, the weight that I was pushing seemed easier and I was left with a great sense of accomplishment and fulfillment with the workout. I always get something from a workout, but not necessarily fulfillment in the sense that I could transfer the energy of that commitment into other things that I am up to.

How strong are we finishing? If we understand that the whole idea of finishing is a temporary phenomena and while the concept of starting and finishing exists, we are always in perpetual motion. If we can understand the concept at its core we recognize this is all about momentum.

Within the dynamics of start to finish to start again an energy of commitment exists. President-elect Obama knows it. Finish strong: win the popular vote, win states democrats rarely win, dominate in the electoral college=move into the White House powerfully. Simple:

Strong finishes create strong starts.

When we finish strongly and do so consistently we can create an unstoppable energy of commitment that is so highly concentrated, that upon completion of one thing we are doing, it propels us powerfully into the next thing, regardless of what it is. You finishing strongly will start your next endeavor off in a way that gives you the the energy of success regardless of the outcome.

FINISHING STRONG=POWERFUL STARTS in whatever you are up to whether it is job seeking or studying for your boards, vying for a promotion, or running for public office. If you want an awesome career and an incredible life, finish strong without excuse every time!

Finishing the Race

2008-11-09T11:27:00.000-05:00

The 2008 Elections have come to a conclusion and our new President-elect has made history in many ways. I am an Obama supporter so I am very excited, too. I am also aware that there is a lot of work to do and all of us as health care professional and those committed to diversity in health care.

One of the most powerful lessons I learned watching this election season was one that speaks to how we finish the races we run.

During the primary, Senator Clinton in her attempt to come from behind, winning several key states, would often reference Mr. Obama's inability to "close the deal". It was a challenge for Obama. Of course, he eventually one, but many headlines at the end of the primary stated, "Obama Limps to the Finish Line". Of course Obama finished with the nomination in hand and while doing so learned a very important lesson--Finish Strong and Take Nothing for Granted.

There was a point during the primary campaign in which Senator Clinton took for granted the nomination, in fact, she in some people's opinions she acted as if she was entitled to primary victory and the nomination and in a sense she took it for granted. Now, I am not sure if she relaxed and did not strategize in preparation for unknown threats or in search of unseen opportunities. Nonetheless, what it looked like was that she was not taking a 360 degree view and making sure all of her bases were covered. As a result, she gave her the opponent the chance to make his move.

Senator Clinton re-grouped and made a valiant come back, and if she had recognized that she was missing opportunities to finish each phase of her campaign more powerfully earlier, the outcome of the primary may have been different and perhaps history would have been made in another fashion. However, she missed finishing when she had the chance.

Fortunately, she taught our soon to be 44th president a lesson about finishing a race powerfully. During the general election, Obama dotted every proverbial "i" an crossed every proverbial "t". He never stopped campaigning up until election day and for everything thrown at him he had a response that met the specific need for each moment.

When you are looking for a job, candidate, or working on an important project, how well do you finish the race?

Where your diversity and cultural competency efforts are concerned, are you taking a 360 degree view and assuring that you are being inclusive of the needs of all patients, clinics, and staff? If not, get started now and know that there will be a series of races in front of us and that if we complete them, the possibilities of the kind of high-functioning organizations we desire. And of course, we can also move towards health equity.

The next time you get close to the finish line remember what Senator Clinton taught President-elect Obama: Take Nothing for Granted--go harder, it will take you to victory without doubt!

Abundance and The Job Search

2008-10-27T00:19:00.000-04:00

In a tough economic climate, it is very easy to get discouraged about the prospects of finding work. It is challenging to think you are going to find a job that will allow you to pay the bills and keep a little something extra on the side to save, invest, etc. What I want to make sure you consider is give this dip we are in, what mindset do you need to be your most powerful in your job search activities.

Over the past couple weeks, I have been bombarded by many writers and speakers talking powerfully about the distinction between abundance and scarcity.

Let me first share Webster's (http://www.merriam-webster.com/) take on the two ideas and then a little from a couple of other writers:

ABUNDANCE
Pronunciation:
\ə-ˈbən-dən(t)s\
1 : an ample quantity : profusion 2 : affluence , wealth 3 : relative degree of plentifulness

SCARCITY (http://www.dictionary.com/)
/ˈskɛərsɪti/ 1. insufficiency or shortness of supply; dearth. 2. rarity; infrequency.

Steven M.R. Covey in his book The Speed of Trust says, "Abundance means that there is enough for everybody. The opposite--scarcity--says that there is only so much to go around, and if you get it, I won't." He goes on to state that, "Abundance is a choice!"

I agree and I agree that you can make the choice to focus on what you can contribute regardless of your current situation.

It is likely that you are thinking that I don't know your situation. You are right and on the other hand we may be more closely related than you think. I have been in situations many times as an entrepreneur where I did not know where my next meal ticket was coming from. What I learned as a result is that the more I thought in scarcity the more scarce opportunities arose. (If you think that sentence sounded like a oxymoron and contradictory, try getting results with a scarcity mindset.)

On the other hand, when I thought in terms of what was possible and had clarity about the reality that I could always contribute to others, I was clear that what I needed to fill my tummy was right in front of my eyes.

What a mindset of abundance does is allows you to not be focused on what you think your current reality is and leads you to considering the needs of others. When you can meet the needs of others and do it in a powerful and credible way, a job, contract, revenue stream is coming your way very soon.

Scarcity scares, Abundance Attracts. . .You choose!

* * *

We are building the largest pool of diverse health care professionals in the world. Stay tuned to find out what a Wii, an iPhone, and a Flip camera have to do with diverse health care professionals!

First National Indian Nursing Conference Embraces Diversity, Excellence

2008-10-21T10:05:00.000-04:00

From Nurse.com
by Lorraine Steefel, RN, MSN, CTN

Indian nurses in the U.S. have made huge contributions in shaping healthcare, says Donald Kautz, RN, MSN, PhD, CHRN, CRRNA, assistant professor at University of North Carolina at Greensboro School of Nursing.

To showcase those contributions, 11 chapters of the National Association of Indian Nurses of America participated in the organization's first national conference Sept. 26 to 28 in Skokie, Ill. The association was inaugurated in May 2007 and embraces nurses' change, growth, and development.

Whole Article

ANCC Magnet and Cultural Competency

2008-10-17T23:28:00.000-04:00

This week I have been at the ANCC Magnet Conference in Salt Lake City, UT. Cook Ross had an exhibit and we were the only consulting organization of our kind (specializing in cultural competency/diversity and inclusion) there. It was very insightful to be with all of the nurses and other health care professionals there to learn about what was up in the world of nursing excellence and of course to see what people are thinking and saying about cultural competency and diversity in their organizations.

What I observed was that the conversation is really just getting started in most places (hospital and healthcare systems). It is also clear that the education that many have had around the subject is leaving them wanting to learn and know more. I heard numerous anecdotes about situations that were culturally oriented and how the nurses learned to deal with them, often times after great struggle--yet with a great deal learned from the experience.

One nurse talked about her experience with a Kurdish refugee family that fled Iraq after the first Persian Gulf War. The nurse was a student and new at caring for patients during her OB rotation. She took care of a pregnant Kurdish woman and observed that that the father was not helping with the child.

The nurse remarked that at first she was judgmental. However, when she learned from a Middle Eastern colleague familiar with Kurdish culture she realized that the dynamic may not be one of neglect but rather one of cultural norms. She later learned that Kurdish men are accustomed to families taking care of the mother and child and since they did not have extended family with them (many of them had stayed in Iraq or were killed) it never occurred to him that his wife would need help.

These sorts of conversations are crucial to the healthcare community in that while many people have these experiences, the stories are not often shared and therefore the learning is limited. Therefore, some healthcare professionals are clear and even passionate about cultural competency while others are desirous of learning more but don't have access to the conversation. In many cases both groups work with one another--how do organizations connect them?

I think this is critical in that a facilitated conversation about an experience is a learning experience on a variety of levels from the personal connection to a certain dynamic or situation that someone else has experienced or is experiencing to an organizational learning that can give health care clinical and non-clinical professionals and staff understanding of their colleagues in a way that lends to improved communication and connection--becoming more aware of how culture affects everything where human interactions are concerned.

Next time I write, I will also discuss a little bit that it coming to me in regards to children's hospitals and cultural competency. I am thinking that there are distinctive dynamics in cultural competency where children's health and the parental component is concerned. We will explore them next time. Make it a great day!

The Power of Collaboration

2008-10-02T16:45:00.000-04:00

". . .much of what we've seen so far suggests that a large group of diverse individuals will come up with better and more robust forecasts and make more intelligent decisions. . ."
James Surowiecki
The Wisdom of Crowds

September 30 and October 1, I had the privilege to be invited to a gathering of about 35 diversity leaders from health care organizations throughout the country to have a very focused conversation about cultural competency in health care and all of the pieces that go along with that. In essence, we talked shop about something which all have a great passion for.

We started out Tuesday evening with dinner and speaker Dr. Francis Jackson. Dr. Jackson is a professor of nursing at Oakland University in Detroit. She spoke on health care disparities. Now, for those of us who have read and heard mountain stream on the subject the thought of this might be, "Okay and what's new?" I would honor the thought yet would be clear that Dr. Jackson had distinctions. She gave us a glimpse of the day in the life of her uncle with a plethora of co-morbidities who was not well versed in his diabetes care and was facing amputation. With her assistance he prevented the amputation of his leg. She contrasted this with a conversation about many others who have not been so fortunate.

She gave very real personal experiences that translated the research and statistics that we hear about into real life, anecdotal situations that potentially could have produced disparate health outcomes from clinical encounters that missed the mark.

I recommend Dr. Jackson as a speaker. She is as authentic as they come, as accessible (personality-wise) as she can be, and is going to deliver a message as real as it gets!

The second day, yesterday (the 1st--appropriate, as it was a first time gathering of these leaders in this format, hosted by Trinity Health and their team of SVP VeLois Bowers, Toni Green, and Chrishonda Smith) throughout the day we had the opportunity to hear from the wealth of knowledge in the room. It is too much to go into great detail, but we touched on everything from training and development, recruitment and retention, and supplier diversity to equity in patient care and health literacy.

I briefly talked about Health Culture Depot and Diversity HealthWorks, and it is likely that part of the proceedings will be published on the HCD site in the near future. I will blog that it is there when I get the write ups.

By the way, Diversity Health Works has been re-launched. Take a look and give me feedback on what is working. The content is coming so stay tuned. We will create the most content rich talent management site in health care! We will need your help to get there. . .

Yesterday, the richness of the conversation reminded me of how important collaboration is and the power that it brings to this conversation. Some of the people in the room may have considered themselves competitors, but for the purpose that we serve as healthcare professionals, we went further. It was powerful and I am grateful for having been a part of such a powerful learning opportunity!

A Quick Note on Leveraging Your Degree

2008-09-29T00:44:00.001-04:00

I spent time with fellow Emory grads on Thursday and Saturday in the kickoff of Emory's $1.6 Billion dollar capital campaign. It was quite exciting with the normal pomp and circumstance, black tie, all of the large donors, and of course many alumni.

It got me to thinking about the value of our leveraging our degrees from the various schools we went to. Many people who went to Emory, have the feeling that Emory doesn't need any more money. "They got enough of mine the first time around". Now, this is not just Emory, but many schools with seemingly large endowments or proverbial pocketbooks. In fact, most of those sentiments are true. However, what we are not taking into consideration is the investment into the future of your institution(s) of higher learning and what that investment translates into.

Giving your time, talent, and money is important. Let me share with you three reason's why:

1) Many schools use money given by alumni for scholarships. If you are committed to a diverse student-body, contribute to the scholarship fund. It often allows students who otherwise could not afford to attend a school the opportunity to do so. This used to just be the case at schools like Emory and other expensive private schools. However, with the cost of all schools state-based or otherwise, it is a high-dollar conversation.

2) The more you give of your money, time, talent, you name it, the more people know you and the more people know you and what you are about (assuming it is positive, which is likely if you are contributing your time, talent, and money) the more opportunities and possibilities open up to you. I have had numerous opportunities for conversation about what I do open up as a result of my involvement with Emory. It is not direct business, but it is branding, personal and for my company. People know more about Cook Ross and learned more about me because I share myself with the school in a variety of capacities.

3) The law of cause and effect: you give something you get something back. Think about something in your life that you have contributed little to and got a lot from. Sure there are a few things, but lets take a macro view. Now, I know you paid a lot for your degree and you got it when you graduated. That was then, this is now. I am not saying that you have to spend half your time and a fourth of your money towards your school, but I am saying contribute something. It is an investment that has to be made if you want your degree to really carry some weight and give a boost at some point. You many not even know you got that boost, but believe you me, if you contribute, there will be a return in some shape or form.

Charitable giving gives you a stake. While you are a graduate and paid tuition while there, the value that your degree has now, is much higher than when you were a student. Schools are like businesses. If you work in a business and don't feel like you have ownership, your level of contribution is much lower than when you do feel like an owner. Colleges and Universities depend on their alumni for so much and we have a lot to give. Giving something each year gives you the empowerment of an owner and moves you on the court as a contributor to a broader dialogue.

So, that is my 3 cent on why to give to your Alma mater. Time, talent, or financial contribution, it all gets paid forward and paid back!

The Countdown Begins

2008-09-14T22:30:00.000-04:00

The totally re-tooled Diversity HealthWorks re-launches on September 18th. That is a powerful day for my family in that my brother, Larry, who we lost in December 2004, was born on that day.

Larry had a stroke and died at age 40. The launch of the site is dedicated to him, one because he was my biggest fan :-) and two because the bottom line premise for Diversity HealthWorks as a vehicle is the elimination of health disparities/health equity. Larry died with many years of potential life left to give his energy to the world. Diversity HealthWorks is a stand to reduce years of potential life lost towards the achievement of health equity.

A little about Diversity HealthWorks:
Diversity HealthWorks™ is a comprehensive resource for healthcare professionals, educational institutions, organizations, and employers to utilize in meeting their respective employment, recruitment, informational, training, and educational needs.

First launched in 2005, Diversity HealthWorks was created to be the destination portal for healthcare talent management. Our premise is that diversity and talent management are integral parts of one another and cannot exist separately. Given this premise, we believe that if an organization intends to be a competitive and innovative market leader, cultivating top talent, diversity must be a central theme in its pursuit of success.

Diversity HealthWorks is the first on-line resource dedicated entirely to careers, employer branding, and the generation of information focused exclusively on diversity and cultural competency in health and healthcare. At the foundation of our mission is the creation of health equity and the elimination of disparities in health outcomes focusing on the workforce as central to the achievement of this goal.

Diversity HealthWorks features the following components:
-- Traditional Job board with wide variety of healthcare jobs from allied health and nursing to public health and research
-- Comprehensive resource (www.healthculturedepot.com), edited and contributed to by professionals focused on cultural competency and diversity in healthcare, disparities/health equity, and current issues
-- Features and best-practices in the healthcare industry
-- Pod casts, web seminars
-- Monthly and bi-weekly publications with interviews, current news and notes across the diversity and healthcare space, and opportunities to get involved

More to come on Diversity HealthWorks, stay tuned!

So, when do we really address diversity in the healthcare workforce?

2008-08-15T14:17:00.000-04:00

It has been known for a long time that diversity in the health professions is not only the so-called "right thing to do" but it is also evident that it is the thing we need to do healthcare right.

In December of 1995 The Pew Health Professions Commission (Critical Challenges: Revitalizing the Health Professions for the Twenty-First Century) stated:

There is a substantial body of literature which concludes that culturally sensitive care is good care. This means two things for all health professional schools. First, they must continue their commitment to ensure that the students they train represent the rich ethnic diversity of our society. Important investments and many successes have been achieved, but this is an obligation that must be continued at each institution until it is no longer an issue. Second, diversifying the entering class is not sufficient to ensure understanding and appreciation of diversity. Cultural sensitivity must be a part of the educational experience that touches the life of every student.

About 10 years later, the Sullivan Commission on Diversity on Diversity in the Healthcare Workforce published Missing Persons: Minorities in the Health Professions stating:

Diversity in the health workforce will strengthen cultural competence throughout the health
system. Cultural competence profoundly influences how health professionals deliver health
care. Language is a critical component, with two out of ten Americans speaking a language at home other than English. The cultural challenges posed by a shifting patient demographic can
best be addressed by health professionals educated and trained in a culturally dynamic environment. . .

The business community has long recognized that workforce diversity is essential to success
and maintaining competitiveness in the marketplace. Corporate executives as well as local
chambers of commerce describe the economic benefits of developing a workforce that reflects the customer base.

After publication #1 (Pew) we were left with a greater understanding of the issue. In between the Pew report and the Sullivan (publication #2 above) report, there were myriad reports on this issue and related issues such as health disparities, other workforce-related studies examining diversity, numerous conferences, and a lot of conversation about the importance of it, how it is affecting health outcomes, etc. There have been other subsequent to Sullivan, too.

What I personally have not seen a great deal of is a publication of best practices: How to diversify and expand the healthcare pipeline?; "Where do we go from here in healthcare workforce diversity?"; and so on and so forth--in essence, action!

Now, my not seeing this much does not mean that it is not happening. So if it is, and you happen to pass by this blog and read some of it, please share your success with me and I will do my best to share it with my network, my clients, etc.

In the meantime, when do we really address diversity in the health professions; in the healthcare workforce? There are many steps that have been taken in states and by cutting edge foundations like the California Endowment. Check out what they are up to:

http://www.calendow.org/article.aspx?id=1382&ItemID=1382

You may also find programs taking place through educational institutions like the Summer Enrichment Program at the University of Michigan as well as another such program run by the Institute for Diversity in Health Management.

These programs are great, the question lies in the details and in the measurement of what is coming from them. I would say there are positive outcomes anecdotally, and I actually believe anecdote is measurable. However, we generally are not even capturing the stories that these programs produce in aggregate. As a result, the funding for them is usually sparse, running low, running out, and has already run away with little hope hope for renewal.

Don't get me wrong, I am confident that we can make continued and bigger strides towards understanding pipeline building in the healthcare workforce. To me it lies in moving towards a clear understanding that this is not "initiative-based". Initiatives come to an end. Diversity in the healthcare workforce is not something that some do and others don't if they want success long-term and it has no ending. Diversity recruitment is recruitment, period. If diversity is not being considered, quite frankly you are not really recruiting. You are selecting some folks that will meet your needs for the next few years, but you are not building the workforce that will add to bottom-line growth in the future of your organization, hospital, institution, etc. It simply won't lead to the innovation, connection with patients, market share growth, or any other aspect that you are looking to advance including cultural competency.

So, when do we really address diversity in the healthcare workforce? We are doing it now, but not nearly to the extent we need to. Do we understand the implications? I doubt it. Right now they are theoretical and not practical.

I am in search of a healthcare organization that has focused on diversity and has documented how it has positively affected them. If you hear of any, let me know, I would be thrilled to do an interview with them.

If you are interested in an interview talking about your talent management efforts, drop me a line at amrijohnson@gmail.com. We are in the process of creating our interview and publication schedule for Diversity HealthWorks. I am sure the world would love to hear about the great things you are doing. . .

New Mexico Taking a Lead In Healthcare Cultural Competency

2008-08-10T19:05:00.000-04:00

Below is a link to a very nice article that speaks to the fact that cultural competency in healthcare is an issue that every state needs to be engaged. Looks like New Mexico is really engaged in the conversation. Other states like New Jersey and California have implemented similar legislation as it relates to culturally and linguistically appropriate care.

What state is next to push this to their healthcare workforce?

http://www.cnn.com/2008/HEALTH/08/08/cultural.medicine.ap/

You maybe want the Hot and Sour Soup

2008-08-08T12:19:00.000-04:00

A few weeks ago, I was having dinner at one of our favorite vegetarian restaurants outside of D.C. My friend and I asked about the soup choices, in particular the Won Ton Soup. The waitress whom I have seen quite a bit, described the Won Ton Soup. She said, "Won Ton soup, the Won Tons are made of flour." She then paused. Not fully understanding what she was tying to convey I then asked, if it was good. She did not respond directly to the question, but she did make a suggestion, "You maybe want the Hot and Sour Soup." We looked at one another chuckled and the Hot and Sour Soup it was!

The conversation points to the dynamics that we see in cross-cultural interchanges everyday within healthcare institutions. Perhaps an American wait staff would have said, "I don't really like the Won Ton soup." However, she chose to not be critical of the food, the restaurant, the chef and instead suggested that we choose one that she felt we would like through experience. A very highly contextual response.

Consider the many times we encounter communication styles that are not in alignment with our world view. Are we even aware enough to know that our selective listening begins? Imagine how this could happen with a staff person, a physician, or a patient. We often emphasize language because of CLAS standards or simply because we have so many reminders of language barriers as the diversity of our organizations grow.

While we are aware of the fact that culture matters beyond language, and clarity in communication comes from context, and that we all have both. However, we don't necessarily examine our biases and how our context consistently occurs to others.

How do we begin this process?

My experience is first to begin to learn about cross-cultural communication. Generate an awareness of the nuances of how we relate to one another in communication and what types of questions ask.
Knowledge of all archetypal generalizations of cultures outside is not necessary (or possible) but it without doubt can help with our understanding of how we might be occurring to others based on their cultural lens.
Lastly, get engaged in the process of learning about effective communication. Any education in this topic should inherently include a module related to culture.

Our new healthcare diversity and cultural competency wiki Health Culture Depot is coming soon. If you have topics you would like to write about regularly, let us know. We are building our list authors as I write.

Cultural Competency and Diversity in Healthcare: A Healthcare Diversity Consortium

2008-08-07T16:58:00.001-04:00

Cultural Competency and Diversity in Healthcare: A Healthcare Diversity Consortium

A Healthcare Diversity Consortium

2008-08-07T16:50:00.000-04:00

There are a lot of people doing great work in the diversity and cultural competency space where healthcare is concerned. One organization (the whole team!) that is doing outstanding work is Trinity Health under the leadership of VeLois Bowers, Sr. VP. of Diversity.

They are hosting an event that is going to be awesome! It is not too late to RSVP although the note below says different. Reach out to Toni Green and be there. If you are in healthcare and have a diversity responsibility in any capacity, you have to be there!
________________________________________________
Greetings,

Today, diversity executives and practitioners in health care are faced with many factors impacting our diversity efforts. Recently, there has been an expressed interest in health care diversity professionals coming together to address initiatives in an industry where the diversity journey is just beginning. In this light, Trinity Health is pleased to host a health care diversity consortium to benchmark and share best practices from the industry across the nation. We will focus not only on recruitment, retention, and talent management but how diversity and inclusion initiatives impact responsive and respectful patient centered care.

Trinity Health's Office of Diversity and Inclusion would like to invite you to join us September 30 and October 1, 2008 at the Dearborn Inn located across from Henry Ford's historic Greenfield Village located near the Detroit metropolitan airport. The hotel logistics and an agenda will arrive under separate cover. We are planning a robust agenda that will include guest speakers and topics to stimulate dialogue and share best practices.

Please RSVP with your, or your designee's availability by Monday, July 28, 2008.

If you know of other healthcare diversity colleagues who may be interested in attending, please forward this invitation. Please contact me if you would like additional information.
I look forward to our meeting.

Best Regards,
Antoinette Green PHR
Director, Diversity & Inclusion
Trinity Health
34605 W. 12 Mile Rd, Ste 127
Farmington Hills, MI 48331
248-489-6371

Where do we need to go?

2008-07-09T00:09:00.000-04:00

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

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

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

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

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

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

2008-07-01T11:29:00.000-04:00

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

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

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

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

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

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

Institute for Diversity in Health Management

2008-06-23T00:39:00.000-04:00

We've been away for a while. But are moving back to regular postings.

I recently had the chance to attend the bi-annual conference of the Institute for Diversity in Health Management. In attendance were a number of top hospital systems including Trinity Health, HCA, Community Health Network (Indianapolis), and Texas Health Resources.

The conference was a tremendous opportunity to network with some of the finest minds in the area of diversity and cultural competency in healthcare. I will write more later.

In the meantime, stay tuned for a BIG Project that you will be able to participate in!

Ulysses W. Burley III discuss cancer research and the challenges facing African Americans

2008-01-16T10:24:00.000-05:00

THE BLACK COLLEGIAN Online's featured blogger and columnist Al "The Inspiration" Duncan is kicking off the new year by posting a new interview and hosting a dialogue with Ulysses W. Burley III, at 24 already a noted cancer researcher. The timely new dialogue gives insight into the career path and mind of a young man who is passionate about confronting a disease that, he says, "affect(s) black people twice as much as anybody else."

This theme has been explored on the IMDiversity.com/BLACK COLLEGIAN network of sites a great deal in the deal in the past year, becoming more timely as the election year has resurrected the issue of universal healthcare and who's falling through the cracks of insurance coverage in America. The topic's also coming to the fore through the increased media coverage and national discussion of the particular challenges facing African Americans in battling cancer.

As Dr. Burley observes, these challenges to African American cancer sufferers receiving the attention and treatment they need are both internal and external, social and psychological.

In terms of research, he observes that "There aren’t enough African Americans going into research period, let alone cancer research." Further, "only 13% of African Americans" who aim for them "end up graduating with science and math degrees. Only 3% of us are going to pursue graduate degrees in science and mathematics."

In the interview, he suggests that ethnicity can affect both which types cancer certain groups disproportionately suffer from ... and which types can receive (also disproportionate) research focus and funds. He believes that the upcoming elections may bring national and government leadership focus back onto cancer research, not only because of the attention to universal coverage, but because several of the presidential candidates from both parties have had direct, personal experiences with and suffered tragic losses from cancer.

At the same time, he acknowledges that ethnic disparities in research and treatment are not only caused by external obstacles. If African Americans disproportionately from certain kinds of cancer, he saks, “why is this and what are we doing to intervene? I believe that if you want to change something you need to become a part of it."

He says that research careers can draw lower salaries than many other paths in the medical sphere, which may dissuade some African Americans from pursuing scientific research as a vocation.

Further, there may be a stigma attached to cancer that is prevalent in the African American community, as well as cultural and spiritual aspects to how many Blacks deal with the disease that may not be widely understood by mainstream healthcare practitioners. This was a topic recently highlighted in a new book, "You Have Cancer": A Death Sentence That Four African-American Men Turned Into An Affirmation To Remain In The “Land Of The Living”, co-authored by THE BLACK COLLEGIAN founder Preston Edwards Sr. and three of his longtime best friends. They learned they suffered from the same disease at the same time later in life. They discuss the spiritual and psychological aspects of fighting the cancer, as well as the stigmas and social issues that can prevent Black men with cancer from seeking and embracing needed treatment and attention. They also discussed the book this past week on an episode of Weekend Today with Lester Holt focused on African Americans and cancer.

In the spirited dialogue with Burley that followed the interview, many readers voiced their appreciation for the young doctor, not only admiration for his dedication and his life and work choices, but for how he stressed the importance of research.

In one response from the dialogue, however, Dr. Burley took care to stress that the need for African Americans to become advocates for community health and to pursue science degrees and careers was not limited to cancer research.

"To answer a question asked earlier, I do believe that cancer and cancer funding will become more visible in the upcoming elections. Currently candidates are solely casting their respective health care plans mainly because this is what we the people have asked for. Therefore it is up to us to demand more from them. I am hopeful that the primaries will reveal worthy representatives for both parties, and that the narrowing of possibilities will produce more focused and pronounced plans within health care, not only for cancer intervention, but global AIDS, child obesity, and diabetes to name a few. Until then, we must continue to be advocates through initiatives such as the ONE Campaign that allow citizens to apply pressure on the government through letters, emails, and phone calls of demand and concern."

Join the continuing dialogue with Ulysses W. Burley III at Al's blog.

"Making Strides to Recruit Doctors Fluent in Spanish"

2007-12-21T19:07:00.000-05:00

In follow up to November's post, Language gaps hinder doctor-patient relaitonships:

Recently posted on the Healthcare Careers Channel, a good discussion by MIRIAM JORDAN, Staff Reporter of The Wall Street Journal Online, tackles the real challenges of bilingual healthcare.

In Making Strides to Recruit Doctors Fluent in Spanish, she observes that Hispanics constitute 14% of the nation's 300 million people, but only 5% of U.S. practicing physicians. But there are new approaches, including international recruitment and university programs, such as one offered by UCLA, which takes advantage of the surplus of medical-school graduates in Latin America by helping them finish coursework to prepare for boards in the U.S., where a blend of medical and language skills are in chronically short supply.

Language gaps hinder doctor-patient relationships

2007-11-28T14:17:00.000-05:00

This article, to me illustrates a polarity/dichotomy that we see too often in cultural competency as a whole. Cost and profitability vs. patient safety and quality of care. Opponents of accomodating non-English speakers use the argument that doctors will be put out of business if they have to provide translation/interpretation services. One could argue that they will be put out of business and out of much more money (where acquiring new patients (with health insurance) who speak English as a second or third language and potential costs of malpractice if an error is made as a result of a patient not understanding the doctor or the translation not being made correctly. The bottom and top lines are that we have to pay for both. One is responsive (providing the services to assure that people's needs are met regardless of their language capacity) vs. reactive (resisting inevitable changes in how clinicians practice based on the culture(s) of their patients).

People who are insured but speak little or no English often experience embarrassment, stress and confusion. State regulations aim to help.

By Francisco Vara-Orta, Los Angeles Times Staff Writer November 23, 2007

Shortly after being diagnosed with breast cancer, Enaida Cornejo had another problem: She and her oncologist could not understand each other.Her primary doctor was bilingual, but this new doctor spoke English. Cornejo, a native of Peru, felt more comfortable speaking Spanish. At their first few appointments, doctor and patient relied on Cornejo's husband, her friend and even strangers in the waiting room to help them talk about her illness."It was already painful enough to deal with the cancer itself," said Cornejo, 42, of Santa Ana. "Let alone not being able to understand my doctor and then having strangers come into my room."The state Legislature decided four years ago that the estimated 1.1 million patients in California who pay for private health insurance but speak little or no English should receive services such as language interpreters and translated materials from their insurance providers. Lawmakers set a deadline of mid-2008 for providers to submit a compliance plan to state regulators, with fines for noncompliance scheduled to begin in 2009.The move, expected to cost tens of millions of dollars in private money, has generated little opposition. P

Proponents of English as the official language of the United States vary in their views of the new regulations.K.C. McAlpin, executive director of Washington, D.C.-based ProEnglish, called California's decision a "misguided approach.""Instead of spending money on doctors, nurses and medicine, private providers will have to use that for interpreters," McAlpin said. "It's going to drive up costs, encourage doctors to turn away limited-English patients because they're too much trouble, and may even force doctors and providers out of business.

"Rob Toonkel, a spokesman for D.C.-based U.S. English, said basic healthcare services generally do not draw much ire."I don't think anyone in their right mind would tell someone in a health emergency, 'Sorry, you didn't learn English, so too bad,' " he said. "If we English-speakers were in another country, you bet we'd hope there would be translators on hand to help us understand."Insurance providers are taking steps to meet the state requirements. Blue Cross of California, the state's largest private insurer, expects to spend about $20 million to meet the new regulations.

Several other insurance providers declined to provide cost estimates or indicate whether premiums will increase. State officials said each provider's language assistance program will vary in cost and size, depending on their number of limited-English patients. But all plans must include a demographic profile of their membership, a list of what services they will offer to limited-English-speakers, and a system for training staffers on how to handle phone calls in different languages, officials said. Under the new regulations, limited-English patients must receive vital medical documents, including bills and medication forms, in their native language.

Non-vital materials, like promotional fliers, may be issued in English but must be translated within 21 days if the patient asks for such a service.Most important, according to some officials, the new rules will require that private health plans provide an interpreter, either in person or by phone, for patients at appointments or for those calling customer service.

The new regulations focus on a group that usually gets lost as most attention goes to uninsured residents or those receiving public healthcare, said Ellen Wu, executive director of California Pan-Ethnic Health Network, a patients' rights group. "It helps cover a large portion of limited-English-speakers who have jobs and have insurance but don't know their rights to better services," Wu said.Health officials said they could not provide examples of any fatalities tied directly to the existing conditions. The problems generally result in stressful, embarrassing, confusing moments that come at times when people already are at their least comfortable. Marbella Sala, operations manager at UC Davis' Center for Reducing Health Disparities in Sacramento, said she's seen various mishaps over the years related to miscommunication. In one case, Sala said, a Chinese-speaking patient was rushed to the hospital after she mistakenly placed hemorrhoid ointment in her eye.

In another case, a Spanish-speaking patient whose husband served as her interpreter during a medical visit believed she had contracted a venereal disease from a toilet seat. In another, a deaf patient canceled a minor surgical procedure after her 12-year-old daughter broke down while using sign language to explain the risks, which included death, Sala said. Those patients received proper treatment after interpreters arrived to help, she said.

People need to understand that language services have to do with a patient's quality of care," Sala said. "I mean, just go ask your 8-year-old what an IV is, they won't likely be able to describe it to you in any language."

California's hospitals and public healthcare plans, such as Medi-Cal, are already required to offer interpreting services and translated documents.With the new regulations, private providers could face fines of $10,000 or more if they fail to comply, said Lynne Randolph, a spokeswoman for the Department of Managed Health Care, the state agency enforcing the new law for HMOs. PPOs are regulated by the state Department of Insurance.

See the rest of the article at:
http://www.latimes.com/news/local/la-me-language23nov23,1,2670969.story?ctrack=1&cset=true

Culture-Based Care in NYC

2007-11-20T11:01:00.001-05:00

As you can see, part of the purpose for this blog is to keep you up to date with things happening in healthcare that related to cultural competency and diversity. Kaiser foundation recently published this article about the New York City Public Hospital System.

Culture-Based Care Hospitals in New York, Other Cities Increase Culturally Competent Care, Particularly Among Minorities With Diabetes
[Oct 23, 2007]

Medical professionals across the nation are "beginning to bone up" on culturally competent health care, in particular with diabetes, "given the rising incidence of the disease, its prevalence among minority groups and the changes in diet and lifestyle that treatment often entails," the Wall Street Journal reports. In New York City, nearly 50% of Asian-Americans have diabetes or pre-diabetes and about one-third of blacks and Hispanics have one of the conditions, compared with roughly 30% of whites. According to the Journal, the 50,000 diabetes patients at the city's 11 public hospitals speak "scores of languages" and are accustomed to "varied cuisines." Area hospitals have begun to tailor treatment and educational materials to minority populations, including making print information available in several languages, providing on-site cooking classes that focus on ethnic-specific recipes and offering a range of translation services. The public hospitals' electronic health record system is the "backbone" of the city's effort, the Journal reports. It allows providers to track clinical indicators, check when patients are due for certain exams and alert patients to missed appointments in their native languages.

For more. . .
http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=48391

In DNA Era, New Worries About Prejudice--New York Times

2007-11-13T09:23:00.000-05:00

At Cook Ross, in our healthcare cultural competency work, we talk about pharmacogenomics and genetics and its impact. The research is allowing practicioners to be more patient centered. The opportunity is to leverage difference. The challenge is when scientific distinctions are used, like other diversity distinctions (race, gender, sexual orientation, ethnicity, etc.) have historically been used, to discriminate. With genetics, this could engender a very interesting and in some cases dangerous dynamic in that, as we know phenotypically we may be one thing while our genotypes may yield something totally different. There are also the social implications of people making implicit associations about someone because they have heard or read about one ethnicity or race having something less than or greater than another. . .if in fact greater dichotomy and social division is created from the Human Genone Project we could lose the profound impact of the scientific traction that the deconstruction of DNA has provided.

By AMY HARMON
Published: November 11, 2007

When scientists first decoded the human genome in 2000, they were quick to portray it as proof of humankind’s remarkable similarity. The DNA of any two people, they emphasized, is at least 99 percent identical. . .

Such developments are providing some of the first tangible benefits of the genetic revolution. Yet some social critics fear they may also be giving long-discredited racial prejudices a new potency. The notion that race is more than skin deep, they fear, could undermine principles of equal treatment and opportunity that have relied on the presumption that we are all fundamentally equal. . .

For the full article:
http://www.nytimes.com/2007/11/11/us/11dna.html?em&ex=1195016400&en=654c92ed2a9ed7fe&ei=5087

Great Article about Pharmacies and non-English Proficiency

2007-11-04T07:26:00.001-05:00

Blogger's note: I think this could be the beginning of something that is talked about more in hospital pharmacies, too. I have heard anecdotally in some hospitals we have worked with that it can be a significant challenge even with a good interpreter services program, so I am sure the conversation about it is only going to increase. . .

By ANNE BARNARD

Published: October 31, 2007
Pharmacies across the city routinely fail to help non-English speakers understand their prescriptions, raising the chances that customers could harm themselves by taking medicines incorrectly, immigrant advocacy groups charge in a discrimination complaint that they plan to file today with the New York attorney general’s office.

The complaint names 16 pharmacies in Brooklyn, Queens and Long Island, most of them operated by chains. It argues that federal civil rights law and state health regulations require pharmacies to provide linguistic help to guarantee that people who speak little or no English receive equal access to health care. That assistance should include interpreters at pharmacies and written translations of medication instructions, the advocates say.

For the full article click below:
http://www.nytimes.com/2007/10/31/nyregion/31pharmacies.html?_r=1

Racism May Affect Infant Mortality Rates

2007-10-29T09:06:00.000-04:00

Racism May Affect Infant Mortality Rates
by Halimah Abdullah

WASHINGTON - For decades, health experts have tried to determine why African-American babies are twice as likely to die as white infants. A new series of studies from the Joint Center for Political and Economic Studies’ Health Policy Institute, along with a small but growing number of neonatalogists nationwide, suggests that the stressful effects of racism play a role.

more...

http://www.commondreams.org/archive/2007/09/29/4203

Upcoming Diversity Healthcare Events of Interest

2007-10-23T16:58:00.000-04:00

Cook Ross Web Seminar Series, Cultural Competency in Healthcare
Making the Case for Cultural Competency in Healthcare
January 9, 2008
Location: Web Seminar
Transform your healthcare organization by practicing daily cultural competence while improving patient satisfaction and bottom-line results. Module I of Cook Ross series.
http://cookross.com/docs/free_jan_2008_HC.pdf or visit http://www.cookross.com/

American Association for Cancer Research
The Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved
November 27 - December 1, 2007
Location: Atlanta, GA
http://www.aacr.org/home/scientists/meetings--workshops/cancer-health-disparities.aspx

Diversity in Pharmaceuticals and Biotechnology

2007-10-23T16:37:00.000-04:00

According to Universum Communications and THE BLACK COLLEGIAN’s report “The Top 100 Diversity Employers 2006” healthcare surpasses financial services as the most popular industry among diverse students overall. Healthcare was also determined to be the top industry among undergraduate students.

Undergraduates listed top pharmaceutical companies including Johnson & Johnson, Pfizer, Mayo Clinic, Glaxo Smith Kline and Merck in the top 40 desired companies. Pharma companies that were on the top 100 list in previous years have moved up in preference. Wyeth Pharmaceuticals rose in undergrad preference from 186th to 64th, Eli Lilly from 95th to 80th, Novartis from 140th to 130th and Roche from 154th to 140th. Even newcomers that were not ranked the previous year such as Hospira, Bayer and Takeda Pharmaceuticals North America made it in the top 200 list.

So what is causing diverse students to migrate towards the healthcare industry and hold a better opinion of pharma companies as potential employers?

These are conditions explored in a recently posted feature article on the Healthcare Channel, Diverse Talent Recognizes Pharma’s Efforts to Create More Diverse Workforce. This guest contribution presents the insider's perspective of Kristin Rand, JD, Director of Education Strategy in the Professional Education Support Department for Wyeth Pharmaceuticals. Her exploration, focusing particularly but not exlcusively on the representation of women in the industry, thoughtfully examines the benefits of diversity to industry organizations -- both to the customers and to the organizations. It also examines how smaller, more nimble companies in the biotechnology sector are succeeding in raising the representation of women in their ranks, and how Big Pharma -- despite its strides -- can still learn a thing or two from these companies.

The feature appears on both the Healthcare Industry Careers Channel and the Pharmaceutical Industry Channel at IMDiversity.

Abbott Named One of the Best Companies for Hispanics by Hispanic Business Magazine

2007-10-10T11:55:00.000-04:00

Abbott Named One of the Best Companies for Hispanics by Hispanic Business Magazine

We will highlight things such as this regularly on our blog where healthcare and health-related topics are concerned. Abbott has been pretty active in their diversity efforts for quite some time. From what I understand they are moving towards more cultural awareness and cultural competency-related work to better service their customers in sales interactions. In fact, many pharmaceutical companies are engaged in these efforts now.

Racism May Affect Infant Mortality Rates

2007-10-02T19:48:00.000-04:00

Saturday, September 29, 2007 by McClatchy Newspapers

Racism May Affect Infant Mortality Rates by Halimah Abdullah

WASHINGTON - For decades, health experts have tried to determine why African-American babies are twice as likely to die as white infants.
A new series of studies from the Joint Center for Political and Economic Studies’ Health Policy Institute, along with a small but growing number of neonatalogists nationwide, suggests that the stressful effects of racism play a role.

more...
(http://www.commondreams.org/archive/2007/09/29/4203/)

Healthcare, Cultural Competency, Diversity Live Here. . .

2007-10-01T21:00:00.000-04:00

Greetings All,

Welcome to our new Blog. Diversity HealthWorks has created this blog to share relevant health care information and editorials to you on a regular basis. Our intention is to create a space that allows you as a healthcare professional, consumer, or advocate to gather and share information about healthcare, cultural issues affecting healthcare, and the myriad diversity-related issues that impact our health that we are aware of and those we are not.

The fact is, all of us are aware of something. Given this fact, PLEASE SHARE what you know. We welcome you and if you are blogosphere or someone that is not and has something to say, please pass it along and we will do the same.

Stay tuned for what we are hoping is the #1 blog focused on the opportunities, challenges, and overall elevation of the diversity/inclusion and cultural competency conversation in healthcare.