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!
Sunday, October 25, 2009
Friday, September 25, 2009
Health Care Reform: Is it all about costs?
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!
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!
Friday, August 7, 2009
Parrots and Protectionism: Healthcare Reform and American Society
"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!
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!
Wednesday, July 22, 2009
Cultural Competence is a Strategy II
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!
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!
Tuesday, July 14, 2009
Cultural Competence is a Strategy
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!
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!
Friday, July 10, 2009
Considering Immigration in Health Reform
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.
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.
Saturday, July 4, 2009
Health Disparities are Quality Disparities
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!
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!
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