Patient Centeredness, Cultural Competency, and Health Quality

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

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Supply, Demand, Universal Coverage as Transformational?

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.

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HCAHPS and Cultural Competency

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

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

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

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

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Racial Health Disparities: The Civil Rights Issue of Decade?

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

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

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

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

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. . .

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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.