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!
Showing posts with label health reform. Show all posts
Showing posts with label health reform. Show all posts
Tuesday, July 14, 2009
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!
Wednesday, June 24, 2009
Culture and Quality Part IV
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!
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!
Friday, June 19, 2009
Draft Summary on Health Reform Bill from the House Ways and Means Committee
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!
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!
Thursday, June 11, 2009
Minority Politicians and Health Disparities: The Messenger, the Message
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)
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)
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