If senior leaders want to cut the bottom line and improve quality, they need to deliver culturally sensitive health care.
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| Shawn Foster | Frederick Hobby |
These days, senior leaders have to be keenly aware of whether their hospital truly reflects the community it serves. Does the hospital’s workforce mirror the changing faces in the community? Does it deliver the highest quality, most culturally sensitive health care to patients?
Four years ago, the Institute for Diversity in Health Management asked these questions, challenging leaders to assess their organizations. Today, more hospitals are taking stock of these issues and the unintended health care disparities existing within their walls.
But it’s clear we still have a long way to go. In many cases, leaders seeking interventions are ill-equipped and under-resourced to drive major change. Even more are unable to link necessary investments to any comprehensive organizational strategy or performance measures. Some senior executives have expressed concern over the number of competing priorities and the difficulty of adding change initiatives that are neither reimbursable nor mandated.
Those organizations that create a culturally competent environment for care may well realize increasing market share, create an inclusive work environment that helps recruitment in a highly competitive labor market, and avoid costly state and federal mandates.
Cultivating Change Agents
In 2005, the Health Research & Educational Trust (HRET), the Institute for Diversity in Health Management, and the National Center for Healthcare Leadership launched the first-ever Cultural Competence Leadership Fellowship (CCLF), an innovative, yearlong program. Since then, 55 leaders have been armed with essential tools to better strategize cultural competence and activities to reduce disparities. Key elements in the fellowship include:
Cultural competence cannot be advanced by a one-size-fits-all approach, and the fellowship was designed with this fact in mind. Fellowship participants represented unique points of view from academic, business, community and health care sectors. Differences raised debates, but they also connected the fellows on a deeper level of understanding and helped them reach every level of their organizations. As one alumni noted, “The fellowship helped open up communication and allowed us to ask hard questions of providers and ourselves.”
Making the Case with Data
The CCLF program gave leaders a platform to outline intentions and pilot an action plan. Some began by focusing on simple action steps such as evaluating linguistic needs in their facilities. Others set out to provide front-line clinicians with resources to support patient-centric interactions. Still others worked to put real meat on the bone when implementing culturally and linguistically appropriate standards. But all eventually had to make a business case for why their interventions justified the investment.
Typically, those who struggled could only plant the seed for change. Some of these participants lacked full support of their organization or a capable champion who viewed the efforts as necessary to raise the bar on performance. Securing support from senior leaders is absolutely critical. But senior leaders need data to better comprehend how cultural competence and disparities interventions are inextricably linked to key indicators—higher patient satisfaction, improved quality, enhanced patient flow and fewer medical errors.
Those making the connection are more likely to expand the scale of their work. In Philadelphia, CCLF alumna and global nurse ambassador Rita Adeniran and her nursing staff began a change process at the Hospital of the University of Pennsylvania School of Nursing. They conducted a cultural competency assessment with critical feedback about staff training needs and a dearth of patient translation services.
Assessment outcomes were an eye-opener for the nursing staff and provided leverage within the organization. Adeniran gained resources and support from hospital leaders, which contributed to a fourfold increase in the use of translation services. Later, she implemented a successful train-the-trainer program, resulting in the first housewide training of 900 nurses. “Staff are proud of the progress, acknowledging that three years ago this was a different place,” Adeniran said.
Carrying the Message
The CCLF ended in June 2008, but much work remains undone. Many of the first learners in the CCLF pilot now serve as teachers in the field. Adeniran believes that “hospitals across the country have not yet quantified the economic loss due to the lack of cultural competency training.” She added, “If patients and families are not satisfied with care, they will seek services somewhere else. Hospitals and health systems that embrace cultural competence can provide an organization with a competitive advantage.”
To assist health care leaders working to reduce disparities in the delivery of care and medical outcomes, and to increase the diversity of their workforce, leadership and governance, the American Hospital Association (AHA) and its affiliates have developed several innovative products and services.
HRET has created a toolkit to facilitate collecting patient data pertaining to race, ethnicity and language preference. Collecting demographic data from each patient is necessary for performing stratified analysis of resource utilization, length of stay, acuity and satisfaction scores.
The Center for Healthcare Governance and the Institute for Diversity in Health Management, with support from the AHA, have developed the Trustee Professionalism Training program to identify and recruit minority community leaders interested in hospital governance, and provide them with one-day training on governance duties and responsibilities. This innovative pilot program offers a new tool to help hospitals diversify their boards of directors.
The Institute for Diversity in Health Management has developed a first-of-its-kind data collection and information sharing program that will take a snapshot of the current state of diversity in the health care field. “The State of Healthcare Diversity and Disparities: A Benchmark Study of U.S. Hospitals” will allow hospitals to see how their programs compare with one another, while sharing the strategies of high-performing organizations. This effort will help hospitals keep pace with the changing needs of an increasingly diverse workforce and patient population.
We think that acknowledging disparities takes courage. We know that doing something about it takes leadership. We believe there is no shortage of either trait in our industry.
Shawn Foster is director of fellowship operations at HRET in Chicago. Frederick Hobby is president and CEO of the Institute for Diversity in Health Management, also in Chicago.
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