ORGANX project

Working with Diverse Populations in Health and Human Services Beverly W. Henry, PhD, RD, 2007

Developing Organizational Cultural Competence Focus on Communities and Organizations

The importance of standards to support culturally and linguistically appropriate care was introduced early in your textbook readings. By now, yu have read about the 14 national standards for culturally and linguistically appropriate services in health care. These standards inform accreditation and credentialing agencies as they assess and compare providers on the services and quality of care to diverse populations. Transforming the face of health professions through cultural and linguistic competence education has been a priority of the U.S. Department of Health and Human Services (HRSA). By completing ORGANX, you are laying the groundwork of the why, what, and how to support cultural competence in organizations and communities.

Concerning ‘why’ work towards culturally competent health care, the information you have read about the depth and breadth of disparities in health care made a clear case for working to improve the situation. Support for improving culturally competent care can also be drawn from the guiding principles and goals identified by HRSA (see resource below). In brief these are: A. To respond to current and projected demographic changes in the United States B. To eliminate long-standing disparities in the health status of people of diverse racial, ethnic, and cultural backgrounds C. To eliminate disparities in the mental health status of people of diverse racial, ethnic, and cultural groups D. To improve the quality of services and primary care outcomes E. To meet legislative and regulatory mandates F. To meet accreditation mandates G. To gain a competitive edge in the marketplace H. To decrease the likelihood of malpractice claims These eight points provide rationale for evaluating cultural competence system-wide and provide key points for you to consider as you plan your group project.

The full report on the National Standards for Culturally and Linguistically Appropriate Services in health Care, Final Report, U.S. Department of health and Human Services is available at http://www.omhrc.gov/clas/. The standards are primarily directed at health care organizations, such as hospital settings. However, the principles and activities of culturally and linguistically appropriate services should be and can be integrated throughout any organization and undertaken in partnership with the communities being served. This is why you have the option, for your ORGANX project, to make a service organization the focus of your analysis and recommendations.

There are resources to review when planning your process for assessing and supporting cultural competence in organizations and communities – the ‘what’ and ‘how.’ Information on two models that identify steps in the process to develop cultural and linguistic competence is noted below. First, the Lewin model shows how an organization can move through the stages of development and support. Second, the Cross Model describes the stages of cultural competence at an organizational level. Additionally, the Action Kit for Community Leaders provides information and tools to engage in health advocacy and improve the health and well-being of your community. This kit (url noted at the end) emphasizes the importance of public programs in reducing racial and ethnic health disparities. Please note, the url’s may be subject to web address changes. If a link does not work, simply complete an internet search for the specific resource you are looking for and you should be able to quickly locate it.

Working with Diverse Populations in Health and Human Services Beverly W. Henry, PhD, RD, 2007

Lewin Model II.

KNOWING CULTURAL COMPETENCE WHEN WE SEE IT: COMPONENTS OF THE PROFILE

(source http://www.hrsa.gov/culturalcompetence/indicators/)

The Assessment Profile has three major components: 1) domains of cultural competence; 2) focus areas within domains; and 3) indicators relating to focus areas, by type of indicator. A. Domains and Focus Areas: Where to Look for Evidence of Cultural Competence The project team identified seven domains (or performance areas) for assessing cultural competence. These are the critical arenas or spheres in which cultural competence should be evident or manifest in an organization. These seven domains reflect to a great extent, although not exclusively, the underlying construct of cultural competence in health care delivery organizations and are areas to examine for evidence of cultural competence. Within each of the domains, the project team developed several focus areas. Focus areas are the substantive topic areas that characterize the domain. They are more specific arenas to examine for evidence of cultural competence and form the particular focus for identifying indicators. The Profile's domains are described below.

Organizational Values: An organization's perspective and attitudes with respect to the worth and importance of cultural competence and its commitment to provide culturally competent care. Governance: The goal-setting, policy-making, and other oversight vehicles an organization uses to help ensure the delivery of culturally competent care. Planning and Monitoring/Evaluation: The mechanisms and processes used for: a) long- and short-term policy, programmatic, and operational cultural competence planning that is informed by external and internal consumers; and b) the systems and activities needed to proactively track and assess an organization's level of cultural competence. Communication: The exchange of information between the organization/providers and the clients/population, and internally among staff, in ways that promote cultural competence. Staff Development: An organization's efforts to ensure staff and other service providers have the requisite attitudes, knowledge and skills for delivering culturally competent services. Organizational Infrastructure: The organizational resources required to deliver or facilitate delivery of culturally competent services. Services/Interventions: An organization's delivery or facilitation of clinical, public-health, and health related services in a culturally competent manner. B. Indicators by Type: Specific Evidence to be Used in Assessing Cultural Competence Within each of the domains and focus areas, the project team identified specific indicators of cultural competence in health care delivery organizations. Indicators are the particular observable or measurable characteristics of an organization that signify cultural competence. The indicators directly answer the question: "How can cultural competence be monitored and assessed?" by identifying the specific items on which information is to be gathered. The project team identified only those indicators deemed as critical and reasonable exemplars of organizational cultural competence to minimize complexity and facilitate the use of the Profile. While the indicators included in no way represent the universe of indicators possible for each domain and focus area, they still reflect a comprehensive view of cultural competence. Indicators

Working with Diverse Populations in Health and Human Services Beverly W. Henry, PhD, RD, 2007

were also selected because of their particular relevance to cultural competence. For the most part, more generic indicators of performance, quality, or access are not included. Further, the Profile contains indicators that are either qualitative or quantitative in nature. (Again, it is important to note that the Profile does not present performance measures, which typically specify baselines and target values for those indicators that are quantifiable.) Exhibit 1: PROFILE DOMAINS AND FOCUS AREAS

DOMAIN FOCUS AREAS

Organizational Values: An organization's perspective and attitudes regarding the worth and importance of cultural competence, and its commitment to providing culturally

competent care.

• Leadership, Investment and Documentation • Information/Data Relevant to Cultural Competence • Organizational Flexibility

Governance: The goal-setting, policy-making, and other oversight vehicles an organization uses to help ensure the

delivery of culturally competent care. "

• Community Involvement and Accountability • Board Development • Policies

Planning and Monitoring/Evaluation: The mechanisms and processes used for: a) long- and short-

term policy, programmatic, and operational cultural competence planning that is informed by external and

internal consumers; and b) the systems and activities needed to proactively track and assess an organization's level of

cultural competence.

• Client, Community and Staff Input • Plans and Implementation • Collection and Use of Cultural Competence-

Related Information/Data

Communication: The exchange of information between the organization/providers and the clients/population, and internally among staff, in ways that promote cultural competence.

• Understanding of Different Communication Needs and Styles of Client Population

• Culturally Competent Oral Communication • Culturally Competent Written/Other

Communication • Communication with Community • Intra-Organizational Communication

Staff Development: An organization's efforts to ensure staff and other service providers have the requisite attitudes, knowledge and skills for delivering culturally competent services.

• Training Commitment • Training Content • Staff Performance

Organizational Infrastructure: The organizational resources required to deliver or facilitate delivery of culturally competent services

• Financial/Budgetary • Staffing • Technology • Physical Facility/Environment • Linkages

Services/Interventions: An organization's delivery or facilitation of clinical, public-health, and health related services in a culturally competent manner.

• Client/Family/Community Input • Screening/Assessment/Care Planning • Treatment/Follow-up

Working with Diverse Populations in Health and Human Services Beverly W. Henry, PhD, RD, 2007

Indicators in the Profile were classified into four types: 1) structure indicators, 2) process indicators, 3) output indicators, and 4) intermediate outcome indicators.

Cross Model of Cultural Competence

Six Stages

1. Cultural Destructiveness. Attitudes, policies, and practices within the organization are destructive to cultures and individual members of those cultures.

2. Cultural Incapacity. The Organization does not intentionally seek to be destructive but rather lacks the capacity to help minority clients or communities.

3. Cultural Blindness. The organization functions with the belief that color or culture makes no difference and that all people are the same.

4. Cultural Pre-competence. The organization recognizes its weaknesses and attempts to improve some aspects of its services to a specific population.

5. Cultural Competence. The organization is characterized by acceptance and respect for differences, continuing self assessment regarding culture, careful attention to the dynamics of differences, continuous expansion of cultural knowledge, and a variety of service models to meet the needs of minority clients.

6. Cultural Proficiency. The organization seeks to develop a base of knowledge of culturally competent services by conducting research, developing new therapeutic approaches based on culture, publishing and disseminating information on cultural competence, and hiring specialists in culturally competent practices.

Additional Resources

HRSA Resource. Transforming the Face of Health Professions Through Cultural & Linguistic Competence Education: The Role of the HRSA Centers of Excellence http://www.hrsa.gov/culturalcompetence/curriculumguide/

Cultural Competence Resources for Health Care Providers http://www.hrsa.gov/culturalcompetence/ Making Public Programs Work for Communities of Color: An Action Kit for Community Leaders http://www.familiesusa.org/resources/tools-for-advocates/kits/minority-health-tool-kit.html

Cultural and Linguistic Competence Health Practitioner Assessment (CLCHPA) self-guided learning activity developed by the Georgetown University National Center for Cultural Competence. The CLCHPA is designed to enhance the delivery of high quality services for diverse patient/client populations, and promote cultural and linguistic as essential approaches addressing health and healthcare disparities. https://www.clchpa.org/

Please note, the url’s may be subject to web address changes. If a link does not work, simply complete an internet search for the specific resource you are looking for and you should be able to quickly locate it.