Second National Conference on
Quality Health Care for Culturally Diverse Populations:
Strategy and Action for Communities, Providers, and a Changing Health System

1-5. Why Choose Cultural Competence: The Impact Of Internal And External Factors On The Decision-Making Process

Why don't more health organizations have professional interpreter services and other culturally appropriate (CLAS) services? This panel will discuss the challenging structural issues in health organizations, which work against the implementation of CLAS services. The three presenters in this panel will share their different experiences of the challenging complexities involved in helping health organizations address and accommodate language and cultural matters.

Niels Agger-Gupta, PhD Candidate, The Fielding Institute. Niels is the Executive Director of the California Healthcare Interpreters Association, based in Santa Barbara, California and is currently on the Policy and Research Committee of the NCIHC. Previously, Niels was Regional Interpreter Services Co-ordinator in the Calgary Regional Health Authority, Calgary, Alberta, Canada. Niels will present his PhD research into how professional interpreter services were created in a number of health organizations in Canada and the US. In his grounded theory research across 14 organizations in Seattle, Chicago, Boston, Oakland, Calgary and Vancouver, Niels identified some of the common essential prerequisite conditions as well as the challenges, obstacles and the catalysts, which appear to be required to create a professional interpreter service. Further, interpreter services exist in a matrix of at least 5 structural domain layers, simultaneously inside and outside of the health organization. On a practical level, the emerging model identifies some of the leverage points for change, and may provide some insights for advocates about where the opportunities for health organization changes for CLAS services may come.

Niels Agger-Gupta, PhD Candidate
The Fielding Institute
927 West Valerio Street
Santa Barbara, CA 93101
Phone: (805) 898-0206
Email: Agger@attglobal.net

Julia S. Henion, RN, MBA is currently the Associate Administrator for Ambulatory Care Services at Harborview Medical Center in Seattle, Washington. Julia will present an executive perspective on enabling cultural and linguistic competency in health organizations. This will include discussion of how a provider organization might attempt to fit the right thing to do within a structure of cost-control absent adequate reimbursement. The purpose of this presentation will be to identify how an organization can evaluate the effectiveness of seemingly additive costs for an interpreter model that goes beyond mandated thresholds for regulatory compliance but is quantifiable in measurable health and wellness outcomes for defined limited-English speaking populations.

Julia Henion, RN, MBA
Associate Administrator for Ambulatory Care Services
Harborview Medical Center
252 Ninth Avenue, Box 359704
Seattle, WA 98104
Phone: (206) 731-2149
Email: jhenion@u.washington.edu

Thomas Lonner, PhD is research manager of the Cross Cultural Health Care Program. A medical sociologist, he has studied and reported on women in the health care professions, social justice and local control over alcohol in Alaska Native villages, Indian child welfare compliance by state agencies, and, most recently, the role of community health centers and similar safety-net providers in meeting their funded roles and their unfunded challenges in meeting the needs of growing refugee and immigrant communities and the uninsured. In his recent work, Tom found a common assumption among advocates for far greater cultural and linguistic competence in health care that such competence must, can, and will be advanced among safety-net and mainstream providers of health care to poor and minority populations. Advances are to be made through new laws and policies, contract requirements, local community controls, professional and organizational self-assessment and education, changing local demographics, market considerations, and moral and political suasion. The author of a new book on cultural competence and Medicaid managed care, Tom argues that small individual and local solutions are not national solutions, that these solutions may not be pervasive or permanent even in the best-intentioned and most capable plan or provider organization, that many forces individually, collectively, and interactively undercut the original assumption, and asks that advocates become more reality-based in their strategies.

Thomas Lonner, PhD
Research Manager
Cross Cultural Health Care Program
1200 12^th Avenue, South.
Seattle, WA 98144
Phone: (206) 621-4661
Email: research@pacmed.org

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