 |
|
 |
The Third National
Conference on |
|
|
|
October
2 - 4, 2002, Chicago, IL |
|
| Thursday |
|
|
||||||||||
|
Preconference | Wed., October 2nd | Th., October 3rd | Fr., October 4th | | ||||||||||
Session C-2: Designing and integrating the results of internal assessments to improve organizational cultural competenceA Systemic Approach to Implementing Cultural Competency Assessment and Training of Providers in a Managed Care SettingThe Alameda Alliance for Health (the "Alliance") evaluates, implements, and integrates cultural and linguistic competency throughout plan operations in order to create a culturally competent organization, increase access to care, enhance quality of care and health outcomes, maximize patient satisfaction and retention, and reduce health disparities. We will discuss a two-year feasibility study funded by The California Endowment to establish the business case for cultural competency training and assessment of health practitioners in a managed care setting. This study examines quality of health care, with a focus on processes of care (eg. access, preventive care, satisfaction, and trust), as well as selected health indicators. The Alliance goes beyond cultural "sensitivity" and changing value systems, and instead seeks to implement a new model for knowledge and skills building through training and measurement. The Alliance is the first managed care organization to implement a newly scientifically validated tool that assesses level of cultural competency among medical providers, based on a model of a continuum of culturally competent care. This continuum has a vertical axis composed of three areas of competency and a horizontal axis specifying the four levels of cultural competency. Results of this two-year project will inform the Alliance and other health plans of how to institutionalizing a systemic approach to providing culturally and linguistically appropriate health care services. The Feasibility Study of Implementing Cultural Competency Assessment and Training of Providers in a Managed Care Organization examines the feasibility and effectiveness of implementing cultural competency assessment and training of providers as part of a systems approach to dealing with culturally competent health care in a managed care setting. The ultimate aim is to contribute to the development of a business case for an institutionalized, ongoing cultural competency assessment and training program with related ongoing quality improvement initiatives. Specifically, the goals of this study are to:
This study uses scientific methodology, as well a business model of organizational analysis. This is a randomized control treatment study examining the effect of assessment alone v. assessment plus training on increasing level of cultural competency among providers, and the effect of cultural competency on quality of health care. The business model relies on systems management and the organizational effectiveness evaluation (OEE) model. This model focuses on a coordinated chain of means-ends connections and the use of standardized numerical measures in determining effectiveness and cost efficiency. In this process, managers seek to identify which business activity contributes most to achieving the desired outcome of the organization. When health care organizations address cultural and linguistic activities, they typically do so from a compliance point of view. A few organizations implement a range of one or more specific efforts (such as translation, interpreter services, and cultural sensitivity training). However, these are typically stand-alone services, often dependent on a specific individual within the organization. The Alliance implements its vision for culturally competent health care through business practices as part of a coherent and dynamic system. This systemic approach helps to avoid defining cultural competency as the final desired outcome, and instead, desired outcomes are defined at the member/patient level, provider level, and MCO level. This type of approach to delivering a cultural competency assessment and training program poses unique opportunities as well as challenges. While challenging, this coordinated approach to evolving the project has benefited the organization with institutionalization and sustainability of the interventions.
Alameda Alliance for Health, is the managed care health plan serving Medi-Cal, Healthy Families (SCHIP) and other low-income, vulnerable populations throughout Alameda County in Northern California. Comprehensive medical and behavioral health services are provided through over 1,300 public and private physicians, hospitals, and community clinics. As part of the Alliance’s commitment to serve a diverse community, the Alliance has taken active steps to design organizational-wide and program specific cultural and linguistic infrastructures to best meet the needs of the communities of Alameda County.
Juanita Dimas serves as the Cultural and Linguistic (C&L) Program Manager of the Alameda Alliance for Helalth. The C&L Program develops strategies and provides guidance in the implementation of culturally and linguistically appropriate health care services, including organizational assessment and C&L program development, the Culturally Competency Initiative, the Language Proficiency Initiative, as well as ongoing C&L operations. Dr. Dimas is a licensed clinical/community psychologist, with a specialization in working with diverse, poor and underserved populations, and in researching cultural factors related to health disparities. As a professor of psychology, she taught a variety of graduate level courses, including cultural competency. Dr. Dimas’ numerous presentations have been made to national and state health institutes, professional organizations, as well as colleges and universities; her publications focus on cultural factors and health and include book chapters, professional journal articles, and policy reports. Dr. Dimas earned her PhD in Clinical Psychology from the University of California, Berkeley, and served her clinical internship and postdoctoral fellowship at the University of California, San Francisco, Public Service and Minority Cluster, based at San Francisco General Hospital.
Dr. Miguel D. Tirado is Professor of Health and Human Services at California State University, Monterey Bay. He also is a Research Associate at Stanford University and the University of California, San Francisco. He served as Research Director for the US Government (HRSA) sponsored study on standards and tools for monitoring for health care professionals serving culturally and linguistically diverse populations and Co-Investigator of two California Endowment funded studies of cultural competency in primary care. His professional experiences include serving in the private health care sector as the Director of Special Projects at American International Healthcare and the Director of Management Development at Pacific Bell. He has also has been a Consultant to the California State Assembly, and a Congressional Aide in the US House of Representatives where he specialized in health care policy. He is the author of the Cultural Index of Accessibility to Care, which served as a guide for MediCal contractual guidelines of the State of California.
Implementing Institution-Wide Cultural Competency Assessment: Lessons Learned in Planning, Design and InstitutionalizationDescription: This workshop will focus on how CHA’s Immigrant Health Improvement Program (IHIP) is planning, designing and working on institutionalization of cultural competency assessment. IHIP is the umbrella for cultural competency work undertaken at the Alliance and IHIP projects—including the assessment—are implemented through an Advisory Board. Board members include representatives from departments throughout the CHA system including primary care, mental health, inpatient, emergency, organizational development, quality management and representatives from CBOs, particularly ethnic advocacy agencies. The IHIP Advisory Board proposed development of cultural competency plans for each department. Specific issues that will be addressed include:
Elisa Friedman is a team member for CHA’s Immigrant Health Improvement Program, an initiative that crosses departmental and service lines and involves community partners to plan, develop, and monitor health access and outcomes for CHA’s diverse patient population. Elisa’s work focuses on planning and evaluating initiatives related to health access and disparities, cultural competency and behavioral health. She is an evaluator for the Neighbors for a Better Community and Cambridge College Medical Interpreter Training Program, a one year program available for college credit. Elisa is Board Member of the Community Action Agency of Somerville and a member of the Massachusetts Immigrant and Refugee Advocacy Coalition. Prior to working at the Alliance, Elisa worked internationally on projects in El Salvador, Honduras, Brazil, Mozambique and Angola.
Marcy Lidman has been an organizational development practitioner since 1979. She has worked in a variety of public and private settings, including two health care organizations and a large public mental health system. Marcy has been teaching and learning about cultural diversity for over 20 years, and finds tremendous satisfaction and challenge in the multi-lingual and multi-cultural constituencies at the Cambridge Health Alliance. Her work as Director of Employee Development includes workforce development planning, management consultation, leadership development, team-building, and personal and professional development for all levels of the organization.
Multilingual Interpreting at CHA provides medical interpreting to all CHA sites for all hours of service, with more than 10,000 interpreter patient contacts per month in more than 30 languages at more than 18 sites. The department also has a written translation service providing quality translations to both internal and external customers. CHA, under the leadership of CEO John O’Brien, has been a major advocate for immigrant health rights and health access for the underserved. Loretta has been a major advocate in Massachusetts for access to medical interpreters, and a vocal advocate for Massachusetts’ Emergency Room Interpreter Law. She is also a leader for CHA’s Immigrant Health Improvement Program, an initiative that crosses departmental and service lines and involves community partners to plan, develop, and monitor health access and outcomes for CHA’s diverse patient population. She was a collaborator with two community partners, Neighbors for a Better Community and Cambridge College, to develop the Cambridge College Medical Interpreter Training Program, a one year program available for college credit. The program graduated it’s second class in March 2002 Loretta’s doctorate is in anthropology, from Boston University (1988) where her dissertation examined the evolution of Haitian political economy, Haitian family structure, and migration. From 1988 to 1993 she provided psychotherapy as a clinical anthropologist in CHA’s Haitian Mental Health Clinic. She also is a member of the Massachusetts Medical Interpreters Association, the Interpreter Services Collaborative, the Massachusetts Immigrant Health Access Coalition, the Massachusetts Immigrant and Refugee Advocacy Coalition, and the Emergency Room Interpreter Law Advisory Committee. She is a former co-chair of the Diversity Task Group of Vision 20/20 in the Town of Arlington, Massachusetts, and a former member of Town Meeting in Arlington. |
|||||||||||
  |
|||||||||||
|
|
|
|
|
|
|
| As with the rest of Diversity Rx, this section
is a work in progress and we welcome information on other efforts, programs,
and reports that will expand upon the information offered here. Please
let us know if you have other examples to include here. |
||||||
  |
essentials | models and practices | policy | legal issues
| networking | table
of contents | contact us
| who we are |
|||||
 |
 |
|||||
|
Diversity Rx is sponsored by: |
 The National Conference of State Legislatures |
 Resources for Cross Cultural Health Care |
 Henry J. Kaiser Family Foundation |
|||
