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| Workshop C-1: Transforming organizations to improve cultural competence and quality Putting Healthcare into Culture, not Culture into HealthcareHealthcare is in crisis. Patients are frustrated, healthcare staff are frustrated and angry, and payers are unhappy with the outcomes. Populations who are different from the mainstream in terms of language, culture, financial status, and other attributes continue to experience huge health disparities. The proposed ‘fixes’ and ‘improvements’ are mostly focused on improving the current system. We at SCF assert that this approach will never ‘fix’ the system. We need to quit ‘forcing’ customers into what ‘works’ for healthcare and start figuring out how to put ‘healthcare’ into customer’s lives in ways that work for them and put the power and control into their hands. National data, and our data from SCF, demonstrate that impressive improvements in outcomes, patient satisfaction, employee satisfaction, and markedly decreased costs are all possible to obtain all at the same time when systems apply all known best practices in a fundamentally changed focused system based on customer power and control. Our successes include utilization data that includes decreases on a per person basis of 50% in the Emergency Room and Urgent Care, 65% in use of medical specialists, and nearly 20% in use of primary care visits. We also have demonstrated customer satisfaction and employee satisfaction levels that are well above industry averages. Clinical process measures and clinical outcomes are also mostly better than national averages and some are better by a large amount. We also have received recognition in many quarters for our culturally based approaches to residential and outpatient treatment programs addressing substance abuse, prevention of fetal alcohol affected infants, behavioral health, and troubled youth. Our completely integrative approaches to incorporating Native Traditional Healers, chiropractors, massage therapists, and acupuncture are also receiving widespread attention. Huge challenges existed for us in finding funding, creating Native centered – customer centered programs, and changing the existing provider-centric models present in the medical services we took over from the Indian Health Service. Moving to a system designed and managed based on Native driven operational principles has been transforming in terms of our ability to build a radically different system. Finding and keeping talented leadership, intentional development of Native leadership, and overall intentional workforce development have been key to our progress. We feel that the following are some of the most critical success factors:
Katherine Gottlieb has personal roots in rural village Alaska and a long professional career in leadership in urban Alaska. She has been the President/CEO of a large Native owned health corporation (SCF) for over 12 years. Under her leadership this customer-owned Native health corporation has developed an international reputation as a leader in health related system design and innovation based on Native values and Native ways of thinking, leading, and organizing. The work of SCF has become a template for many locations across the nation and internationally. Her leadership work has resulted in interactions and relationships in many cultures and locations around the world. Her passion and vision for making healthcare customer owned and customer controlled while managing a large complex, financially successful health corporation are admired by many. Doug Eby has lived and worked in a number of multi-cultural environments. For the past 14 years he has worked in healthcare in the Alaska Native health system, the past 9 years in leadership with Southcentral Foundation, an Alaska Native owned and managed not-for-profit healthcare corporation. He has provided leadership and insight into the appropriate role for non-Native professional leadership in a Native environment that is supportive and facilitative rather than paternalistic or intrusive.
Collaborative Approaches to Addressing Health Disparities: Practical Application of Policy to Real Life Practice A City-Academic Health Center Case-StudyIn 2002, the Boston Public Health Commission, under the leadership of Mayor Thomas Menino, invited all Boston hospital presidents to participate in an effort to develop strategies to eliminate racial/ethnic disparities in the city. This process would be shepherded by the Boston Public Health Commission and the Conference of Boston Teaching Hospitals. In February of 2003, MGH appointed a Disparities Committee charged to: 1.Identify key areas where racial disparities in health care may exist at MGH; 2.Develop solutions to address disparities found here at MGH; 3.Coordinate our efforts with the Mayor’s city-wide initiative. The Disparities Committee, composed of several leaders at MGH from various administrative, clinical, and patient services departments, had four meetings over the course of 6 months in 2003. Three subcommittees were formed with the end-goal of taking action and presenting findings to the MGH Board of Trustees in September 2004. These included a: Quality Subcommittee Examples of Activities:
Patient Experience and Access to Care Subcommittee
Education and Awareness Subcommittee Example of activities
We will present the genesis and development of this collaboration, challenges encountered and progress to date as a case-study. Joan Quinlan, MPA is Director of Community Benefits at Massachusetts General Hospital. Joan Quinlan is the co-chair of Massachusetts General Hospital’s Disparities Committee, along with Dr. Joseph Betancourt, and represents the hospital on a citywide disparities initiative as well. She has been a long time member of the hospital’s Diversity Committee, which is led by the president and focuses on workplace diversity. As director of the Community Benefit program, she is responsible for the development and implementation of programs to enhance the hospital’s responsiveness to diverse and underserved patients. These programs include an immigrant and refugee health initiative, patient navigators, substance abuse and domestic violence services, and other outreach and intervention efforts. Prior to joining MGH in 1995, Ms. Quinlan was the administrative director of the Boston Health Care for the Homeless Program. Prior to that, she was the women’s advisor to Massachusetts Governor Michael S. Dukakis, where she worked on issues of concern to low-income women, such as child care and teen pregnancy.
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National Conference is presented by State University of New York Downstate Medical Center, Resources for Cross Cultural Health Care, Arthur Ashe Institute for Urban Health, US Department of Health and Human Services, Joint Commission on Accreditation of Healthcare Organizations |
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| 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. |
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Diversity Rx is sponsored by: |
 The National Conference of State Legislatures |
 Resources for Cross Cultural Health Care |
 Henry J. Kaiser Family Foundation |
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