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Title: Tackling a Life-and-Death Issue: Culturally and Linguistically Appropriate Healthcare
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Disp: 12 Sig: 1 q.o.d.” The language of prescription medicine is impenetrable and foreign for most of us. But, “Dispense 12 tablets; take one tablet every other day” can also be a foreign language for many people using local healthcare systems. These patients may need medical information in Spanish or Vietnamese or Russian. And they need someone fluent in their language and sensitive to their culture to explain how the medicine should be taken or to determine if it will conflict with other medications, including culturally-based home remedies.
The growing diversity of America’s population brings more challenges of language and culture to hospitals and other healthcare facilities. And when patients cannot understand what they must do to regain their health, clinical outcomes are in jeopardy. This misunderstanding can lead to distrust, driving patients away from the very institutions whose mission it is to help them. Diverse population groups become disproportionately less healthy, and die younger and more often.
The Goal
Everyone agrees that the ultimate goal for any healthcare system is to provide the most effective care for each patient. Every patient is an individual, the product of a combination of factors that makes each of us unique. Our economic level, educational history, social background, language and cultural influences - together with our genetic makeup, age and gender - all play a part in determining what treatment is most appropriate and how it should be delivered. But the disparity among outcome figures for different groups shows that healthcare in the U.S. has a long way to go before we reach parity between the rich and the poor, African-Americans and Caucasians, inner-city and rural communities or any other comparison of population segments.
Examination – Diagnosis – Treatment - Cure
What can be done to improve healthcare outcomes across our communities? First, hospitals and healthcare organizations must determine whether they have a problem. And just as it’s difficult for a doctor to diagnose himself or herself, it’s best to have an outside expert perform an objective analysis to determine the level of cultural sensitivity and competence. The analysis points out where things are going well and where they could be improved. Finally, the expert can point the way to resources to help solve any problems that exist.
The US Department of Health and Human Services’ Office of Minority Health has determined 14 National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Healthcare. Four of these are based on providing language services to improve communication not only between doctors and patients, but in other areas of the hospital, such as medical testing, financial offices, social services and more. Currently, federal funding is tied to the hospital’s ability to meet these four standards. The other ten standards describing culturally competent care and how it is supported by the institution are currently considered ‘guidelines’.
Larry James recognized in 2003 the need for an objective analysis and evaluation of hospitals’ multicultural competence based on these CLAS standards. All 14 standards, not just language services, are vitally important to providing quality care for all patients. And federal funding may soon depend on adhering to all 14.
CMCHO
In July of 2005, Mr. James founded the Center for Multicultural Competence for Healthcare Organizations (CMCHO) to provide an organized, objective evaluation to determine which hospitals and healthcare facilities are meeting CLAS standards. In doing so, he also assembled a group of healthcare specialists to assist in the analysis, evaluation, recommendations and the certification of multiculturally competent facilities. The members of the CMCHO consortium, along with their respective areas of expertise, are:
• Larry James – hospital administration, marketing, diversity and service excellence, insight, planning and execution
• Roland D. West - organizational development, cross-cultural training and coaching
• Robert V. Miller of Cooper Research - healthcare market research
• Kathleen Gallon - healthcare human resources
• Thomas A. Scott, MD – multicultural health disparities, cultural competence, physician training, development and coaching
CMCHO’s research shows while economic and educational differences are slowly beginning to be addressed in the U.S., there have been little or no improvement in language and cultural understanding before the CLAS standards were established in 2001. And since most hospitals don’t have the luxury of being able to pick their patients, they must treat all the patients who come to them.
The Process
Before surveying staff and patients of any healthcare organization or hospital, CMCHO reviews the previous 12 months of discharge data. This information gives an accurate portrayal of who uses the hospital and what services are involved as well as patient outcomes. These statistics are analyzed by all demographic variables and then compared against a profile of the hospital’s service area. This is done to search for any noticeable inconsistencies. For instance, is there a significant portion of the population that has not been treated by the hospital? Are key clinical outcomes seen in proportion to service area representation and hospital admission rates? CMCHO’s analysis pinpoints these and many more issues.
Next, CMCHO conducts demographic mapping studies and quantitative market surveys to identify key patient populations and their perceptions of the hospital and its competitors. What are the key sub-groups in the service area and, does one group feel differently about the hospital versus another? Why?
Then, CMCHO representatives meet with leadership groups, including the hospital board, the executive team, hospital management and the medical staff. These interviews identify the leadership’s level of awareness, understanding and commitment to providing culturally sensitive and competent care. Subsequent review of hospital policies, procedures and physical plant determines whether these written guidelines reflect the commitment to multicultural sensitivity and competency expressed by hospital leaders.”
CMCHO then pulls patient charts, targeting representative demographics and diseases specific to the diverse population in the hospital’s service area. (In line with new government privacy requirements, CMCHO personnel sign confidentiality agreements to protect patient identity). These patients are tracked throughout their contact with the hospital, from testing procedures, through diagnosis, treatment, outcome and follow-up care. Interviews with patients and caregivers are also conducted for insights into why treatment decisions were made.
CMCHO tours the entire hospital to assess multicultural compliance both in and outside of clinical areas. Although not directly involved in treatment, non-clinical departments also affect the patient’s relationship with and attitude about the hospital. Admitting; housekeeping; patient financial services; food services; social services; the chaplain and the chapel; volunteers; security; and human resources are just some of the areas surveyed. These peripheral services can either reassure patients and their families or increase distrust of the facility and staff. For instance, if the community has a large Muslim population, does the hospital chaplain have sufficient access to accepted faith leaders of this group and, can the hospital accommodate the meal schedules required during Ramadan? Moreover, does staff understand how important these issues may be to the well-being of the patient?
When all of these tasks are completed, the CMCHO team meets to analyze survey findings and come to a consensus on the hospital’s competency score. CMCHO believes every healthcare facility deserves credit for recognizing that multicultural competency is an issue worthy of their attention and response. For that reason, every facility receives baseline certification following their first survey. After that baseline year, the institution is surveyed again to determine its follow up certification score. All of this is done in an effort to be fair. CMCHO recognizes the need to hold healthcare organizations accountable, but also realizes in many cases, they are uncovering information that hospitals are seeing for the very first time.
Scores are based on a 100-point scale and range from conditional certification (50-69 points), to full certification (70-89 points) and certification with distinction (90-100 points). Evaluations include a complete SWOT analysis, a summary of what needs to be done, and a correction or maintenance plan. CMCHO was created specifically to certify an institution’s level of multicultural competence; the hospital may either choose their own resources to implement the compliance plan, or CMCHO will provide a list of experts they can consult to help them solve any problems.
For hospitals that achieve certification, CMCHO notifies the media of this achievement and publishes the institution’s name on the CMCHO website.
What Does CMCHO Certification mean and how does it help?
CMCHO certification is public recognition of a hospital’s dedication to serving all patients in its community in the most understanding and medically effective manner with the ultimate goal of better outcomes for all. Certification involves an extensive, thorough analysis of the hospital’s staff, policies, procedures and outcomes and should signal to the public that this is a caring institution concerned with the health of the entire community. It is, above all else, an indication that the hospital is doing the right thing - but it also conveys certain benefits to the hospital, to businesses whose employees turn to that hospital for treatment, and to the community at large.
For the Hospital
The competition for patients today is fierce. To function successfully and profitably, healthcare institutions must attract patients from across their communities. In every part of the U.S. today, diversity continues to grow and minorities often become majorities in many locations. Moreover, “minority” is not synonymous with “disadvantaged.” Every population group represents a range of economic levels as well as differences in attitudes and opinions. Patients are more likely to choose a hospital where they feel welcome and well cared for. CMCHO certification is the outward symbol of this attention to providing the best care for every patient. Thus, certification can be a distinct marketing advantage in a very competitive healthcare environment.
For Employers
The U.S. workforce is also growing more diverse. Employers depend on healthy employees to get the job done, and attention to the particular healthcare needs of population segments that make up the company’s workforce can not only keep them healthier, but it can decrease healthcare costs overall. CMCHO certification indicates that a hospital or healthcare facility understands and serves diverse populations effectively.
For the Public
Excellent care, attuned to the needs of each individual patient, is what we all want everyone. CMCHO certification tells each community that their hospital understands them. Mr. James and his associates at CMCHO believe that, once the community understands the significance of certification, it will factor into families’ decisions on healthcare and the public will begin to demand that CMCHO-certified hospitals become part of their medical care.
About Lawrence W. James, L. W. James & Associates
“I’ve always been fascinated with people and their motivations,” said Larry James. Whether it was helping a friend win a high school election or developing brand identity for high-end Procter & Gamble products, Mr. James has sought to understand what people need and why, then gone about providing ways to meet those needs.
Born and raised in Columbus, Ohio, Mr. James received his bachelor’s degree in Business from Wittenberg University in Springfield, Ohio, and earned a master’s degree in Management in Marketing, Finance and Organizational Behavior from the J.L. Kellogg Graduate School at Northwestern University.
He began his professional career with Procter & Gamble, achieving more and more brand development responsibility before moving to Borden, Ross Laboratories, LensCrafters, and ChoiceCare/Humana. Although he was recognized for his product marketing skill, he realized that he felt the need to give back to his community. As he sought to reach his full potential in more meaningful work, he found he was drawn to health care.
Just prior to launching his own healthcare marketing company, Mr. James served the Middletown Regional Hospital System for eight years as Vice-President and Chief Marketing Officer. His strategic leadership, planning and executional skills were instrumental in moving the Middletown health system to its position as a premier healthcare leader for in southwestern Ohio. Evidence of the hospital’s sound financial position, clinical quality, service excellence and diversity is its outstanding growth, culminating in the opening of a new facility, Atrium Medical Center, in 2008.
It was his experience at Middletown Regional Hospital that led Mr. James to realize the need for all hospitals to be more culturally competent in caring for their patients and to develop a way to show the community that they have met this challenge.
“We must eliminate the disparity of outcomes from one population group to the next and bring all to the highest level,” Mr. James emphasizes. “As a person of color, I want to be sure that my loved ones receive the best treatment possible when they go to the hospital. CMCHO examines whether culturally diverse patients are treated appropriately as individuals. The CMCHO certification process helps hospitals understand where improvement is needed and recognizes their achievement when they reach that vitally important goal.”
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The Center for Multicultural Competence
in Healthcare Organizations
4555 Lake Forest Drive - 650 Westlake Center
Cincinnati, OH 45242
P: 513.563.3004 - F: 513.563.3011
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