Building Cultural Competence through Sustainable Change: Findings - - PowerPoint PPT Presentation

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Building Cultural Competence through Sustainable Change: Findings - - PowerPoint PPT Presentation

Feb 15, 2023 361 likes •610 views

Building Cultural Competence through Sustainable Change: Findings from the NCHL Diversity Leadership Demonstra?on Project Judith G. Bryant, MSOD NCHL Diversity Leadership Organizational Coach Judithbryant@consultant.com Janice L. Dreachslin,

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Building Cultural Competence through Sustainable Change: Findings from the NCHL Diversity Leadership Demonstra?on Project

Judith G. Bryant, MSOD

NCHL Diversity Leadership Organizational Coach Judithbryant@consultant.com Janice L. Dreachslin, Ph.D., Principal Investigator Professor of Health Policy & Administration, Penn State University Great Valley School of Graduate Professional Studies jld13@psu.edu Rob Weech-Maldonado, Ph.D., Co-Principal Investigator Professor & L.R. Jordan Endowed Chair Department of Health Services Administration University of Alabama at Birmingham rweech@uab.edu

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Agenda

  • Introduc?ons
  • Project Overview PowerPoint

Presenta?on

  • Panel Discussion and Dialogue
  • Closing
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Defining Cultural Competency

Na?onal Quality Forum. (2008). Endorsing a Framework and Preferred Prac?ces for Measuring and Repor?ng Culturally Competent Care Quality. Washington DC: Na?onal Quality Forum.

The Na(onal Quality Forum (NQF) (2008. p3) defines cultural competency as the:

  • "ongoing capacity of healthcare systems, organiza(ons, and

professionals to provide for diverse pa(ent popula(ons high‐ quality care that is safe, pa(ent and family centered, evidence based, and equitable.” And states that Cultural competency is achieved through:

  • "policies, learning processes, and structures by which
  • rganiza(ons and individuals develop the aNtudes,

behaviors, and systems that are needed for effec(ve cross‐ cultural interac(ons”

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Need for Project

  • The Business Case
  • Social Responsibility
  • Changing Regulatory Environment
  • Changing Demographics & Social ANtudes
  • Ongoing Dispari(es
  • Career accomplishment
  • Percep(ons of equity & opportunity in the workplace
  • Process & outcome of care
  • Pa(ent percep(ons of quality
  • Best Prac(ces & Organiza(onal Performance
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Need for A Leadership‐Focused Systems Approach

  • Five year study of associa(on between race and

gender diversity and business performance (Kochan 2003)

  • Diversity won’t automa(cally translate into be[er (or worse) results
  • Diversity is a labor market impera(ve and social expecta(on or value
  • The business case for diversity is complex and nuanced
  • Impact of demographic diversity depends on the context
  • Context includes organiza(onal culture, HR prac(ces, and strategy

The BoUom Line: Unless explicit aUen?on is given to managing diversity, its impact is likely to be nega?ve

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Strategic Diversity Leadership

  • “Diversity leadership is a differen(a(on strategy that

is responsive to demographic shi`s and changing social aNtudes among both the pa(ents and the workforce.” (Dreachslin, 1999:428)

  • The diversity sensi(ve orienta(on of leaders drives

investment in diversity management and culturally & linguis(cally appropriate care (Dansky et. al., 2003)

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Diversity Leadership

Predicts CLAS Adherence

Strategic Plan

  • Strategic plan goals for diversity in two areas:
  • Recruitment and Reten(on of a Culturally Diverse Workforce
  • Provision of Culturally and Linguis(cally Appropriate Pa(ent Care

Performance Metrics

  • Rou(ne assessment of diversity goal achievement as part of strategic planning

Accountability

  • Dedicated person, office or commi[ee assigned responsibility to promote

the hospital’s cultural diversity goals Community Involvement

  • Annually report to the community about the hospital’s performance in mee(ng the cultural and

language needs of the service area.

Source: Weech‐Maldonado, R., M.N. Ellio[, C. Schiller, A. Hall, J.L. Dreachslin, and R.D. Hays. 2007a. “Organiza(onal and Market Characteris(cs Associated with Hospital’s Adherence to the CLAS Standards.” Presenta(on at the APHA Annual Mee1ng in Washington, D.C. on November 5.

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Diversity Leadership & Organiza?onal Prac?ces

Source: Weech‐Maldonado, R., M.N. EllioU, C. Schiller, A. Hall, and R.D. Hays. 2007b.

  • Adherence to the CLAS standards resulted in significant

increases in sa?sfac?on for all pa?ents, irrespec?ve of race, ethnicity or primary

  • Diversity leadership can result in across the board

improvement in pa?ent percep?ons of high quality health care.

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NCHL Leadership Development & Transforma?on System

Aligning leadership development and business strategy

The key principles for managing innova(on and performance improvement that are essen(al for systema(c and sustainable change:

  • Leadership development and organiza(onal business strategy are aligned
  • Board is accountable for leadership succession
  • Learning is competency‐based, inter‐professional, and ac(on‐oriented
  • Key talent management and strategic human resource processes are integrated and aligned
  • Leadership development dashboard tracks key measurable outcomes
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The NCHL Diversity Leadership Demonstra?on Project

  • Project began in 2007 with a review of the evidence‐

base for diversity management1

  • First study that employs pre‐post interven(on

assessment of system‐wide diversity change ini(a(ves

  • Currently involves three (3) major heath care

systems

  • 2 hospitals per system
  • Funding provided by Sodexo, par(cipa(ng
  • rganiza(ons, and NCHL fundraising

1Cur(s, E.F., & Dreachslin, J.L. (2008). Diversity management interven(ons and organiza(onal performance: A synthesis of current literature. Human Resource Development

Review, 7(1), 107‐134.

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Goals of the Research

  • Evaluate impact of a planned series of diversity

interven(ons on organiza(onal performance

  • Contribute to the literature:
  • Current published research is limited1
  • Rigor: over emphasis on case study, literature review,

self‐reported results

  • Collabora(on: necessary to balance prac(cality with

rigor to build the business case

1Cur(s, E.F., & Dreachslin, J.L. (2008). Diversity management interven(ons and organiza(onal performance: A synthesis of current literature. Human Resource Development

Review, 7(1), 107‐134.

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Research Study Ques?on

The overarching research ques?on:

What impact does a formal, phased and mul(‐faceted strategic diversity leadership interven(on have on performance metrics at the individual, group, and organiza(onal levels?

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Project Design

Control Hospital

  • Baseline Assessment
  • Organiza(onal
  • Individual
  • Leaders
  • Nursing Unit Staff
  • Repeat Assessments a`er

18 Months

Interven?on Hospital

  • Baseline Assessment
  • Organiza(onal
  • Individual
  • Leaders
  • Nursing Unit Staff
  • Systema(c Interven(ons
  • Leadership
  • Infrastructure
  • Nursing Unit
  • Repeat Assessments a`er

18 Month Interven(on Phase

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Pre‐Post Outcomes and Assessments

  • Structured Interviews &

Focus Groups

  • Individual Level Outcomes
  • Diversity Self‐Awareness
  • Discovering Diversity Profile
  • Racial/Ethnic Iden(ty Status
  • Racial Iden(ty ANtude Scales
  • Implicit Bias
  • Implicit ANtude Test
  • Hospital Level Outcomes
  • Organiza(onal Climate Survey
  • Strategic Human Resources

Management

  • Na(onal Leadership Index
  • Diversity Leadership
  • Diversity & Cultural Proficiency

Assessment

  • Pa(ent Cultural Competency
  • Cultural Competency Assessment

Tool for Hospitals (CCATH)

  • Diversity Climate
  • Mor Barak Assessment
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Addi?onal Pre‐Post Outcomes Measures

Financial & Human Resources

  • Financial performance:
  • pera(ng & total profit

margins pre‐post

  • Human resource outcomes:
  • Diversity demographics pre‐

post by level

  • Employee turnover rate pre‐

post

Pa?ent

  • Pa(ent experiences with

inpa(ent care pre‐post

  • Hospital CAHPS
  • Pa(ent clinical outcomes

pre‐post

  • Agency for Healthcare Quality

& Research (AHRQ) Pa(ent Safety Indicators

  • Medicare Hospital Compare

Outcomes

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Data Analysis

  • Quasi‐experimental study design with pre‐ and post‐

interven(on analysis

  • Analysis of Covariance (ANCOVA) with covariates
  • Dependent variables: Post‐interven(on scores
  • Covariates: Pre‐interven(on scores, hospital type

(experimental vs. control), and demographic variables of par(cipants (age, educa(on, and gender)

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Pre‐Assessments 3 Months

  • Interviews
  • Focus Groups
  • Archival Data
  • Organiza(onal‐Level Instruments
  • OCS
  • NCHL Diversity Assessment
  • Na(onal Leadership Index
  • CCATH
  • Diversity Climate Assessment
  • Individual‐Level Instruments
  • Discovering Diversity Profile
  • Racial Iden(ty Scales
  • Implicit Bias Assessments

Feedback and Consulta?on 1 Month

  • Diversity Coach
  • CEO & Leadership Team

Organiza?onal Level Ac?on Plan 1 Month

  • Diversity Coach
  • CEO & Leadership Team

Diversity Demonstra?on Project Interven?on Flow Diagram

Interven?ons 18 months

  • Infrastructure Development
  • Human resource/talent management

systems

  • Pa(ent care delivery
  • Diversity leadership
  • Execu?ve Coaching & Ac?on Plans
  • Training
  • Standard Basic Awareness Training
  • Standard Advanced Training
  • Customized Advanced Training
  • Staff Individual‐Level Ac?on Plans
  • Other Individual Interven?ons

Post‐Assessments 2 Months

  • Individual
  • Team
  • Organiza(onal

Post‐Project Feedback & Planning for Sustainable Change & Con?nuous Improvement 1 Month

  • Diversity Coach
  • CEO & Leadership Team
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Diversity Management Infrastructure: Selected Examples

  • f Evidence‐Based Best Prac?ces
  • Recruitment & Selec(on
  • Review the recruitment and selec(on process and retool as needed for cultural

sensi(vity and equity of impact

  • Job Design/Work Systems
  • Iden(fy needed changes for post‐demonstra(on project implementa(on
  • Learning & Development
  • Diversity training and coaching, resul(ng in organiza(onal and individual

diversity leadership development plans

  • Performance Management
  • Add a diversity competency to the exis(ng performance management system
  • Reward & Recogni(on
  • Link compensa(on to diversity goals
  • Implement peer‐nominated Champion of Diversity Award program‐peer with

formal evalua(on criteria/process and reward appropriate to organiza(onal culture

  • Succession Planning
  • Implement formal mentoring program that includes mentor training/

development and ‘stretch assignments’

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Culturally & Linguis?cally Appropriate Care Infrastructure: Selected Examples of Evidence‐Based Best Prac?ces Review and retool policies & prac(ces as needed:

  • Interpreter services
  • Transla(on services
  • Visita(on
  • Food services
  • Physical Plant
  • Artwork, Signage, Design, e.g. wai(ng rooms
  • Informa(on
  • Collec(on of race/ethnic and other demographic data
  • Use of race/ethnic and other demographic data
  • Pa(ent/Caregiver rela(onship
  • Concordance
  • Communica(on
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Challenge and Opportunity

  • Challenge‐ To move past

inac(on and resistance to ac(on and involvement

  • Opportunity‐ To Emerge as

the Exemplar of Diversity Leadership and Renew the Historic Values and Mission

  • f Healthcare Organiza(ons
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Rohini Anand, Ph.D., Global Chief Diversity Officer Sodexho

"This project has the poten(al of genera(ng groundbreaking research to inform execu(ve office and board room issues confron(ng healthcare today. We expect this demonstra(on project to offer insights into understand the impact of diversity and cultural competence on performance at healthcare organiza(ons, including the impact of leadership structures on cri(cal outcomes such as pa(ent safety."

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Project Advisory CommiUee

Rohini Anand, PhD Global Chief Diversity Officer Sodexho William Lee Director, Corporate Diversity, Inclusion, and Compliance Abbo[ Joseph Betancourt, MD, MPH The Dispari(es Solu(ons Center Massachuse[s General Hospital Marie Sinioris President and CEO Na(onal Center for Healthcare Leadership Linda Burnes Bolton, DrPH, RN, FAAN Vice President and Chief Nursing Officer Cedars‐Sinai Medical Center Shoshanna Sofaer, DrPH Robert P. Luciano Professor of Health Care Policy School of Public Affairs, BaruchCollege Frederick D. Hobby President and CEO Ins(tute for Diversity in Health Management Bernard J. Tyson SVP, Health Plan and Hospitals Opera(ons Kaiser Permanente

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Selected References

  • Cur(s, E.F., & Dreachslin, J.L. (2008). Diversity management interven(ons and organiza(onal performance:

A synthesis of current literature. Human Resource Development Review, 7(1), 107‐134.

  • Dansky, K., Maldonado, R.W., DeSouza G., & Dreachslin, J.L. (2003). Organiza(onal strategy and diversity

management: Diversity‐sensi(ve orienta(on as a modera(ng influence. Health Care Management Review, 28(3), 243‐253.

  • Dreachslin, J.L. (1999). Diversity and organiza(onal transforma(on: Performance indicators for health

services organiza(ons. Journal of Healthcare Management, 45(1), 427‐439.

  • Dreachslin J.L., Maldonado R.W., & Dansky K.G. (2004). Racial and ethnic diversity: A focused research

agenda for health services management. Social Science and Medicine, 59(5), 961‐971.

  • Dreachslin, J.L. & Cur(s, E.F. (2004). Factors affec(ng the career advancement of women and racially/

ethnically diverse individuals in healthcare management. Journal of Health Administra(on Educa(on, 21(4), 441‐484.

  • Dreachslin, J.L. (2007). Diversity management and cultural competence: Research, prac(ce, and the

business case. Journal of Healthcare Management, 52(2), 79‐96.

  • Dreachslin, J.L. & Hobby, F. (2008). Racial and ethnic dispari(es: Why diversity leadership ma[ers. Journal
  • f Healthcare Management, 53(1), 1‐12.
  • Kochan, T., K. Bezrukova, R. Ely, S. Jackson, A. Joshi, K. Jehn, J. Leonard, D. Levine, and D. Thomas. 2003.

“The Effects of Diversity on Business Performance: Report of the Diversity Research Network.” Human Resource Management 42 (1): 3–21.

  • Weech‐Maldonado, R., M.N. Ellio[, C. Schiller, A. Hall, J.L. Dreachslin, and R.D. Hays. 2007a.

“Organiza(onal and Market Characteris(cs Associated with Hospital’s Adherence to the CLAS Standards.” Presenta(on at the APHA Annual Mee1ng in Washington, D.C. on November 5.

  • Weech‐Maldonado, R., M.N. Ellio[, C. Schiller, A. Hall, and R.D. Hays. 2007b. “Does Hospital’s Adherence

to the CLAS Standards Predict Diverse Pa(ents’ Experiences with Inpa(ent Care?” Presenta(on at the APHA Annual Mee1ng in Washington, D.C. on November 5.