Hospital Cultural Competency as a Systematic Organizational - - PowerPoint PPT Presentation

Hospital Cultural Competency as a Systematic Organizational Intervention: Lessons Learned from the National Center for Healthcare Leadership (NCHL) Diversity Demonstration Project

Robert Weech-Maldonado Department of Health Services Administration

2

Research Team

Judith Gail, MSOD, Diversity Coach

• Health Industry & Corporate

Janice L. Dreachslin, PhD, Principal Investigator

• Professor Emerita of Health Policy &

Administration, Penn State Greater Valley Rob Weech-Maldonado, PhD, Co-Principal Investigator

• Professor, L. R. Jordan Endowed Chair in Health

Services Administration, University of Alabama at Birmingham Josue Epane, PhD, Co-Investigator

• Assistant Professor, University of Nevada, Las

Vegas

Cultural Competency/Health Systems Focus

• “Ongoing capacity of health-care systems” to provide for high quality care to

diverse patient populations (NQF, 2008).

• Cultural competency achieved through policies, learning processes, and

structures by which organizations and individuals develop the attitudes, behaviors, and systems that are needed for effective cross-cultural interactions (Betancourt et al., 2003).

• Successful implementation of cultural competency requires an organizational

commitment towards a systems approach

Study Contribution

• Weech-Maldonado et al. (2012) found a positive relationship between hospital cultural

competency (adherence to CLAS) and HCAHPS scores in California hospitals

• Few studies have examined the impact of systematic, organizational-level cultural

competency interventions on hospital performance metrics

• This demonstration project makes a contribution by:
• Using a pre-post intervention assessment to explore the impact of a systematic and multi-faceted, and
• rganizational-level cultural competency initiative on performance metrics at the organizational and

individual levels among two health systems.

Figure 1: Conceptual Framework

Systematic Diversity Intervention Individual Level Competencies:

• Diversity Self-awareness
• Implicit Biases
• Racial/ethnic identity

Organizational Outcomes:

• Diversity Climate
• Workforce Diversity

Organizational Level Competencies:

• Diversity Leadership
• Strategic Human Resource

Management

• Patient Cultural Competency

Figure 2: Diversity Demonstration Project Intervention Flow Diagram

Participating Health Systems

• East Coast USA
• Two health systems with two participating hospitals/system
• Random assignment of a control and intervention hospital in each health

system

• Matched on size, workforce, community demographics, service line
• Interventions focused on C-Suite leadership and staff from one

medical/surgical unit in the intervention hospitals

• Demographics
• Predominately white service areas
• Experiencing increases in patient religious, ethnic, and racial diversity

Major Findings

• Intervention hospitals experienced
• Improvements in the organizational-level competencies of diversity leadership and strategic human

resource management.

• Improvements were observed in the individual-level competencies for diversity attitudes and implicit

bias for Blacks

• Outperformed their respective control hospitals with respect to diversity climate.
• Intervention Hospital X had stronger performance improvement than Intervention Hospital

Y across most metrics of the study.

• Although both hospitals experienced the same intervention, contextual differences may have impacted

the implementation of the intervention.

• Qualitative analysis shows that hospital X was more successful than hospital Y in the implementation
• f their organizational action plan as part of the intervention.

9

Intervention Hospital X Intervention Hospital Y

• Influenced corporate Human Resources

to secure a diverse candidate pool prior to starting the interview process for the hospital

• Hospital continues to lead D&I initiatives

locally, with support from the system

• Hospital diversity council re-energized,

with new leadership, active participation by the hospital president and systems- level support

• Leadership team racial/ethnic diversity
• No formal consideration to diversity in

the candidate pool

• System has centralized responsibility for

all D&I initiatives

• Hospital-level diversity councils

disbanded & replaced by systems level

• Leadership team lacks racial and ethnic

diversity

Differences between Systems

Implementation Barriers

• Hospitals inundated by competing priorities delegated by their respective health systems
• Huge resistance on nursing unit floor to participate
• Percentage of respondents who completed both the pre and post-assessment ranged

from a low of 7% to a high of 24%

• Specific individual’s pre-post intervention change scores were not calculated.
• Turnover issue
• The relatively long intervention period of over two years
• A shorter more focused intervention period may have produced better outcomes but was

precluded by competing priorities in the health system.

• Maximum consideration should be paid to start-up of a project of this magnitude
• Ensure adequate support resources are committed
• Align the project with other major health systems initiatives & priorities
• Directly involve health systems leadership in the project
• If resources permit, engage entire hospital in initiative
• Maintain diversity and cultural competence initiatives as a priority

11

Recommendations from Leadership Team

Practical Implications

• Focused and systematic approach to organizational change coupled with

interventions that encourage individual growth and development may be an effective approach to building culturally competent health care organizations.

• Any sustainable strategic diversity initiative must begin with executive

leadership since organizational priorities are driven in large part through the perspective of those in leadership roles.

• A strategic diversity initiative needs to be actively aligned with other hospital

and health system initiatives for it to be effective.