Translating CLAS into Practice

Standard 1. - CLAS
Health care organizations should ensure that patients/consumers receive from all staff members effective, understandable, and respectful care that is provided in a manner compatible with their cultural health beliefs and practices and preferred language.

From an organizational perspective, leadership needs to take the primary role in ensuring that all patients/consumers are treated with respect, and services are provided in accordance to their cultural health beliefs, practices, and preferred language. An organization’s leadership serves as a role model for staff to understand, implement, and practice best culturally and linguistic strategies that give results. Health care organizations should create a culture that opens lines of communication among staff and patients, and it is sensitive to the cultural and linguistic needs of the individuals served. It is important to note that cultural competence or understanding cultural competence is not only related to knowing and learning about ethnic or racial groups that migrate to North America. It is also about understanding the cultural nuances and practices of a single population, for instance in North America, Caucasians have difference cultural differences, if you live in the South even the accent varies from those living in the Northeast. In some words, cultural and linguistic competence is about respecting individuals or groups own way of communication and their practices, and approaches to life.

Respect is one of the most basic good sense practices that an individual can perform in order to interact with another person. However, cultural and linguistic competence should be a “Mirror Effect” meaning that patients also should invest time in learning about the different cultures that are found in North America such as the society, language, health care system, services, and resources such as organizations. It cannot be one direction, it is should be a “Mirror Effect” for patient’s best interest, benefit, and safety.

On the next blog, we will talk about Standard #2!

Author:
Helen Dao is a national recognized expert in implementing Quality Improvement projects and developing/facilitating trainings on cultural competency. You can follow her on Twitter @ http://twitter.com/#!/daoconsulting and @ her blog http://daoconsultingservices.blogspot.com/
www.daoconsultingservices.com

Series: Cultural Knowledge a Key Competency in Care Coordination Part III

Understanding cultural geography and the influence of sub-cultures

As care coordinators have the role and responsibility of negotiating and accessing health services for their consumers/patients, it is vital for them to know and understand that cultural geography and sub-cultures have an impact in the way people understand and utilize services. For example: In Guatemala there are many different types of Indigenous tribes/groups. Maya continues to be the strongest and more prominent indigenous group.

On an article published by Wikipedia, "Medical Anthropologists such as Richard N. Adams, Benjamin D. Paul, and Lois Paul wrote monographs dedicated to the Maya medical beliefs and practices. Richard N. Adams, albeit secondary to his work, described the chasm between Maya medical beliefs and practices and Western science, and showed why Mayans rejected projects applied by the Institute of Nutrition for Central America and Panama (INCAP). His work is seen as setting the stage for four decades for medical anthropology in Guatemala by diagnosing the communication breakdown caused by “ignorance of local beliefs and practices.” Many of those once affiliated with INCAP have since published works on various topics of interest to medical anthropology in Guatemala.

In the 20th century, several things came to undermine the indigenous way of practicing medicine. The religious groups persecution prohibited the practice of indigenous medicine and from consulting traditional healers. The Guatemalan national health care system, based heavily on Western medicine, began to suppress traditional healers by banning them from practicing. While the health care system made efforts to train local midwives, some persons accused those programs of not giving culturally appropriate, high-quality services.

The disparity between Western biomedicine and traditional care has created tensions, i.e., NGO programs primarily focus today on those with higher education levels—those who speak Spanish—and rivalries hamper communication between Western-trained health care providers and traditional practitioners. Additionally, the medical professionals of Western biomedicine neglect the social experience of the patients, as well as the social construction of disease"

The reason why we present this article is because in the USA we have many different people trying to access health care services and navigate the health care system that may have barriers due to their cultural beliefs, education, traditional beliefs, cultural values, and hundred of years legacy in practicing traditional medicine, which they bring with them to the USA.

The Guatemala example is just one of so many. Care coordinators will benefit in understanding how a single population has a vast diversity of cultures and traditions. We cannot generalize and assume that because some groups speak the same or similar language that their cultures are the same.

Please post your comments, questions, and feedback, we are always eager to learn from you!

Helen Dao, MHA

Care Coordination Series - Part I

Cultural Knowledge a Key Competency in Care Coordination Part I

We begin this series by highlighting the function of care coordination.  A care coordinator coordinates and links patients to services and resources in a cohesive and coordinated manner to achieve optimal and continues health care.

Extensive literature describes care coordination as a core component of patient-centered approach by providing coordination of care, referral and follow-up, and quality improvement driven. 

Many initiatives are in progress at the local, state, and federal level with the single goal of containing health care cost.  Patient-centered medical home and health home are some of those initiatives, no matter what we call it; it boils down to the provision of patient-centered care though care coordination. 

As many literature reviews show it, care coordination is the key to coordinate and monitor patient’s access, services, and monitoring of health care services.

One main factor that needs to be considered is the appropriate training of care coordinators; it can be one individual or the entire care team.  No matter which model is used, care coordination should emphasize cultural understanding and strategies for being more effective while working with multicultural populations.

Here are some tips:

•                Identify the population that you are or will work with?

•                Identify for sub-cultures within a single population

•                Identify potential cultural and linguistic barriers 

•                Identify health literature and literacy concerns

•                Be aware of cultural nuances

•                Understand family's dynamics within the culture context

•                Understand families cultural perception and beliefs toward specific illnesses

•                Create a framework for a care plan that meets health history, family dynamics, traditional           and non-traditional treatments, social, educational, quality of life, safety, and culture.

•                Identify and access internal and external resources

•                Use simple language when communicating medical definitions and information

There are many other elements that we can identify when framing a care coordinator competencies.  But if you follow the above framework, it will get you started on the right path.

Author

Helen E. Dao is the President and CEO at her company Dao Management Consulting Services, Inc. (www.daoconsultingservices.com) Helen has been working on cultural diversity and public health strategies development for 11 years.  You can follow her on Twitter @ http://twitter.com/#!/daoconsulting  and @ her blog http://daoconsultingservices.blogspot.com/

 

Management Principles to Reduce Cost and Increase Consumer's Satisfaction

Using management principles to reduce cost in health and social services when increasing consumer’s satisfaction.

In today’s health care system, health disparities continue to be a major concern not just for policy makers and health insurances, but also for the health care providers serving the multicultural landscape of the United States. 

One of the major challenges that organizations are facing is losing private and/or public funding.  So how do organizations continue fulfilling their mission and serving communities in need at a level that assures quality of care and/or services and reduces cost?  This is a big question; we know that many organizations are functioning on a skeleton of staff, closing programs that were vital to many communities, and trying to come up with very innovative ideas to raise new money.  The by-product of current economical stress that organizations are experiencing contributes to health disparities, the inability to serve equally due to lack of resources and funding.

How organizations position is very important; they need to stay in front of their constituents, send a message of loyalty, continuity, and existence.  There are many strategies that can be used and implemented.  At DAO, we are currently working on completing a study that will not only highlight renowned strategy models, but also strategies that organizations can create internally, such as community partnerships, maximizing human capital in order to reduce cost and maintenance, and increase consumer’s satisfaction.

In the mean time, please share with us your most successful strategies and not too successful strategies that we can use as examples (credit will be given to your organizations) so when we publish our work they can be highlighted.  You will receive a copy of our report.

Thank you!

The Power of Diversified and Inclusive Businesses

Diversity is a commitment to recognizing and appreciating the variety of characteristics that make individuals unique in an atmosphere that promotes and celebrates individual and collective achievement (The University of Tennessee Libraries Diversity Committee Spring 2001; Revised January 2003).
 

Studies show that future workforce will have significant demographic variations. Companies report competitive advantage as the key driver of diversity efforts. Diverse markets require diverse strategies; organizations must know the markets they seek to serve and reflect the same diversity within.
 

Future workforce will have huge demographic variations:

The inflow of immigrants has been largely responsible for a continuing increase in the racial and ethnic diversity of the workforce. Hispanics and Asians are the fastest-growing racial and ethnic groups in the population and workforce. In the case of Hispanics, a high birth rate is partly responsible for that, but immigration is the main driver (Census 2000). 

In 2000, about 33% of the U.S. population identified themselves as members of racial or ethnic minority groups.  By 2050, it is projected that these groups will account for almost half of the U.S. population. The U.S. Census Bureau estimated that the United States had almost 38.8 million Blacks or African Americans (12.9% of the U.S. population); more than 45.5 million Hispanics or Latinos (15.1%);  almost 13.4 million Asians (4.4%) (U.S. Census 2000).

In addition, the steadily increasing female labor force participation rates, combined with decreasing male rates, have brought the labor force close to gender balance. The rise in female rates holds for married women and single women alike. It holds as well for women with and without minor children, and, for the latter, it holds whether they are married or not and no matter how old their children are (Department of Labor, USA).

People QuickFacts (Census 2003)                                New Jersey                          USA
Population, 2006 estimate                                             8,724,560                            299,398,484
White persons, percent, 2006 (a)                                      76.4%                                80.1%
Black persons, percent, 2006 (a)                                      14.5%                                12.8%
Asian persons, percent, 2006 (a)                                        7.4%                                  4.4%
Persons of Hispanic or Latino origin, percent, 2006 (b)  15.6%                                14.8%
White persons not Hispanic, percent, 2006                      62.6%                                66.4%
Foreign born persons, percent, 2000                                17.5%                                11.1%

Why Diversity so Important 

Diversity provides a richer variety of approaches to work and problem solving.
Diversity strengthens an organization's resilience in changing environmental conditions.
Diversity allows challenges to long-accepted views.
Diversity creates dynamic work environments through variety of perspectives.
Helps organizations understand how to effectively interact with all of its client base.
Informs organizational practices that create community support in all populations.
Helps manage perceptions of historically underserved markets.
 

Asurvey conducted by SHRM and Fortune, both concluded that diversity:
Improves corporate culture by 83%
Improves employee morale by 70%
Increases creativity by 59%
Decreases interpersonal conflict by 58%

Enables movement into emerging markets by 57%
Improves productivity by 52%
Exceptional performance within groups of medical colleagues representing a wide variety of “values, experiences and disciplines.” (1956)
Mixed gender groups consistently outperformed single-gender groups. Different viewpoints caused inventive solutions to emerge. (1961)
Routine problem solving better handled by homogeneous groups, less-defined problems better suited to heterogeneous groups. (1984)
Diverse ethnic groups produced more effective solutions than homogeneous groups. (1992)
To be successful, your organizational culture must be open to diversity; otherwise this effort will fail.
Managers, supervisors and front line staff need training and education on valuing and managing diversity.
Integrating diversity into an organization’s culture is not easy; the outcomes of a diversified organization are worthwhile all the efforts.
Leadership must value and commit to a long-term vision of diversity.
 

Bottom Line
Diversity can create stronger, more productive organizations.
Innovation is a by-product of diversity.
Innovation is key to vitality in the 21st century.
 

Diversity & Inclusion Part of your Strategic Plan

Diversity and Inclusion, is not just a HR initiative. Organizations looking to become competitive, productive, and innovated must look at Diversity as a quality initiative. Diversity is the new way of business creativity and performance.

THE U.S. POPULATION IS BECOMING INCREASINGLY DIVERSE (U.S. CENSUS BUREAU, 2003). MANY MULTINATIONAL COMPANIES RECOGNIZE THE NEED TO MANAGE THEIR DIVERSE WORKFORCES AS EVIDENCED BY THE PROLIFERATION OF DIVERSITY PROGRAMS BEING IMPLEMENTED IN MULTINATIONAL CORPORATIONS (WENTLING AND PALMA-RIVAS, 2000).

The Influence of Strategic Diversity…
Recent research suggests that firms that effectively manage their workforce diversity may experience positive outcomes. For example, research indicates that firms with higher percentages of women managers report relatively higher financial performance (Shrader et al., 1997) and greater effectiveness (Richard and Johnson, 2001). Recognizing these evolving workplace trends, numerous scholars have addressed issues related to diversity in organizations (e.g., Carter, 2000; Cox, 2001).

Diversity & Inclusion Part of your Strategic Plan Synergetic Model

ORGANIZATION

Executive Management
 

Middle Management
 

Managers/Supervisors
 

Front Line Staff
 

Clients/Businesses

What is Next…
Executive support for diversity initiatives
Tactics to smooth the transition to a more diverse work culture
Provide education programs from top to bottom
Create and maintain a consistent pro-diversity message
Form a diversity council that looks at large-scale organizational issues

"You can and should shape your own future; because if you don't someone else surely will."
"No one will thank you for taking care of the present if you have neglected the future."

-Joel Barker

"Innovation provides the seeds for economic growth, and for that innovation to happen depends as much on collective difference as on aggregate ability. If people think alike then no matter how smart they are they most likely will get stuck at the same locally optimal solutions. Finding new and better solutions, innovating, requires thinking differently. That’s why diversity powers innovation. “

-Scott E. Page, Professor, University of Michigan

For more information contact Helen Dao at helen@daoconsultingservices.com

The Largest Minority Market

On a article released by SHRM (Society for Human Resources Management) in 2007, they identified people with disabilities as the largest minority group in the United States.  U.S. Census Bureau announcements released in 2007 put the number of people with disabilities at 51.2 million, or 18 percent of the population, compared with 44.3 million Hispanics who represent close to 15 percent of the population.

To read full article, click the below link:

What is the Largest Minority Market?

Benefits to Going Bilingual (Guest Blogger)

It is currently estimated that 11.5% of the United States population speaks Spanish at home, and the number of Spanish speakers will be expected to increase to about 530 million by 2050.  Interestingly, in the United States alone, the Spanish speaking population seems to be increasing at more than 1 million per year.

As a result of this rising Hispanic population, would it not be strategically beneficial for businesses to start fully recognizing the importance of hiring Spanish speaking employees?  The truth is that regardless of the size of your company, there is an increase in the need for Spanish speaking employees in the private and public sectors.  The Hispanic community is not and will never abandon their beloved Spanish language, so avoiding this expansion could be futile if you want to remain a successful team player in your industry.  Therefore, it is wise to promote diversity and cross-cultural awareness in your organization.

With respect to jobs in the public sector such as education and government, Spanish speaking employees are particularly valued.  Think about it.  If you hire Spanish speaking employees who efficiently handle customer service matters, your large Hispanic clientele will not only be impressed, but they may be more inclined to bring their business to your organization instead.  Additionally, regarding jobs in the private sector, a competitive advantage would be to hire Spanish speakers because diversity is not only here to stay, but it is a global reality and inevitable.  If you do not have Spanish speakers working for you, you should either allocate room for a few now or have some current employees learn Spanish.  That said, the following is a list of a few benefits you would gain if you take the bilingual route:

• The Spanish community will not hesitate to do business with your company if you already have Spanish employees.

• Hiring bilingual employees represents to the Spanish community that your business is able to service their needs without making them feel ignored.

• Having bilingual employees adds value and a competitive advantage by making the customers feel appreciated and understood.

Whatever path you choose, know that there are more benefits than not to going bilingual.  Hiring Spanish speaking employees in your business is an advantage. 

Wendy Oliveras is a columnist, author, search consultant, and career planning and development advisor.

She can be reached at either (201) 947-6662 or via email wo@oliverascoinc.com.  Please also visit her at http://www.twitter.com/wendyoliveras or http://www.linkedin/in/wendyoliveras or http://www.oliverascoinc.com.

Announcement!

Helen Dao will be a guest speaker at The University of Medicine
and Dentistry of New Jersey-School of Public Health (UMDNJ-SPH) presenting on "Multicultural Health in Public Health Practice"

Date: May 25, 2011
Place: UMDNJ- School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854
Time: 10:30 AM - 12:00 PM

The face of North America has changed and continues to change.  Currently, there are almost 45 million people in the nation who speak a language other than English, and over 30 million who were born outside of the United States.  During the past decade, the number of Spanish and Asian language speakers grew by 50 percent.  Community clinics and health centers are in the position of improving quality of care through the understanding of cultural competence and the implementation of Limited English Proficiency (LEP) strategies in public health practice. This seminar will discuss cultural competence in public health.

Helen will review a definition for cultural competency and its applicability to public health. This seminar will address the barriers to culturally competent care such as: Lack of diversity in health care's leadership and workforce; systems of care poorly designed to meet the needs of diverse patient populations; and poor communication between providers and patients.

For Registration On-line copy and paste the following link into your browser to register on line

https://ophp.umdnj.edu/wconnect/CourseStatus.awp?&course=PHSS041311

Or you can register by telephone. Call Carl Donaldson at (732) 235-9451. All seminars are held from 10:30 AM to 12:00 PM at UMNDJ School of Public Health, 683 Hoes Lane West, Piscataway, NJ. All seminars carry 1.5 CEU, 1.5 CHES, 1.5 Nurse Contact Hours.

Diversity & Inclusion at the Workplace

Dear Reader,

So we start our Blogging Campaign at DAO!  Here is our first short article on The Power of Diversified Businesses.

The Power of Diversified Businesses

Diversity is a commitment to recognizing and appreciating the variety of characteristics that make individuals unique in an atmosphere that promotes and celebrates individual and collective achievement (The University of Tennessee Libraries Diversity Committee Spring 2001; Revised January 2003).

Studies show that future workforce will have significant demographic variations. Companies report competitive advantage as the key driver of diversity efforts.  Diverse markets require diverse strategies; organizations must know the markets they seek to serve and reflect the same diversity within.

To read the full article visit my website at www.daoconsultingservices.com and look under "News"

This week, we will have our first guest blogger,  Wendy Oliveras, Founder & CEO of Oliveras & Company, Inc.  She is also a columnist, author, search consultant, and career planning and development advisor. Look for her article on Benefits to Going Bilingual!

We are taking a different approach at DAO

Dear Reader,

At Dao, we are getting ready to start a Theme Blog Campaign for the rest of 2011!!!

May, we will focus on Diversity & Inclusion at the Workplace (These topics will be health care, social and human services workforce related).

June, we will be providing the latest on revolution of cultural and linguistic competence trends, how changes take place, and how affect the care of minority groups in America.

July, Public Health Practice, based on true community stories.

August, Cultural Broker/Cultural Health Broker (partnering with health care providers in the behavioral change/modification of resistance to treatment).

We will have special guest writers through out the year!

Soon, we will be announcing the themes for September, November, and December!

Helen Dao