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

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

Agenda • Introduc?ons • Project Overview PowerPoint Presenta?on • Panel Discussion and Dialogue • Closing 2

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 organiza(ons and individuals develop the aNtudes, behaviors, and systems that are needed for effec(ve cross‐ cultural interac(ons” 3

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 4

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 5

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) 6

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. 7

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. 8

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 9

The NCHL Diversity Leadership Demonstra?on Project  Project began in 2007 with a review of the evidence‐ base for diversity management 1  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 organiza(ons, and NCHL fundraising 1 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. 10

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 limited 1 • 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 Review , 7(1), 107‐134. 1 Cur(s, E.F., & Dreachslin, J.L. (2008). Diversity management interven(ons and organiza(onal performance: A synthesis of current literature. Human Resource Development 11

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? 12

Project Design Control Hospital Interven?on Hospital  Baseline Assessment  Baseline Assessment Organiza(onal  Organiza(onal  Individual   Individual • Leaders • Leaders • Nursing Unit Staff • Nursing Unit Staff  Systema(c Interven(ons  Repeat Assessments a`er • Leadership 18 Months • Infrastructure • Nursing Unit  Repeat Assessments a`er 18 Month Interven(on Phase 13

Pre‐Post Outcomes and Assessments  Structured Interviews &  Hospital Level Outcomes Focus Groups Organiza(onal Climate Survey  Strategic Human Resources   Individual Level Outcomes Management Diversity Self‐Awareness  • Na(onal Leadership Index • Discovering Diversity Profile  Diversity Leadership Racial/Ethnic Iden(ty Status  • Diversity & Cultural Proficiency Assessment • Racial Iden(ty ANtude Scales Implicit Bias  Pa(ent Cultural Competency  • Implicit ANtude Test • Cultural Competency Assessment Tool for Hospitals (CCATH) Diversity Climate  • Mor Barak Assessment 14

Addi?onal Pre‐Post Outcomes Measures Financial & Human Resources Pa?ent  Financial performance:  Pa(ent experiences with opera(ng & total profit inpa(ent care pre‐post margins pre‐post  Hospital CAHPS  Human resource outcomes:  Pa(ent clinical outcomes pre‐post  Diversity demographics pre‐ post by level  Agency for Healthcare Quality  Employee turnover rate pre‐ & Research (AHRQ) Pa(ent post Safety Indicators  Medicare Hospital Compare Outcomes 15

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) 16

Diversity Demonstra?on Project Interven?on Flow Diagram Pre‐Assessments 3 Months • Interviews Organiza?onal Level • Focus Groups Feedback and Consulta?on • Archival Data Ac?on Plan 1 Month • Organiza(onal‐Level Instruments 1 Month • Diversity Coach o OCS • Diversity Coach • CEO & Leadership Team o NCHL Diversity Assessment • CEO & Leadership Team o Na(onal Leadership Index o CCATH o Diversity Climate Assessment • Individual‐Level Instruments o Discovering Diversity Profile o Racial Iden(ty Scales o Implicit Bias Assessments Interven?ons 18 months • Infrastructure Development Post‐Project Feedback & Planning • Human resource/talent management for Sustainable Change & Post‐Assessments systems Con?nuous Improvement 2 Months • Pa(ent care delivery 1 Month • Diversity leadership • Individual • Execu?ve Coaching & Ac?on Plans • Diversity Coach • Team • Training • CEO & Leadership Team • Organiza(onal o Standard Basic Awareness Training o Standard Advanced Training o Customized Advanced Training • Staff Individual‐Level Ac?on Plans • Other Individual Interven?ons 17