in organizational culture change via cultural competency · keynote speaker: j.r. martinez...

Patient Roles In Organizational Culture Change

via Cultural Competency

Bernard Roberson, MSM, BA, HSC

Administrative Director Patient- and Family- Centered Care

David Andrews

GRMC Patient Advisor

Objectives

• Understand our framework and rationale for enhancing cultural competency.

• Outline the various components of our organizational strategies to improve cultural competency.

• Describe the role of patient advisors in a long-term cultural change process.

• Apply strategies for enhanced patient experience in areas of long term cultural change

Our Mission

• Why cultural competency?

a. Accreditation

b. Quality Improvement

c. PFCC success

d. Diverse workforce

e. Point of distinction

Rationale

Why Cultural Competency?

Cultural Competency

Customer Satisfaction

Strategic Plan

SACS COC

Academic Program

Accreditation

Hospital Accreditation

Quality Healthcare

Institute of Medicine Report

(Health equity and reduce

disparities)

Agency for Healthcare Research

and Quality (AHRQ)

Patient Engagement (PFCC)

Transitioning Forward

Strategic Priority 3: Goal 3

Strategic Priority 4: Goal 3

Strategic Priority 6: all 3 goals

Joint Commission Standards

Culturally and Linguistically

Appropriate Services (CLAS)

Standards ( new standards)

AACN, AAMC, ACGME, ARC-PA, ACOTE,

AMSA, APTA, CODA, LCME, NLNAC

Core Requirement 2.12

Comprehensive Standard 3.3.2

Healthy Respect- Civility project

Patient satisfaction

Student Satisfaction (80+ countries)

Patient- and family-centered care is an approach to the

planning, delivery and evaluation of health care that is

grounded in mutually beneficial partnerships among

patients, families, and health care practitioners. It is

founded on the understanding that the family plays a vital

role in ensuring the health and well being of patients of all

ages.

Patient- and Family- Centered Care

Patient- and Family- Centered Care Linked

with Cultural Competency

D I G N I T Y and R E S P E C T

I N F O R M AT I O N S H A R I N G

PA R T I C I PAT I O N

CO L L A B O R AT I O N

Four Core Concepts

D I G N I T Y and R E S P E C T

Health care practitioners listen to and honor

patient and family perspectives and choices.

Patient and family knowledge, values, beliefs and

cultural backgrounds are incorporated into the

planning and delivery of care.

I N F O R M AT I O N

S H A R I N G

Health care practitioners communicate and

share complete and unbiased information with

patients and families in ways that are affirming

and useful.

Patients and families receive timely, complete

and accurate information in order to effectively

participate in care and decision-making.

PA R T I C I PAT I O N

Patients and families are encouraged and

supported in participating in care and decision-

making at the level they choose.

CO L L A B O R AT I O N

Patients, families, health care practitioners, and

hospital leaders collaborate in policy and

program development, implementation and

evaluation; in health care facility design; and in

professional education, as well as in the delivery

of care.

Healthy Perspectives Framework

Content Delivery

Target Groups Cultural

Competency Learning

*Employees

VINSIM

Facilitated Online Course

Students

QI

*Employees also have yearly refresher as part of annual compliance training.

• Understand our framework and rationale for enhancing cultural competency.

OBJECTIVE REVIEW

– Healthy Perspectives Trainings

– Cultural activities

– Community Partners

Current Cultural Competency Strategies

What is it Cultural Competency?

A set of practice skills, knowledge and attitudes that must encompass five elements:

1. awareness and acceptance of difference;

2. awareness of one's own cultural values;

3. understanding of the dynamics of difference;

4. development of cultural knowledge;

5. ability to adapt practice skills to fit the cultural context

of the client.

Source: Goode, T.D. and Harrison S. (2000, Summer). Cultural Competence Continuum. Policy Brief 3, 5, Washington, D.C.: National Center for Cultural

Competence-Bureau of Primary Health Care Component, Georgetown University Child Development Center..

Which is darker 1 or 2?

1. Improve self-efficacy to perform in cross cultural situations

2. Demonstrate improved communication skills when interacting with culturally diverse patients, families, and health professionals.

Healthy Perspectives Goals

Healthy Perspectives is partially funded through a grant from the Healthcare Georgia Foundation

Course Overview

Self- Awareness

Specific Cultures

Knowledge Skills, &

Attitudes

Pre- Post Changes (N=784)

Assessment Pre score Post score P value Goal

Health Belief Attitude Survey

79.8 85.2 <.0001 1

Quality Interactions

75.2 90.5 <.0001 1, 2

Clinical Cultural Competency

Sub categories

• Health disparities,

• Sociocultural issues,

• Stereotypes and Biases

<.0001

1

VINSIM (Goal 2)

25 decision points linked to CLAS standards: Mean final score 93%

Asian-Pacific American Month May

Diversity Summit 2013 Featured Speaker:

Gary Guller

Motivational Speaker

Acclaimed Mountaineer

Friday, September 12, 2014 9 a.m. - 4 p.m. The Augusta Marriot at the Convention Center

Keynote Speaker:

J.R. Martinez

• Outline the various components of our organizational strategies to improve cultural competency.

OBJECTIVE REVIEW

Roles for Patient and Family Advisors

• Task force members • Members of committees

hiring new staff • Advocates • Participants in focus groups • Program evaluators • Family Faculty • Mentors for other families • Participants in quality

improvement initiatives • Reviewers of audiovisual and

written materials • Advisory board members

• Researchers • Grant reviewers • Program staff or policy

consultants • Members of the board of

trustees • Participants at conferences

and working meetings • Co-trainers for in-service

sessions • Fundraisers

Our Definition of an Advisor?

An advisor is any role or activity that enables families to

have direct input and influences on education, policies,

programs, research, and practices affecting care and

services for patients and families.

Advisor Recruitment Process • Who to Recruit

• Persons who voiced concern but offered solution

• Persons who were eager to learn about their care process

• Provide them with Training & Support • Advisor classes

• Personal coaching

• Recruitment Responsibility • All Staff

• Other Advisors

Advisor Identified

Completes Application

Role Defined

Orientation Certificate

Becoming an Advisor?

• Patient advisors attend and hour long orientation conducted by the Department of Family Services Development.

• During this orientation topics of discussion are:

the definition of PFCC and patient advisory Confidentiality HIPAA the roles and responsibilities of the patient advisor opportunities to serve traits of a good advisor education about Georgia Regents Health System.

Orientation

There are patient advisor certificate classes offered to the patient advisor to further their education and skill sets. The classes last 2 hours and are taught twice a year. In these classes, the patient advisor will learn how to : • be a true partner to our hospital and clinics • manage the emotions involved in advising • Describe the structure of the clinic environment and

opportunities to serve in the clinic environment • develop and tell their stories as faculty • serve on a hospital committee • be an ambassador at home and nationally • interview potential employees

Patient Advisor Certificate Classes

Specific to Cultural Competency

We only use advisors threes times.

Focus Group Composition

3 Focus Groups – 2 hours

• N = 22 (9, 7, 6)

Ethnic / cultural

• African American - 5 males; 8 females

• Caucasian – 1 male; 6 females

• Native American – 1 female

• Latino – 1 female (CLAS staff)

Age 30 - 70+ years

Education High school, post-secondary (MSW); health professions (RT, PT, LPN)

Cultural Competency Focus Group

Introductions & Agenda Review

Background

Discussions

• Large group (N=22) CC defined, advisors own words

• Small group work N=(6-9) review competencies list; rank top 5

Report out small group: Knowledge, Attitudes, Skills

What’s missing? Patient advisors’ advice “My illness does not defined me.”

Patient Perspective: Cultural Competency

Cultural Competency

Beyond the facts, values Beliefs – medical, health, religious

Read the patient, body language

Practice PFCC

Show interest – nod, give attention, reply/respond

“Competent is to know, understand, and empathize.” “Our definition is emotionally rich, the literature is sanitized.”

Patient Perspective: Cultural Competency

Attitude

Humility, respect, accept similarities/differences, show concern, no stereotypes, open to Q & suggestions, “Help me help you.”

Skills Listen for pt. concerns, empathy, treat pt. as a person, respect, negotiate, teamwork, communicate (drawings/photos, body language), translate medical terms to “common language,” ask for assistance with cultural issues, use trained interpreters

Patient Advisor’s Impact

• Influenced the changed from disease model • Changed language in modules • Supported use of working with interpreters • Incorporated ‘real’ situations • Help support funding

Beyond the traditional role

• Examples – Healthy Perspectives Advisory Council

– Strategic Planning

– Policy Input

– Presentations/Dissemination

– Community Outreach -cultural events

• Outline the various components of our organizational strategies to improve cultural competency.

OBJECTIVE REVIEW

Strategies

• Always ask

• Equal partners

• No title needed

• Trust and truth

• Accommodate schedules

• Engagement- Did you learn or grow?

Traditional paradigm Current and Emerging

Deficit/Discrimination Asset/Excellence

Tolerance Open-minded and responsive

Reactive Proactive –future facing

Needs of a select few Benefit to all

Compliance Strategic enabler, improve business agility

Social injustice Social norm

Add on Required prerequisite for advancing

As we Proceed

Final thoughts

Objectives

• Understand our framework and rationale for enhancing cultural competency.

• Outline the various components of our organizational strategies to improve cultural competency.

• Describe the role of patient advisors in a long-term cultural change process.

• Apply strategies for enhanced patient experience in areas of long term cultural change

Questions

Bernard Roberson, MSM, BA, HSC

Georgia Regents Medical Center

aroberson@gru.edu

David Andrews, Patient Advisor

Georgia Regents Medical Center

dandrews324@icloud.com

Contact Information

Quiz Time

A. 10%

B. 20%

C. 25%

D. >50%

What % of new hires in the Children's Hospital of GA interview with patient

advisors?

What % of GR Health committees have patient advisors included?

A. 10%

B. 20%

C. 25%

D. >70%

A. 20-30

B. 50-60

C. 100-200

D. >200

How many patient advisors do we have at GRU?

A. Patient centered

B. Physician centered

C. Nursing centered

D. Reimbursement centered

What do all models of interprofessional team healthcare

have in common?