Welcome Back!

1. Welcome Back!

2. Best Practices in Cultural and Linguistic Services Juana Spears Slade, CDM, CCF Director of Diversity and Language Services, AnMed Health

3. An Illustration in CLASCultural and Linguistic Competence at AnMed Health Juana Slade, CDM, CCF Director, Diversity and Language Services The Organ Donation and Transplant Alliance October 17, 2013 St. Louis, MO

4. Discussion Objectives Meet AnMed Health Milestones in Equitable Care CLAS - PDSA Enhanced CLAS Open Dialogue

5. Mission to passionately blend the art of caring with the science of medicine to optimize the health of our patients, staff and community. Vision to be recognized and celebrated as the gold standard for healthcare quality and community health improvement.

6. South Carolina’s largest private not-for-profit health system Beds: 588 Admissions: 23,442 Patient days: 98,503 Average length of stay: 4.3 days Emergency Department visits: 107,784 Lab procedures: 2,957,026 Radiology procedures: 159,479 Surgeries and endoscopies: 14,390 Heart and vascular procedures: 7,790 Full-time employees: 3,511 Active medical staff: 414 (FY 2012)

7. Affiliated hospitals and health systems • Improves economies of scale • Resources and best practices • 2009 • Carolinas HealthCare System • Cannon Memorial Hospital • March 2013 • Elbert Memorial Hospital

8. Setting the Gold Standard AnMed Health has earned numerous awards and accreditations for quality care, including recognitions from HealthGrades, U.S. News and World Report, and Becker’s Hospital Review.

9. Milestones in Equitable Care 1964 Title VI of the Civil Rights Act 2000 Culturally and Linguistically Appropriate Service Standards (CLAS) 2002 IOM’s Unequal Treatment • Joint Commission’s Hospitals, Language, Culture: A Snapshot of the Nation 2010 Joint Commission Roadmap Monograph 2011 JC’s New and Revised Communication Standards

10. An Industry in Transition 2001 Applicable law or comprehensive vision? Language access compliance or cultural and linguistic competence? Executive authorization or executive leadership? Functional accountability or system integration?

11. In December 2000, The US Department of Health and Human Services’ Office of Minority Health (OMH) in collaboration with the Office of Civil Rights (OCR) issued the Fourteen National Standards for Culturally and Linguistically Appropriate Services (CLAS). Disparity in the delivery of health care to certain racial, ethnic and linguistic groups. Requirements and recommendations providing “guidance on how to prepare for, or respond to culturally sensitive or linguistically challenging situations.” Prior to CLAS, federal, state and local entities independently developed standards: language programs to comprehensive diversity programs.

12. Characteristics of a Culturally & Linguistically Competent Organization Demonstrates capacity to serve vulnerable patient populations Limits (reduces) liability Monitors and works to improve patient and employee satisfaction Monitors and improves patient safety Cost-effective (ROI) Documents and monitors market demographics Establishes effective communication infrastructure Integrates 14 CLAS Standards Source: USHHS/OMH

13. 2001 – 2002 Plan (Infrastructure) 2003 – 2008 Do (Implementation) 2009 – 2013 Study (Competence and Quality) 2014 Act (Audit and Monitor) A 13-year PDSA Cycle

14. Plan – Infrastructure 2002

15. Analysis Finance, policy & procedures, demography PartnersAdministration, Human Resources, Medical Staff, Risk Management, Nursing/Patient Care Services, Emergency Department, Women’s Health, Children’s Health Advisors and Champions (Internal and external) Language Services Leader EducationNew Employee Orientation“Conversation on Diversity” “Effective Use of a Medical Interpreter” “Understanding the 14 CLAS Standards”

16. Do - Implementation 2003 – 2008

17. Data ManagementStandardized policy and protocol Interpretation encounter documentation Race Ethnicity and Language Preference (REaL) collection and documentation MIDAS+ Care Management System (Productivity) LEP (Spanish, Russian, Chinese) Patient Satisfaction Language AccessDispatch and scheduling Video Remote Interpreting (American Sign Language) Interpretation Service Manager (Quality, Service Recovery, CQI) EducationInterpreter qualification Executive engagement Mission, Vision, Building Blocks (#9 Differentiology) Nursing Orientation Nursing Competencies Mandatory computer-based training Admission and registration personnel

18. Act – Cultural Competence and Quality Improvement 2009 -2013

19. LeadershipAnMed Health Differentiology Leadership Academy Health Literacy Collaborative Quality Coordinating Council QualityInternal Operations Review McKesson Horizon Enterprise Visibility (Bed Management) NursingCultural Competency Lecture Series Nursing Advisory Network MAGNET Designation Data ManagementStratified LEP Patient Satisfaction (ESP, Chinese, Russian, English) Integrated electronic interpretation documentation CLAS nursing assessment and documentation EducationIntranet Expanded diversity syllabus Physician Network Services

20. Act – Audit and Monitor 2014 Compliance Work Plan

21. Why this….why now?

22. “Addressing disparities is no longer just about morality, ethics and social justice: It is essential for performance excellence and improved community health.” Association of American Medical Colleges American College of Healthcare Executives American Hospital Association Catholic Health Association of the United States National Association of Public Hospitals and Health Systems Call to Action !

24. 14 NATIONAL STANDARDS FOR • CULTURALLY AND LINGUISTICALLY APPROPRIATE • SERVICES IN HEALTH CARE • The US Department of Health and Human Services’ Office of Minority Health (OMH) in collaboration with the Office of Civil Rights (OCR) • OMH found disparity in the delivery of health care to certain racial, ethnic and linguistic groups. • Combination of requirements and recommendations providing “guidance on how to prepare for, or respond to culturally sensitive or linguistically challenging situations.” • Prior to CLAS, federal, state and local entities independently developed standards: language programs to comprehensive diversity programs. • Released: December 2000 • ENHANCED NATIONAL CLAS STANDARDS • Principle Standard • Provide effective, equitable, and respectful quality care and • services that are responsive to diverse cultural health beliefs • and practices, preferred languages, health literacy and other • communication needs. • Health equity – the attainment of the highest level of health for all people • Unattainable due to social determinants of health or conditions in which individuals are born, grow, live, work, and age (World Health Organization, 2012) • Health inequities are directly related to historical and current discrimination and social injustices • Combined cost of health disparities and subsequent deaths due to inadequate/inequitable care = $1.24 trillion (LaVeist, Gaskin, & Richard, 2009) • Enhanced CLAS Standards – Advance health equity, improve quality, help eliminate health disparities • Released: April 2013

25. Social Determinants of Health The social determinants of health are the conditions in which people are born, grow, live, work and age, including the health system. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. Source: World Health Organization (WHO) Geography Religion or Spirituality Race and Ethnicity Race and Ethnicity PATIENT Language Biology Sociology

26. Mission to passionately blend the art of caring with the science of medicine to optimize the health of our patients, staff and community. Vision to be recognized and celebrated as the gold standard for healthcare quality and community health improvement.

28. Juana S. Slade, CDM, CCF Director, Diversity and Language Services AnMed Health 800 North Fant Street Anderson, South Carolina 29621 Telephone: 864-512-2361 Juana.slade@anmedhealth.org

29. Creating an Organizational Culture that Embraces Diversity Diane Brockmeier Chief Operating Officer Mid-America Transplant Services

30. Creating an Organizational Culture that Embraces Diversity Diane Brockmeier Chief Operating Officer Mid-America Transplant Services

31. What is an Ideal Culture? • Definition of Diversity • Age • Race • Gender • Generation • Organization is managed and organized to benefit from diversity • Diversity helps achieve Performance Excellence

32. Meet the Needs of the People We Serve • Are we reaching out or do we wait? • One call doesn’t remedy the problem • Can’t be accomplished by one individual • Must be intentional • Must be constantly measured

33. Pockets of Excellence in our Community of Practice “Cultural Competency is important as it influences our communication with patients.” Charles Modlin, MD “Who we serve has a great deal to do with how we serve them.” Tom Mone “Diversity leads to adaptability in working with families”. Nancy Kay

34. Increase Engagement in the DSA • “Become a trusted and familiar friend.” Kim Van Frank • “Work the zip codes that need us- the ones that make you uncomfortable.” Jack Lynch • “Build alliances in the community with consistency and follow-through. Honor the small stuff.” Sarah Oland

35. What Might You See if an Organization Has this Culture in Place? • Vision would reflect the community • Drives staffing decisions • Board of Directors’ membership • Establishment of diversity metrics

36. A Culture of Diversity and Inclusion “We strongly believe diversity should be embraced as a key business strategy. We view it as vital to our future growth and performance.  Our workforce should reflect the diversity of the communities in which we do business. Companies that do not strive towards that goal will be left behind; simple as that.” Mike McNally, President and CEO of Skanska USA

37. How do we get there? • Awareness • Vision • Reevaluate • Take Action • Measure

38. Focus on Raising Awareness • Build an environment of understanding and encourage reflection • Training & Education • Diversity impacts business outcomes

39. Develop a Vision • Vision of inclusion will define the change of direction

40. No More of the Same • Key management concepts and principles should be re-thought

41. Take Action • Translate the principles into measureable behaviors • Recruitment • Retention • Assimilation

42. Be the Best • Diversity is what builds teams — a collection of individual experiences, backgrounds, and cultures that can view problems and challenges from a wide-variety of lenses.

43. How Will You Know You are There? • Established track record for recruiting diverse people • Leaders hold themselves and others accountable for diversity progress • Leadership demonstrates a commitment to diversity • Rewarding people for their contributions in the area of diversity

44. Developing the Culture Takes Time • The fabric of our multicultural DSAs have developed over generations…as will the virtues of mutual respect, acceptance and inclusion

45. It’s About Saving More Lives “An individual, acting alone, can accomplish much; but a group of people acting together in a unified force can accomplish great wonders” Don Clark Executive Coach

46. Diversity vs. Multicultural – Do You Know the Difference? Will Ross, MD, MPH Associate Dean for Diversity, Associate Professor of Medicine, Renal Division Washington University School of Medicine

47. Diversity and Multiculturalism: Are They Distinct or Continuous? Will Ross, MD, MPH Associate Dean for Diversity Associate Professor of Medicine, Renal Division Washington University School of Medicine

48. Learning Objectives • Understand the dynamic nature of pluralism, diversity, and multiculturalism • Assess personal and institutional level of cultural competence • Articulate benefits of cultural diversity • Develop successful strategies to creating a diverse and cultural competent institution

49. Culture • Set of values, beliefs, attitudes, languages, symbols, rituals, behaviors, customs of a group of people • Learned and shared • Dynamic and changing

50. Cultural Diversity and Health Care • Pluralism: A situation in which people of different social classes, religions, races, etc., are together in a society but continue to have their different traditions and interests • Multiculturalism: The recognition and acknowledgement that society is pluralistic. In addition to the dominant culture, there exists many other cultures based around race, ethnicity, sexual orientation, gender, religion, class, geography.