For example, a hospital with scores of 20 on leadership and strategic planning, 40 on human resource practices, and 90 on availability of interpreter services would show that it performs relatively well in terms of providing interpreter services but could improve its management practices as it pertains to strategic planning and human resource practices.
Using a tool like the CCATH, hospital administrators would be better positioned to assess their cultural competency and identify particular areas that may require particular improvement.
Organizations striving to become more culturally competent will need to engage in a change process of organizational transformation. This change process has been described as a continuum from early to later stages of development. For example, Dreachslin proposes a five-stage change model from affirmative action to valuing diversity: discovery, assessment, exploration, transformation, and revitalization. Furthermore, becoming culturally competent should be viewed as an ongoing process whereby organizations a determine cultural competency goals in the context of its strategic plan; b assess individual, group, and organizational baseline performance to determine gaps in performance; c develop interventions to close the gaps in performance; and d reassess performance to determine the effectiveness of the interventions.
For example, in designing cultural competency training, the organization should determine goals for its training in the context of its strategic plan, measure current performance against needs, design training to address the gap, implement the training, assess training effectiveness, and strive for continuous improvement Curtis et al. Finally, we should note that there is a potential business case for cultural competency.
Patients of culturally competent HCOs may exhibit higher satisfaction with their care and greater customer loyalty, as these organizations would be better placed to serve their varied needs. To the extent that cultural competency practices are associated with better patient experiences, there will be a market incentive for the implementation of such practices.
There are several limitations to the study. First, the study was limited to hospitals in California, which limits generalizability of the findings to other states.
However, given the diversity of the State of California, it presents an important barometer of what is happening in other states. Second, the survey had a relatively low response rate. However, we found that respondent hospitals did not differ from nonrespondent hospitals in terms of a large number of organizational and market variables.
Respondent hospitals were less likely to be part of a system. Some system hospitals may have not participated, thinking that a system or a coordinated response was necessary. Responses may have varied if the survey would have been administered among middle managers and staff.
Despite these limitations, we believe this study represents an important contribution to the literature on organizational assessments of cultural competency. The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Robert Weech-Maldonado, Professor and L. Janice L. Kelly L. Ron D. National Center for Biotechnology Information , U. Health Care Manage Rev. Author manuscript; available in PMC Aug Hays , PhD.
Robert Weech-Maldonado Professor and L. Author information Copyright and License information Disclaimer. Robert Weech-Maldonado: ude. Dreachslin: ude. Rubin: vog. Hays: ude. Copyright notice. The publisher's final edited version of this article is available at Health Care Manage Rev.
See other articles in PMC that cite the published article. Abstract Background The U. Findings Exploratory and confirmatory factor analyses identified 12 CCATH composites: leadership and strategic planning, data collection on inpatient population, data collection on service area, performance management systems and quality improvement, human resources practices, diversity training, community representation, availability of interpreter services, interpreter services policies, quality of interpreter services, translation of written materials, and clinical cultural competency practices.
Keywords: CLAS standards, cultural competency, diversity management. Conceptual Framework The open systems perspective views organizations interacting with their environment to secure resources, process them, and produce some type of output.
Open in a separate window. Figure 1. HCOs should develop, implement, and promote a written strategic plan that outlines clear goals, policies, operational plans, and management accountability or oversight mechanisms to provide CLAS. HCOs are encouraged to regularly make available to the public information about their progress and successful innovations in implementing the CLAS standards and to provide public notice in their communities about the availability of this information.
Integration into management systems and operations Data collection on inpatient population Data collection on service area HCOs should maintain a current demographic, cultural, and epidemiological profile of the community as well as a needs assessment to accurately plan for and implement services that respond to the cultural and linguistic characteristics of the service area. Performance management systems and QI 9.
HCOs should conduct initial and ongoing organizational self-assessments of CLAS-related activities and are encouraged to integrate cultural and linguistic competence-related measures into their internal audits, performance improvement programs, patient satisfaction assessments, and outcome-based evaluations. Workforce diversity and training Human resources practices 2. HCOs should implement strategies to recruit, retain, and promote at all levels of the organization a diverse staff and leadership that are representative of the demographic characteristics of the service area.
Diversity training 3. HCOs should ensure that staff at all levels and across all disciplines receive ongoing education and training in CLAS delivery. HCOs should ensure that conflict and grievance resolution processes are culturally and linguistically sensitive and capable of identifying, preventing, and resolving cross-cultural conflicts or complaints by patients or consumers.
Community engagement Community representation Patient—provider communication Availability of interpreter services 4. HCOs must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient or consumer with LEP at all points of contact, in a timely manner during all hours of operation. Interpreter services policies 5. HCOs must offer and provide to patients or consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services.
Quality of interpreter services 6. HCOs must assure the competence of language assistance provided to limited English proficient patients or consumers by interpreters and bilingual staff. Family and friends should not be used to provide interpretation services except on request by the patient or consumer. Translation of written materials 7. Care delivery and supporting mechanisms Clinical cultural competency practices 1. HCOs should ensure that patients or 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.
Integration Into Management Systems and Operations The integration into management systems and operations domain focuses on whether cultural competency is integrated throughout all management practices of the organization. Workforce Diversity and Training The workforce diversity and training domain pertains to providing more effective services for culturally diverse populations via proactive human resource practices and state-of-the-art cultural competency training.
Community Engagement The community engagement domain refers to active outreach as well as community inclusion and partnership in organizational decision-making. Patient—Provider Communication The patient—provider communication domain includes all communication between the patient and clinicians, as well as support staff.
Care Delivery and Supporting Mechanisms The care delivery and supporting mechanisms domain encompasses the delivery of care, the physical environment of where the care is delivered, and links to supportive services and providers CLAS Standard 1. Pilot testing of the CCATH The pilot testing had two major goals: a ensure ease of administration, understandability, and clarity and b minimize response burden. Focus groups Focus groups are a research tool that relies on group discussions to collect data on a given topic Morgan, Cognitive interviews Cognitive interviews were conducted with hospital administrators to assess the ease of administration, understandability, and clarity of the survey instrument.
Findings The exploratory and confirmatory factor analysis supported 12 CCATH composite scales subdomains : leadership and strategic planning, data collection on inpatient population, data collection on service area, performance management systems and QI, human resources practices, diversity training, community representation, availability of interpreter services, interpreter services policies, quality of interpreter services, translation of written materials, and clinical cultural competency practices OMH, Table 2 Cultural Competency Assessment Tool for Hospitals CCATH scales, number of hospitals, number of items, internal consistency reliabilities alphas , means, and standard deviations.
Discussion The national CLAS standards in health care were aimed at providing guidelines on policies and practices for culturally competent systems of care OMH, Footnotes The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.
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