www.qualityforum.org a nationally endorsed framework for measuring and reporting culturally...

www.qualityforum.org

A Nationally Endorsed Framework for Measuring and Reporting Culturally

Competent Care

Nicole W. McElveen, MPH

Senior Project Manager, Performance Measures

National Quality Forum


Overview of NQF

NQF Mission

To improve the quality of American healthcare by

• Setting national priorities and goals for performance improvement,

• Endorsing national consensus standards for measuring and publicly reporting on performance, and

• Promoting the attainment of national goals through education and outreach programs.

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Discussion Points

• Summarize NQF’s work to date on disparities and cultural competency

• Review the components of the NQF-Endorsed® framework for cultural competency

• Provide an overview of NQF’s current and future work on disparities and cultural competency

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• (2001) Identified 10 specific recommendations to engage all stakeholders in reducing disparities through measurement and reporting.

Completed Work

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• (2006) Endorsed 35 “disparity-sensitive” measures at the clinician-level of measurement

• (2009) Endorsed comprehensive framework and 45 preferred practices for measuring and reporting quality of culturally competent care


Reducing Disparities Through Culturally Competent Care

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Adapted from Brach C, Fraser I, Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model, Med Care Res Rev, 2000; 57 (suppl1): 181 – 217.


Identifying a Framework for Cultural Competent Care

• Framework, logic model, or definition needed that would move the field beyond race or ethnic-specific interventions

• Framework around cultural competency serves as a road map for organizations delivering care and assists to identify gaps on practices

• Framework intended to be comprehensive and applicable to all healthcare settings and providers of healthcare

• Frameworks Preferred Practices Performance Measures

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NQF Cultural Competency Project

• In 2009, NQF endorsed a framework and preferred practices for measuring and reporting cultural competency

• NQF also identified high-priority research and measure development needs to advance evaluation of cultural competency

• Built consensus around major questions: √ What constitutes culturally competent care?√ Who is accountable to ensure it is delivered?√ How do health systems and providers measure cultural competency? √ Can we attribute culturally competent healthcare to improved health

outcomes?

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Defining Cultural Competency

Cultural competency is the ongoing capacity of healthcare systems, organizations, and professionals to provide for diverse patient populations high quality care that is safe, family- and patient- centered, evidence-based, and equitable.

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Cultural Competency Framework - Components

• Principles are overarching and/or cross-cutting across all (or multiple) domains of the framework

• Domains are the major areas of high-quality, culturally competent care

• Sub-domains further delineate the components of each domain

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Cultural Competency Framework - Principles

• Cultural competency in healthcare embraces the concept of equity and equal access to quality care.

• Cultural competency should be viewed as an ongoing process and a multilevel approach.

• Cultural competency is necessary, but not sufficient, to achieving an equitable healthcare system.

• The successful implementation of cultural competency initiatives requires an organizational commitment with a systems approach.

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Four Guiding Principles


Cultural Competency Framework - Domains

1. Leadership2. Integration into management systems and operations3. Patient-provider communication4. Care delivery and supporting mechanisms5. Workforce diversity and training6. Community engagement7. Data collection, public accountability, and quality

improvement

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Development of Framework

• Referenced existing frameworks with principles for defining and identifying cultural competence from the IOM, Joint Commission, AHRQ and others

• Began with nine domains which included governance, care supporting mechanisms, organizational information systems

• Ranked domains for organization and implementation

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Cultural Competency –Domain 1

1. LeadershipHealthcare providers, clinical and organizational leaders, the Board of Trustees, and the community share responsibility for, and play an essential role in, developing and implementing cultural competency activities, setting policy and strategy, and monitoring organizational performance.

• Organizational culture• Commitment to serving a diverse population• Leadership diversity• Dedicated staff and resources• Policies• Training and development

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Cultural Competency – Domain 2

2. Integration into Management Systems and OperationsFocusing on whether cultural competency is integrated throughout all management and operations activities of the organization is an essential component to supporting the delivery of culturally competent care.

• Strategic planning• Service planning• Performance evaluation• Reward systems• Marketing and public relations

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3. Patient-Provider CommunicationClear communication at all levels and at all times among patients, clinicians, and support staff is essential for effective and culturally competent care.

• Language access• Interpreter services• Translation services• Health literacy strategies• Knowledge of culture and social context• Cultural awareness• Cross-cultural communication skills• Family centeredness

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4. Care Delivery and Supporting MechanismsFrom the first encounter to the last, care delivery structures and supporting mechanisms – the delivery of care, the physical environment where it is delivered, and links to supportive services and providers –should support the provision of culturally competent care.

• Clinical encounter• Physical environment• Assessment tools• Coordination of care• Linkages with alternative medicine providers• Health information technology

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5. Workforce Diversity and Training

Ensuring workforce diversity and training is a way to provide more effective services for culturally diverse populations through proactive recruitment, retention, and promotion strategies. Diversity at all levels of the organization is important. Training and development activities should include state of-the-art content in cultural competency and should reflect organizational commitment to cultural competency.

• Recruitment and retention• Training commitment and content

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Cultural Competency- Domain 6

6. Community Engagement

Active outreach and the exchange of information, as well as community inclusion and partnership in organizational decision-making, help ensure the provision of culturally competent care.

• Community outreach

• Community representation in organizational decisionmaking

• Community investments

• Community-based participatory research (CBPR)

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7. Data Collection, Public Accountability, and Quality Improvement (QI)

Organizations use these methodologies to collect the data needed to access their cultural competency, to access whether they perform routine self-assessments in this regard, and to assess whether they integrate cultural competency into their public accountability and quality improvement activities.

• Collection of patient cultural competency-related information• Collection of community cultural competency-related information• Quality improvement• Accountability• Assessment of patient experiences with care• Performance management systems• Self-assessments of cultural competency• Documentation of cultural competency practices• Documentation of cross-cultural complaints and resolutions

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Crosswalk – NQF Framework with CLAS Standards

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CLAS Standard NQF Framework DomainStandard 8 : develop and implement plan with goals, policies to promote cultural and linguistic services

Leadership

Standard 8 Integration into management systems and operations

Standard 4: offer and provide language servicesStandard 5: provide written and verbal information in patients preferred languageStandard 6: assure competence of bilingual staff and interpretersStandard 7: patient-related materials and signage in common language of service area

Patient-provider communication

Standard 1: ensure patients receive effective care compatible with their cultural beliefs

Care delivery and supporting mechanisms

Standard 2: implement strategies to recruit diverse staffStandard 3: staff receive education & training

Workforce diversity and training

Standard 11: maintain current profile of community servedStandard 12: develop partnerships with communities

Community engagement

Standard 13: conflict and grievance resolution are culturally sensitiveStandard 14: make available information about progress & successful innovations

Data collection, accountability, and quality improvement


Implementation Strategies and Measures

• Convened Expert Panel to identify implementation strategies and concepts for a survey measure related to the NQF-endorsed cultural competency framework and practices.

• Framework domains important for implementation:– Patient – provider communication

– Leadership

– Workforce diversity

– Community engagement

– Quality improvement

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NQF Planned Efforts

• Identify disparity-sensitive measures across NQF portfolio

• Promote the development of tools to measure the implementation of cultural competency practices

• Identify performance measures for measuring and reporting cross-cutting areas in cultural competency and disparities

• Address disparities for each of the NPP goals

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Comments / Questions

Nicole W. McElveen, MPH

Sr. Project Manager, Performance Measures

[email protected]

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