CDE Appendix 1 Literature Review - Central East Local Health ...

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The Culture, Diversity and Equity Project: Literature Review The HRSA project team moreover identified more specific indicators of cultural competence in health care delivery organizations in relation to these domains and focus areas. The indicators are classified into four types: 1) structure indicators, 2) process indicators, 3) output indicators, and 4) intermediate outcome indicators. 14 As indicators, these are designed to “directly answer the question: ‘How can cultural competence be monitored and assessed?’ by identifying the specific items on which information is to be gathered” (HSRA, 2002). A grid chart, developed by the HRSA, aligning these four kinds of indicators with the abovementioned domains and focus areas is elaborated in Appendix 1. Such performance assessment and evaluation frameworks are in line with more recent ‘diversity management’ trends in North America, which seek to embed and mainstream diversity issues and competencies within the core operations and strategic functions of organizations (as opposed to the tendency of older approaches to silo diversity within human resources departments, in the hands of specialists). Among the numerous intervention frameworks geared towards cultural competence organizational self-assessment are: • The GTA Diversity and LHIN’s Working Group’s (2008) “A Diversity Self-Assessment Tool for Local Health Integration Networks; • Olavarria et al.,’s (2005), “Organizational Cultural Competence: Self-Assessment Tools for Community Health and Social Service Organizations”; • Vancouver Ethnocultural Advisory Committee of Ministry for Children and Families (1998) “Cultural Competency Assessment Tool”; and • SHAD’s (2008) Home for All: How to make supportive housing more culturally competent and anti-oppressive. Thematically Organized Intervention Frameworks Office of Minority Health’s (2001) CLAS Standards Framework A third class of cultural competence intervention frameworks in the literature are distinguished by their organization around themes for intervention, which are designed to inform action across organisational/system domains. The Office of Minority Health’s (2001) National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Healthcare is a primary example of such a thematically organized framework for guiding health interventions. The 14 standards proposed therein are organized by three broad themes: 14 Defining indicators as “the particular observable or measurable characteristics of an organization that signify cultural competence”, the HRSA further elaborate the specific content of these four different kinds of indicators. As they explain: Structure indicators are used to assess an organization's capability to support cultural competence through adequate and appropriate settings, instrumentalities, and infrastructure, including staffing, facilities and equipment, financial resources, information systems, governance and administrative structures, and other features related to the organizational context in which services are provided. Process indicators are used to assess the content and quality of activities, procedures, methods, and interventions in the practice of culturally competent care and in support of such care. Output indicators are used to assess immediate results of culturally competent policies, procedures, and services that can lead to achieving positive outcomes. Intermediate outcome indicators are used to assess the contribution of cultural competence to the achievement of intermediate objectives relating to the provision of care, the response to care, and the results of care (2002). 46
The Culture, Diversity and Equity Project: Literature Review • Culturally Competent Care (Standards 1-3); • Language Access Services (Standards 4-7); and • Organizational Supports for Cultural Competence (Standards 8-14). The specific standards within these three themes are elaborated in Section 4.3 (see Box 4.3 for listing of CLAS standards). Standards 1-7 address interventions that have the most direct impact on clinical care while Standards 8- 14 address organizational structures, policies and processes that support the implementation of these. Joint Commission’s (2008) ‘One Size Does Not Fit All’ Framework (Hospitals, Language, Culture Study) Another good recent example of a thematically organized intervention framework is that elaborated in the Joint Commission’s (2008) recent report, One Size Does not Fit All: Meeting the Health Care Needs of Diverse Populations. The Report, authored by Wilson-Stronks et al. (2008), draws on the findings of the Hospitals, Language, and Culture (HLC) study. This study set out to better understand how the challenges associated with cultural and language (C&L) barriers are being addressed at 60 hospitals across the country, and to initiate the development of the first ever hospital accreditation standards for culturally and linguistically appropriate health care. The recommendations of the One Size Does not Fit All Report may eventually become officially adopted as (or translated into) standards that are required for hospital’s to get accreditation from the Joint Commission on Accreditation of Healthcare Organizations (see Section 5.2 for more on growing role of accreditation agencies in healthcare quality assurance of culturally competent care). The thematic framework developed in One Size Does Not Fit All is derived from current best practices that hospitals are employing to provide care and services to their diverse patient populations. This framework is presented below in Figure 2.12. 47
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