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

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The Culture, Diversity and Equity Project: Literature Review While requiring health equity standards and/or benchmarks of health equity performance as a condition of funding is one direct and sure means of ensuring action on health equity, making health equity a funding priority and criterion for resource allocation more generally – by designating funds to health equity/cultural competence research, capacity building, training and evaluation - is also critical to the realisation of health equity as a strategic (IHSP) LHINs priority (SHAD, 2008a; Gardner, 2008a; WHO, 2008). B. Licensing and Accreditation Though largely beyond the direct control of the LHINs, licensing and accreditation agencies within the healthcare system also have a critical role to play in assuring quality care standards and providing healthcare providers with further incentives to increase their cultural and linguistic competency and commitment to tackling healthcare inequities (Exworthy et al., 2006; Betancourt et al., 2002; Office of Minority Health, 2001). The US Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is currently developing the first-ever accreditation standards for the provision of culturally competent patient-centred care. The standards currently being developed will eventually become mandated as a condition of receiving hospital accreditation in the near future. Launched in August 2008, the 18-month standards development project builds upon the research framework of the Joint Commission’s ongoing Hospitals, Language and Culture: A Snapshot of the Nation study, which has been examining how a sample of 60 hospitals across the country are providing health care to culturally and linguistically diverse patient populations. The study’s findings have been published in reports such as the recent One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations (see Section 2.3B/III for more on the recommendations and framework of One Size Does Not Fit All). A 26-member Expert Advisory Panel has been assembled by the Joint Commission to guide this project that is reviewing available evidence-based best practices and identifying principles that can be the basis for new and revised standards. (For more information about the Joint Commission’s initiative to develop culturally competent patient-centered care standards, visit www.jointcommission.org [click on “Patient Safety,” then “Hospitals, Language and Culture”]). Quality assurance of culturally competent care in the US has also been promoted, more recently, through medical licensing boards. The passing of New Jersey Senate Bill S-144, introduced in 1999 and signed into law in 2005, is exemplary in this respect. It requires that physicians in New Jersey take cultural competency training as a condition of licensure by the State Board of Medical Examiners (see Salas-Lopez et al., 2007; also see Baquet et al., 2004). A considerable portion of the recent cultural competence literature, moreover, focuses on ways to evaluate, improve and require cultural competence components in core curricula of various educational institutions educating the next generation of doctors, nurses and healthcare workers (see Quereshi et al., 2008; Xu 2007; Shaya et al., 2006; Luquis & Perez, 2003; Chevannes 2002). C. Contracting and Procurement While it is essential that the Ministry of Health and Long Term Care embed health equity accountabilities within its own accountability agreements with the LHINs, the service accountability agreements entered into between the LHINs and health service providers (HSPs) are another critical means or ‘lever’ by which the LHINs can ensure equity considerations and strategic priorities are realized and managed in practice at the local level, in accountable ways (GTA Diversity and LHINs Working Group, 2008a; Gardner, 2008a). Requiring health equity plans, on the bases of analyses of relevant health equity issues in the local catchment area, as part of contractual agreements and obligations between the LHINs and health service providers is another essential means of embedding accountability for the furtherance of LHIN health equity strategic goals at the local level. 86
The Culture, Diversity and Equity Project: Literature Review Focusing more specifically on hospitals, Gardner outlines some of the key elements the LHINs might expect and look for in a hospital health equity plan. An effective and comprehensive hospital equity plan, he argues, would include elements such as: • A broad overall vision or commitment to reducing health disparities through their service delivery; • Demonstrating that the hospital has analyzed health status and disparities in the area in which they are located or their broader catchment area - or if they haven’t done the necessary local analysis, how they will; • Indicating how they have or will incorporate this data and analysis into program planning; • Analysing how closely hospital utilization patterns and service mixes reflect the demography and meet the needs of their catchment areas – and if they don’t, indicating critical unmet needs; • Describing what current programs, outreach and resources are targeted to addressing health disparities in their area, and what additional expanded or new services are needed; • Operationalizing a comprehensive commitment to women’s health – not simply sexual and reproductive healthcare – but ensuring all research, diagnoses and treatment take gender differences into account; • Clear standards for culturally competent care – and consumer satisfaction, evaluation and performance management mechanisms to ensure these standards are consistently achieved; • Describing how the hospital is reducing physical and other access barriers; • Human resources, recruitment, training and other diversity practices to ensure the ‘face’ of hospitals reflects their communities; • Setting out how internal organizational structures and working cultures such as governance, performance management and communications have been or will be changed to prioritize equity and diversity; • Indicating how the hospital does or will systemically collect appropriate equity and diversity- relevant data on services and patients, and build this into their monitoring and accountability processes; • Assessing how the hospital has built solid relationships with community-based service providers in their area, and developed networks and partnerships to deliver innovative services to disadvantaged populations; and • Community engagement processes and advisory forums to guide and evaluate equity plans and delivery (2008a, p.10). Community Health Centres and other service providers, Gardner adds, should also demonstrate how they plan to meet the abovementioned expectations. Health equity plans developed by hospitals and other local health service providers, moreover, would need to also explain, in clear terms, how they relate to the LHINs overall equity vision and strategic health equity goals. Granted, there would need to be sufficient flexibility in how such requirements are adapted in local organizational settings, in accord with local capacity. The LHINs could also play an important capacity building and support role by, for instance, “provid[ing] some planning, analysis and other enabling support, especially for smaller agencies” (Gardner, 2008a). For compliance cannot be mandated into existence, where there is insufficient capacity to comply with espoused equity goals objectives. Among the potential capacity building and support roles of the LHINs are: providing or supporting training initiatives; developing health equity/cultural competence ‘guidelines’, if not standards, for care; and establishing or collaborating with existing health equity researchers, teams and/or corporate research and evaluation units to assist in knowledge/data gathering and exchange processes that are critical to ensuring effective implementation and accountability (see below). The next section describes potential roles for the LHINs in providing health equity research and ‘intelligence’ to local health providers, in collaboration with researchers and the MOHLTC-based health equity research unit. 87
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Appendix 1: Health Equity Literatur
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The Culture, Diversity and Equity P
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HEALTH EQUITY LITERATURE REVIEW INT
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