Poster Presentations (Group I)

Description
Our multi-site HIV clinical care network had concerns about the cultural competence of our program and its impact on patient care. We saw worrisome indications of disparities in outcomes among our patients. Time-consuming conventional cultural competence trainings were provided, but we had doubts that these were having an impact on health outcomes—and evaluation of the impact of training on outcomes was fuzzy at best.
Staff and leadership were interested in an approach to cultural competence improvement that was better integrated into daily work and more sustainable. We decided to use QI methods to approach improving disparities and cultural competence. QI processes emphasize a system-wide approach, use of multidisciplinary teams, steady incremental change, bottom-up problem solving, and accountability without finger-pointing. We found that most QI tools and measures addressing cultural competence were designed for hospitals and health systems, not for individual clinics and practices. Given the lack of “off the shelf” resources, we researched our own set of promising performance improvements and measures to adopt in our community health center-based project. Through our QI system we have monitored these measures quarterly along with our other quality improvement measures. 
In this session, we will review our experiences and share performance measures and improvement ideas that we have adopted in our program.  An interactive session at the end will have participants select measures and improvement ideas to try in their own work sites.

Successes

• We selected several QI performance measures that we will be tracking for the next two years to see if we are narrowing racial and ethnic gaps in care.
• CQI committee chose a cultural proficiency assessment tool that best fit the agencies in our network, and had a mixed group of providers, leaders and line staff complete them.
• Agencies chose one improvement strategy to test around cultural competence and discussed the results at quarterly QI team meetings.
• Agencies disseminated a uniform patient satisfaction survey which contained cultural competence questions that were approved by the consumer task force.
  

Challenges

• Obtaining accurate race/ethnicity data was difficult. Discovered that data was usually obtained by observation.
• Developing a training that would be useful and engaging for leaders, providers and line staff.
• Obtaining impact data to see whether we can use this mechanism to make real progress on reducing disparities.
  

Lessons Learned

• Having leadership and QI team working together is key. Leadership will be able to push cultural competence initiative through QI methods and staff will feel QI is more core to their work, not picayune, since it is taking on the big issues. This has helped boost the morale around the detail of QI work.
• Use consumer input in areas such as patient satisfaction surveys and health belief inventories.
• Integration of cultural competence work into existing quality improvement priorities and processes can be an efficient and successful way to make progress toward disparity reduction.