Organizational journeys to CLAS, Part II: Challenges and successes for implementation

NAME:                       John Kvasniska, M.D.
TITLE:                       Medical Director, HealthEast Emergency Medical Services
ORGANIZATION:    HealthEast Care System
DATE:                        June 13, 2008
PRESENTATION TITLE:    “Organizational Journeys to CLAS, Part II, Challenges and Successes to Implementation.”
Relevance to Key Conference Themes: This topic addresses several conference themes, notably:

• CLAS Standards
• Conducting a Successful Organizational Assessment 
  

Description of the Presentation:
About HealthEast: HealthEast is the largest health care provider in the Twin Cities East Metro area. It’s primary service market is one of the most racially, culturally and linguistically diverse markets in the State of Minnesota. Comprised of four hospitals, twelve clinics, homecare and outpatient services, HealthEast has over 7,000 employees.
Overview: Prior to 2005, cultural competence was not a system-level priority at HealthEast. Since then, HealthEast has engaged in a sweeping cultural competence initiative that has made HealthEast a regional leader over the past three years. This seminar will discuss the many challenges we faced and our successes to date. Our organization’s story will be told by Dr. John Kvasniska, Medical Director of HealthEast Emergency Medical Services.
Organizational Challenges: Like many organizations, our first major challenge was to obtain executive level buy-in. Changing market and workforce realities and an examination of the business, medical and legal “cases” for cultural competence helped to gain executive support. With help from Critical Measures, a national consulting firm specializing in cross cultural health care, HealthEast conducted a CLAS-based, cultural competence organizational assessment. (CLAS Standard number 8 recommends that organizations conduct cultural competence organizational assessments.) The results revealed three key challenges. First, even though HealthEast has consistently been rated as “One of the Best Places to Work” in Minnesota by the Minneapolis/St. Paul Business Journal, its employees of color were found to be less satisfied than their white counterparts. Second, few HealthEast physicians had had any formal training in cross-cultural health care and many felt less than well prepared to care for growing numbers of immigrant LEP patients. Finally, analysis of patient satisfaction data found that patients of color and LEP patients were less satisfied with their care than white, English-speaking patients. 
Successes To Date: In the face of these findings, HealthEast has made cultural competence a top executive-level and Board priority. Over the last two and one-half years the organization has:
·        Begun collecting race, ethnicity and primary oral and written language preferences on all hospital and clinic patients and begun designing a process to connect demographic patient data to clinical outcomes. CLAS Standard 10
·        Dramatically increased the number of employed, qualified foreign language interpreters from two to sixteen, hired an interpreter scheduling coordinator and  substantially improved language access procedures in the emergency room. CLAS Standards 4-7.
·        Retained a hospital signage consultant to revamp and transition to universal symbols in all of the way-finding signage throughout each of HealthEast’s four hospitals. Signage information will appear in the four most prominent languages of our patients (Hmong, Somali, Spanish and Karin). CLAS Standards 4-7.
·        Provided diversity and cultural competence training for over 600 top executives, managers, nurses and other key employees throughout the system. CLAS Standard 3.

·        Provided cutting-edge training to HealthEast emergency room physicians on the subject of cross-cultural medicine via the use of the nationally recognized Quality Interactions e-learning program. (User satisfaction scores were outstanding.) CLAS Standard 3.

·        Developed a three-year strategic plan and budget for continuing to enhance cultural competence at HealthEast, in part through the process of establishing clinical quality and safety benchmarks that relate to cross-cultural medicine. CLAS Standard 8.