Sixth National Conference on Quality Health Care for Culturally Diverse Populations: Peer-to-Peer Practice Advancement Sessions Spreading Change: Culturally Competent Care Within and Across Organizations

A-4 Organizational journeys to CLAS, Part I: Readiness to engage

Spreading Change: Culturally Competent Care Within and Across Organizations
Monday, September 22, 2008: 10:45 AM-12:15 PM, Minn Marriott, 6th Floor - St. Croix I
In the past three years of the program, LEADing Organizational Change: Advancing Quality through Culturally Responsive Care, we have used QI methods and tools to improve the delivery of culturally competent care in California safety net hospitals.  This approach grew out of the notion that if health care disparities reflect poor quality of care, perhaps rapid cycle improvement methods could be used to reduce gaps in care. Recognizing that successful improvements benefit from being spread, we undertook two related projects  to develop the knowledge from our collaborative work with California public hospital systems. The first was an in-depth study of one public hospital’s successful endeavor to transform and expand its language access services. The second was an analysis of the mechanism used to initiate and spread change within hospitals which are recognized for their best practices for culturally competent care.  An outcome of this latter effort was to develop materials to help champions make an effective organizational case for cultural competence.

In our presentation, we will briefly discuss spread theory and share findings of both projects to understand the spread of successful efforts. Discussion of the case study of the language access services will highlight the fundamental decision nodes, potential challenges to implementing change, as well as facilitators to successful implementation and internal spread. Recognizing and anticipating these issues is critical for a hospital system contemplating the necessary task of providing readily available and high quality language access services.  The workshop will also provide a high level summary of the analysis of strategies for initiating and spreading cultural competence programs across organizations. The presentation will review two complimentary pathways for achieving success with an emphasis on how they differ relative to:  the impetus for change, the process for change, roles for leadership, timeline, spread and sustainability.

Presentation Information:

Program: Peer-to-Peer Practice Advancement Sessions
Primary Category: Organizational Cultural Competence
Subtopics: Implementing the CLAS standards or other cultural competence frameworks, Organizational plans, policies, management strategies, Interpreter services—development and management, Organizational internal policies

Region Addressed by Presentation: US - California
Organization: Health Care System
Population/Demographic: hospital leadership; LEP patients
Keywords: Spreading change, Leadership, Champions


Leah Karliner, MD, MCR , Division of General Internal Medicine, Department of Medicine, University of Calfiornia San Francisco, San Francisco, CA
    Assistant Professor of Medicine
    University of Calfiornia San Francisco
    Division of General Internal Medicine, Department of Medicine
    1701 Divisadero
    Suite 500
    San Francisco CA, USA 94143-1732

    Phone: 415-885-7893
    Fax: 415-353-7932
    Email Address:

    Biographical Sketch:
    Dr. Karliner is a primary care internist and clinical investigator. Her work focuses on improving quality of care for limited English proficient (LEP) patients at critical clinical junctures. She has studied the impact of professional interpreters on clinical care, diagnosis and prognosis, communication challenges for breast cancer physicians (surgeons and oncologists), knowledge gaps for Spanish-speaking patients with a diagnosis of ductal carcinoma in situ of the breast, and women’s comprehension of their abnormal mammogram results. For the past three she has been on the faculty of the program LEADing Organizational Change: Advancing Quality through Culturally Responsive Care, and as part of this program has completed an in-depth case-study of a public hospital’s successful organizational change of its language access services.

Bruce Occena, MPH, MBA , Health Access, Oakland, CA
    VMI Coordinator
    Health Access
    414 13th Street
    Suite 450
    Oakland CA, USA 94612

    Phone: 510-506-0775
    Email Address:

    Biographical Sketch:
    Bruce Occena, MPH, MBA has worked in public health and public hospitals for decades. He has directed programs and projects in diverse areas, from substance abuse to tele-medicine. For much of the past several years, he has been a consultant for hospitals implementing system-wide changes to their interpreter services and language access programs. This work has given him hands on knowledge of system-change and spread in complex hospital systems. He is a valued resource for hospital-systems struggling with fundamental decisions about how best to meet the needs of their most vulnerable patients. His expertise ranges from the foundational requirements for change in language access, to the importance of clinical-champions to sustain and spread change, to cutting edge technological approaches, including both challenges and benefits.

Thomas Lonner, PhD , Cross-Cultural Research Program, Foundation for Health Care Quality, Bainbridge Island, WA
    Research Director
    Foundation for Health Care Quality
    Cross-Cultural Research Program
    1313 Aaron Ave, NE
    Bainbridge Island WA, USA 98110

    Phone: 206-780-0956
    Email Address:

    Biographical Sketch:
    Thomas Lonner, PhD is a medical sociologist who was most recently the research director for Cross-Cultural Research Program at Foundation for Health Care Quality. He has studied and reported extensively on various aspects of cultural competence, including: 1) a meta-evaluation of a language access initiative, 2) assessment of the effect of medical interpreters on health behaviors, health status and health care costs, 3) development of survey to assess outcomes of cultural competence training for managers and supervisors, 4) an analysis of the mechanism used to initiate and spread change within safety net hospitals that are recognized for their best practices for culturally competent care, and 5) creation of a survival guide for change agents interested in advancing cultural competence practices.