Organizational journeys to CLAS, Part I: Readiness to engage

Although care givers at the bedside are frequently most aware of gaps in a hospital’s services to diverse patients, they often feel least able to affect systems change that would improve services in a meaningful way. At Barnes-Jewish Hospital in St. Louis, expertise in the implementation of some of the CLAS standards (particularly in the area of access to interpreters) wasn’t translating to a coordinated effort to achieve all the relevant standards. For many years, efforts were championed by just a few people, not embraced by senior administration and could not gain traction to pull in other key players such as physician staff from our affiliated Washington University School of Medicine or key educational institutions on our campus such as our schools of pharmacy, nursing, radiology, etc.. With a new hospital president came new energy and the creation of our Center for Diversity and Cultural Competence, a tangible commitment to doing “whatever it takes” to reduce health disparities. A strategic plan was developed that focuses leadership energy on improving all aspects of our cultural competence from staff recruitment/training/retention to minority contracting to and to the deliverly of culturally congruent bedside care. This presentation focuses on replicable actions at the bedside that mesh with our strategic plan.  It describes our training of trainers program of educators already embedded in nursing divisions and in critical departments such as Security, Housekeeping, Nutritional Services, Patient Safety, Social Work and others, a program developed in conjunction with the International Institute of St. Louis, one of our local Refugee Resettlement Agencies. It spells out crucial changes in utilization of interpreters and cross-cultural consults, new standards for documentation in the patient record and measurable expectations for clinical and service managers that are reflected in annual performance reviews.  It also addresses preparation for certification and regulatory activities such as Magnet and JCAHO.