A Proposed Framework for Integration of Quality Performance Measures for Health Literacy, Cultural Competence, and Language Access Services Proceedings of a Workshop (2018) / Chapter Skim
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3 Reaction Panel of Developers and Users
3 Reaction Panel of Developers and Users
Pages 17-36
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From page 17... ...
The first question asked was whether the idea of an integrated approach to measurement was useful. Brach responded, "Providing care that is health literate and culturally and linguistically competent is the hat trick of quality improvement for vulnerable populations.
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From page 18... ...
"The level of detail you need to do quality improvement work will likely not appear when you start rolling up performance measures to cover the bigger terrain," said Brach, "so as we hold organizations accountable for these measures, we may lose the spotlight on vulnerable populations, which is what we were striving to achieve in the first place." She noted that the authors recognized this issue to some extent by recommending that there be a package of measures for vulnerable populations, but to her that seems counter to the idea of integration. Brach suggested that rotating measurement sets could address the fact that integration usually produces long surveys with too many items.
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"But I would say [that] about any patient safety or quality improvement initiative, that we [should]
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Second, she wanted to address all kinds of communication barriers, which led her to establish nationwide interpreter services to provide health care systems, community health organizations, and payers with a means of helping indi viduals to understand and be compliant with their care plans. The third step was to work with organizations to engage their workforces, educate their employees about the importance of delivering culturally competent, 2 This section is based on the presentation by Yolanda Robles, founder and president of CulturaLink, and the statements are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
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"All of those components tie together to provide the best experience for your patient," said Robles. Noting how often health literacy, cultural competence, and language services exist in silos, each managed separately, Robles said that treating these as distinct issues impedes an organization's ability to promote culturally competent care and use its resources effectively.
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One way the framework can get organizations to change is by providing payers with the means to create incentives based on how organizations do on these measures. One of her clients, for example, bases payments in part on whether providers are delivering culturally and linguistically competent care.
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The first step, as he mentioned earlier, is for an organization to recognize that disparities exist and commit to actions in two domains: prioritizing equity and reporting performance data stratified by race, ethnicity, language, and socioeconomic status. The second step is to implement a quality improvement infrastructure and process, and the third step is to make equity an integral part of quality.
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From page 24... ...
Aligning financial incentives to promote equity, said Chin, will require aligning equity measures across public and private payers, as well as increasing payments to safety net providers such as by risk-adjusting performance measures or payment by patients' social risk factors. The bottom line, he said, is to have an explicit equity lens when designing payment and quality improvement programs so that they reduce disparities intentionally rather than deal with them after the fact as unintended consequences.
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Though a culture that supports equity is important, Chin said, organizational structures must also support equity. Organizational structures must have the capacity and resources to identify patients' social risk factors, report and improve on stratified performance data, support a learning health system driven by quality improvement through an equity lens, and include population health management.
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From page 26... ...
"The way we pay for medical care largely does not support efforts to achieve health equity." In his opinion, movement advocacy can break down ingrained structural barriers and policies that impede health equity (Chin, 2017) , and he suggested that the roundtable's efforts to work on structural policies and regulations that impede equity can play an important role in breaking down those barriers.
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From page 27... ...
In 2010, Northwell Health created the Office of Diversity, Inclusion, and Health Literacy, formalizing its approach to diversity, inclusion, and health literacy across the organization. In 2011 and 2012, the organization embarked on a multiyear strategic plan to conduct a baseline assessment of several of its hospitals' readiness to deliver effective, culturally competent communication in the context of patient-centered care.
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From page 28... ...
"All of these essential components must work together, much like a well-oiled machine." He supported the commissioned paper's call for an integrated framework for quality and structure measures related to patient care, education, research, and governance, calling them necessary to support Northwell Health's efforts. He noted that in 2016 the organization joined more than 1,400 hospitals in committing to the American Hospital Association's #123forEquity Campaign to Eliminate Health Care Disparities.6 This campaign aims to make progress in three areas that provide opportunities for hospitals to increase the equity of care they deliver: 1.
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From page 29... ...
"Underpinning all of this is the critical need for the integration of health care quality measures related to health literacy, language access, and cultural competence," said Wright. Creating a total health organization that emphasizes reducing the prevalence of chronic disease requires a new way of working with patients to address their health care, said Wright.
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We have to be intentional about how we are designing and applying methodologies to support a complex approach in addressing all the variables and the needs of our key stakeholders." Noting that there is a process methodology for effectively integrating change management activity streams within a project and ways to assess and measure outcomes related to good change practice, managing change effectively requires thinking about the impact of change from the stakeholders' perspectives. "Our ability to be successful and to implement and sustain the measures we are suggesting in our proposed framework is ultimately dependent upon the consideration of fundamental questions impacting the targets of our change," said Wright.
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From page 31... ...
Wright replied that, although he was not at Northwell Health in 2012 when this integration occurred, he understood that the organization relied heavily on the Core Capacity Assessment Tool, an online, survey-based tool designed to collect information from key decision makers in an organization and create prioritized recommendations for building organizational capacity, to help develop a foundation on how to move forward around health literacy, cultural competency, and language access. Rosof, who was at Northwell Health at that time, commented that leadership was the focus of activity that moved the organization forward.
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From page 32... ...
Terri Parnell from Health Literacy Partners noted that she was at Northwell Health when it launched its diversity, inclusion, and health literacy initiatives and that the organization found several documents helpful in its efforts. These included the roundtable's Ten Attributes of Health Literate Health Care Organizations (Brach et al., 2012)
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From page 33... ...
Fortunately, he added, the leadership team is deeply committed to this work and to health equity. Jennifer Dillaha from the Arkansas Department of Health commented that a challenge her state has with implementing quality improvement strategies arises from the struggle that health care providers have in getting the data needed to drive these strategies from health information technology systems.
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From page 34... ...
In that respect, the data collection and mining issue is part of a larger discussion on how to use health information technology and payment reform to drive systemwide quality improvement. Wright noted that his group is working with Northwell Health's information technology organization to determine how registration systems and electronic health records can collect these data.
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From page 35... ...
A second point he made was that cultural competency training is important but insufficient by itself to improve many clinical performance measures. Organizations need to include cultural competency training as part of their overall quality improvement and community engagement processes.
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