What makes today different

E XECUTIVE O UTLOOK

Cultivating ‘smart growth’ leaders W HAT MAKES TODAY DIFFERENT The perspectives of a CFO ?

Why is the time for healthglobal care organizations to adopt cultural competence to now outpace the economy master class

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by Michael O’Callaghan and Chris Campbell B ESSA M ISIASZEK, Scott DAVIDKingdom SHABOT, Pand ATRICIA MELFORD ByY T Peter Everaert, Indranil Roy, AND GERRY LUPACCHINO

August 2013 Health care organizations, under pressure to produce better outcomes for patients, should consider building cultural competence into their strategy. Training for staff, physicians, and administrators around diversity and inclusion can pay dividends in terms of improved medical outcomes, higher patient satisfaction, and better recruiting.

In today’s transforming health care environment—in which revenues are becoming more tied to medical outcomes and patients’ perception of quality service—why should hospitals focus on instilling cultural competence and developing a culture of inclusion?

Health care organizations have many competing priorities and demands on their limited resources, and yet there are multiple reasons—from regulation to revenue—why they should incorporate cultural competence into their business strategies and management practices. In this article, we explore the relevance of a diversity and inclusion strategy, as well as cultural competence in today’s health care environment, and the strategic advantage it gives hospitals in the recruitment of health care providers and administrators.

Drivers for cultural competence: Regulatory requirements, patient satisfaction, and payment When the Office of Minority Health created its Culturally and Linguistically Appropriate Standards in 2000, it established fourteen guidelines that have provided a framework to guide hospitals to incorporate cultural competency strategies.

There have also been regulatory drivers, including a number of states legislating for cultural competence in health care, starting with New Jersey in 2007, which made it a requirement for medical licensure. In addition, the Joint Commission, the accrediting body for hospitals, released recommendations in 2010 for hospitals regarding addressing health care disparities and cultural competency; the new patient-centered communication standards became enforceable in July 2012.

Even with such regulatory prompts, there still remains the question: What makes today different? Why does cultural competency and creating a culture of

inclusion matter more for health care providers and hospitals today versus six months ago?

With the Supreme Court’s decision in June 2012 to uphold the Patient Protection and Affordable Care Act, a new reality set in for many hospitals.

This law transitions our health care system from a transaction-based system to an outcomes-based system. The Center for Medicare/Medicaid Services (CMS), as well as other payers, are requiring more accountability for keeping patients healthy, in part by tying reimbursement to successful clinical outcomes. In addition, payment is also being directly linked to Hospital Consumer Assessment of Health Plans Surveys (HCAHPS), or patient satisfaction scores, making the patient experience a more valuable component of the hospital’s delivery of care.

In a study of 66 hospitals and 19,583 HCAHPS respondents (Weech-Maldonado et al. 2012), hospitals with greater cultural competency were found to have better HCAHPS scores for doctor communication, hospital rating, and hospital recommendation. In addition, HCAHPS scores for minorities were higher at hospitals with greater cultural competency for four dimensions, including nurse communication, staff responsiveness, quiet room, and pain control. The general conclusions of the researchers were that cultural competency not only increases patient satisfaction scores, but also improves communication between minority patients and health care providers, which in turn, can produce better clinical outcomes.

In addition, cross-cultural issues—such as language, the patient’s understanding of his/her illness, or the patient’s understanding of the treatment regimen—affect outcomes for those with chronic diseases. Applying cultural competence strategies to these issues in the clinical setting can allow for a better negotiation of treatment between the provider and patient, leading to higher HCAHPS scores.

A strategy for diversity and a culture of inclusion An organization should approach diversity in an active way, integrating the full range of human differences and similarities into the fabric of its infrastructure. Inclusion is the active process an organization undertakes to engage all employees toward success.

Today’s hospital and health care organizations comprise some of the most diverse workforces. From an occupational perspective, with roles ranging from management to clinicians, hospitals are challenged today to create a flatter 2

organization that promotes team delivery of health care services. In addition to racial and ethnic diversity, we can examine diversity from a cognitive perspective: A full spectrum of values, beliefs, educational backgrounds, and decision styles is also represented within the employee population.

By promoting a culture of inclusion for all these facets of diversity, health care organizations stand to gain a great deal in terms of the engagement of employees and becoming an employer of choice, which can also affect the patient experience. A strategy that connects a cultural competence to the mission of reducing health care disparities will enhance the patient experience and improve outcomes.

Defining and implementing cultural competence The definition of cultural competence by the Joint Commission (2013) is as follows:

Cultural competence in health care is the ability of systems to provide care to patients with diverse values, beliefs, and behaviors—including the ability to tailor delivery to meet patients’ social, cultural, and linguistic needs. It requires organizations and their personnel to do the following: value diversity; assess themselves; manage the dynamics of difference; acquire and institutionalize cultural knowledge; and adapt to diversity and the cultural contexts of individuals and communities served.

This definition extends beyond simply enhancing the patient experience by understanding cultural beliefs of patients. It also implies that systems and processes must be in place for employees to manage cultural differences among one another and understand how their differences lead to a strategic advantage in the health care market.

Cultural competence also requires health care staff and providers to have a deep understanding of common cross-cultural issues that may be present in the health care setting and management strategies to resolve them. Such concerns might include mistrust of the health care setting, roles of family in medical decision-making, impact of socioeconomic stressors on health, or simply a different health belief model from what is traditionally practiced in a hospital setting.

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A holistic approach to cultural competence Understanding the health belief systems among diverse patient populations can improve treatment compliance. And yet learning in depth about multiple cultural frameworks is a challenge: health care providers often have limited time with patients or their caregivers.

A holistic approach to cultural competence, on the other hand, allows health care professionals to understand the key elements of diversity that must be considered in the health care setting. It also gives them strategies for engaging colleagues and patients in a respectful manner. In addition, such an approach prepares health care professionals to embrace change and successfully work in dynamic teams, crucial at this moment of transition.

To provide a holistic approach to cultural competence, an organization should consider the following: •

Broad-based training that engages health care professionals and staff to embrace changes in health care and to become willing learners.

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Team-based training to help health care delivery systems that are reorganizing to meet demands of new legislation (e.g., accountable care organizations, patient-centered medical homes).

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Cultural competency training focused on providing high quality care to diverse patient populations.

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Methods to equip patients with the skills to communicate effectively with health care providers and understand impact of their active participation.

Recruitment for a twenty-first-century health care system While hospitals remain challenged to recruit talented health care providers, administrators, and staff, that challenge becomes greater when they seek a workforce that reflects the diverse population of their patients. According to the US Census Bureau (2010), racial and ethnic minorities will account for more than half the US population by 2050. Today, approximately 36 percent of the US population is comprised of underrepresented minorities, yet these populations only represent 12 percent of physicians (Association of American Medical Colleges 2006).

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Why does it matter that hospitals strive to employ a workforce that reflect its patient population? Research has found that a diverse physician workforce can improve access to care for racial and ethnic minorities; to that point, more than half of African-American graduating medical students state that they intend to practice medicine in underserved areas. In addition, there is increased patient satisfaction when patients are cared for by doctors of similar cultural background. Diverse providers also ensure a more culturally competent organization (Association of American Colleges 2013).

Today’s medical students and future health care administrators are diverse, smart, and savvy—and many will prefer to join organizations that demonstrate a culture of inclusion. Their breadth of experience in being able to serve diverse patient populations and conduct residency trips to care for patients in developing countries promotes their desire to work for culturally competent organizations that address health care disparities. The opportunity that exists today is ensuring top health care leaders are aware of the impact cultural competence can have on a patient community and engage in the opportunity to promote a culture of inclusion within the hospital.

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References Agency for Healthcare Research and Quality. 2008. “National Healthcare Quality and Disparities Report.” Retrieved from http://www.ahrq.gov/research/findings/nhqrdr/nhqrdr08/qrdr08.html#toc on April 29, 2013.

American Medical Association. 2008. AMA Physician Masterfile.

Association of American Medical Colleges. 2012. “Diversity in Medical Education: Facts and Figure 2012.” Retrieved from https://members.aamc.org/eweb/upload/Diversity%20in%20Medical%20Educ ation_Facts%20and%20Figures%202012.pdf on April 29, 2013.

Association of American Medical Colleges. 2013. “America Needs a More Diverse Physician Workforce.” Retrieved from https://www.aamc.org/download/87306/data/ on April 29, 2013.

Office of Minority Health. 2000. “National Standards on Culturally and Linguistically Appropriate Services.” Retrieved from http://minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=15 on April 29, 2013.

US Census Bureau. 2010. “Overview of Race and Hispanic Origin.” Retrieved from http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf on April 29, 2013.

Weech-Maldonado, R., M. Elliot, R. Prahan, C. Schiller, A. Hall, R.D. Hays. 2012.

“Can hospital cultural competency reduce disparities in patient experience with care?” Medical Care. 50: 48-55.

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Tessa Misiaszek, PhD, MPH is a Principal Consultant in Korn/Ferry’s Diversity, Inclusion, and Talent Optimization practice. She consults with health care organizations throughout North America, with an emphasis on cultural competency and health professions education.

David Shabot is a Senior Client Partner in Korn/Ferry’s North American Health Care Services Practice. His executive search practice focuses on health care systems, academic medicine, managed care, and health service companies.

Patricia Melford is a Managing Principal in Korn/Ferry’s Diversity, Inclusion, and Talent Optimization practice. Her specialties include strategic planning, team development, executive coaching, diversity council and resource group development and facilitation, and qualitative and quantitative assessments.

Gerard Lupacchino is a Senior Partner in Korn/Ferry’s Diversity, Inclusion, and Talent Optimization practice, where he leads the consulting and business development teams. His work focuses on talent optimization strategies, including engagement, performance management training, and coaching.

About The Korn/Ferry Institute The Korn/Ferry Institute generates forward-thinking research and viewpoints that illuminate how talent advances business strategy. Since its founding in 2008, the institute has published scores of articles, studies, and books that explore global best practices in organizational leadership and human capital development.

About Korn/Ferry International Korn/Ferry International is a premier global provider of talent management solutions, with a presence throughout the Americas, Asia Pacific, Europe, the Middle East, and Africa. The firm delivers services and solutions and resources that help that help clients cultivate greatness through the design, building and attraction of their talent.

Visit www.kornferry.com for more information on Korn/Ferry International, and www.kornferryinstitute.com for thought leadership, intellectual property and research. © 2013 The Korn/Ferry Institute

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