Cheri C. Wilson, MA, MHS, CPHQ

The U.S. Census Bureau projects that the United States will become a minority-majority between 2042 and 2050, meaning that today’s minorities will numerically outnumber non-Hispanic whites.  Four states (Hawaii, New Mexico, California and Texas) plus the District of Columbia are already minority-majorities.  At the same time that the country is becoming increasingly diverse, health care organizations struggle to provide culturally and linguistically appropriate services.  These issues have been brought to the forefront by the following external legislative and regulatory pressures:

·         Title VI of the Civil Rights Act of 1964;

·         2001 CLAS Standards, which are currently under review by the U.S. Department of Health and Human Services, Office of Minority Health;

·         The Joint Commission Standards on Effective Communication, Cultural Competence, and Patient-Centered Care;

·         NCQA Multicultural Health Standards Distinction Program;

·         Meaningful Use of Electronic Health Records; and

·         Provisions of the Affordable Care Act.

The Cultural Competency Organizational Assessment-360 (COA360) http://www.coa360.org was developed by Dr. Thomas LaVeist, professor and director of the Hopkins Center for Health Disparities Solutions, a research center within the Johns Hopkins Bloomberg School of Public Health (http://www.hopkinshealthdisparities.org), which has been designated a “National Center of Excellence” by the National Institutes of Health’s National Institute on Minority Health and Health Disparities.

The COA360 is a multilevel, evidence-based, web-based cultural competency tool that dynamically evaluates the readiness of a healthcare organization or clinical unit to meet the needs of a rapidly diversifying U.S. population. The COA360 is designed to assess the cultural competency of health care organizations, rather than individuals. It is a multi-dimensional tool providing a "360-degree view" of an organizational unit from the perspective of health care administrators, providers, non-provider staff and clients/patients. The measure was designed for use in hospital organizational sub-units, such as clinical departments, hospital inpatient service units, or outpatient units, and is adaptable to the unique configuration of diversity within an organization's service area (i.e. nationality, ethnicity, language, tribal affiliation or religion).  The COA360 is the only organizational cultural competency tool with a validation study published in a peer-reviewed journal[1].   The COA360 received the 2008 Innovation Award from the National Institutes of Health, National Center on Minority Health and Health Disparities. The COA360 recently underwent substantial revision, and the new version was launched at the DiversityRx Conference on Health Care for Culturally Diverse Populations in October 2010.

Your organization could benefit from a COA360 assessment to achieve the following:

·         Document adherence to CLAS standards.

·         Gain a competitive advantage with diverse patient populations.

·         Learn how to best allocate resources for language services.

·         Determine where enhanced services for culturally and linguistically diverse patients are needed.

·         Facilitate patient-provider communication.

·         Improve patient safety and health care quality with the goal of reducing health disparities for culturally and linguistically diverse patients

The Culture-Quality-Collaborative (CQC) (http://www.thecqc.org) is a network of leading health care organizations that is working in conjunction with Hopkins Center for Health Disparities Solutions faculty to share ideas, experiences, and solutions to real world problems arising from cross-cultural interactions that hinder the elimination of disparities in health care settings.  These problems include:

·         How do you determine what cultural competency means within your unique organizational context?

·         How do you introduce cultural competency to your organization?

·         How do you encourage others to think outside the box and accept new ideas? and

·         How do we create an evidence base for determining best‐practices in cultural competency? 

CQC member organizations participate in monthly webinars, attend an annual in-person conference, and have access to the members-only section of the CQC website.  The webinars provide members with the opportunity to learn, network and share experiences as we develop and deploy the various interventions.  Each webinar features an expert on cultural competency who will present on a topic about which the CQC founding members have expressed an interesting in learning.  In addition, a brief case study of a success or challenge associated with the topic is presented by one of the CQC founding members.

Prior to developing and deploying interventions, each of the CQC founding members completes the cultural COA360 for several units or departments within their respective healthcare organizations.  These assessments will establish a baseline of performance.  Following the implementation of interventions, the same units or departments will be reassessed to determine the effectiveness of the intervention.  Once the effectiveness of the interventions has been determined, the interventions will be included in an online interventions database.

Ten health care organizations currently have agreed to participate. These founding members serve as the Coordinating Council for the CQC.  The founding member organizations are:

1)    Catholic Health East (Newtown Square, Pa.);

2)    Catholic Health East – Holy Cross Hospital (Fort Lauderdale, Fla.);

3)    Catholic Health East – Mercy Philadelphia Hospital (Philadelphia);

4)    Catholic Health East – Saint Francis Hospital (Wilmington, Del.);

5)    Catholic Health East – Saint Mary Medical Center (Langhorne, Pa.);

6)    Henry Ford Health System (Detroit);

7)    The Johns Hopkins Hospital (Baltimore);

8)    Johns Hopkins Bayview Medical Center (Baltimore);

9)    Saint Elizabeth Regional Medical Center  (Lincoln, Neb.);and

10) Sinai Hospital (Baltimore). 

We are seeking to expand the CQC membership.