Project Option 1.4.4: Clinical Cultural Competence: Develop cross-cultural training program that is a required, integrated component of the training and professional development of health care providers at all levels; the curricula should increase awareness of racial and ethnic disparities in health and the importance of socio-cultural factors on health beliefs and behaviors; address the impact of race, ethnicity, culture, and class on clinical decision making; develop tools to assess the community members’ health beliefs and behaviors; develop human resource skills for cross-cultural assessment, communication, and negotiation:ENHANCE INTERPRETATION SERVICES AND CULTURALLY COMPETENT CARE

Unique Project ID: 130601104.1.2

Performing Provider Name/TPI: Providence Memorial Hospital / TPI: 130601104

Project Description:

This project will improve effective communication by designing and developing a program to improve the cultural competency of UMC staff as well as staff competency in assessment of health literacy.

This goal of this project will be to design and develop a program to improve the cultural competency of the staff as well as competency in assessment of health literacy for the improvement of effective communication. Tenet believes that effective health communication is as important to health care as clinical skill. Tenet is committed to improving individual health and building healthy communities, and Tenet wishes to support our health care providers as they recognize and address the unique culture and health literacy of our diverse patient population. When this support is provided, patients will have access to qualified health care in their primary language and will support the likelihood of safe and effective care, open communication, adherence to treatment protocols, and better health outcomes. This project will involve the implementation of organizational performance improvement and transformational activities that spread learning and awareness, thereby building patient/provider communications that are culturally competent and health-literacy aware.

Goals and Relationship to Regional Goals:

Project Goals: A major goal of the project will be the improvement of patient experience as evidenced by improvement of Nurse/Physician communication scores and overall program scores on patient assessment tools.

This project meets the following regional goals: There is consensus about the nature and importance of cultural competence as an essential component of accessible, responsive, and high quality health care. Health care services that are respectful of and responsive to the health beliefs, practices and cultural and linguistic needs of diverse patients can help bring about positive health outcomes. This project will align to the Regional goals of improvement of the management patients with chronic diseases, to help prevent unnecessary readmission and providing patients the care they need to prevent disease and to self-manage their disease process. The intent of the this project will support the Regional goals of overcoming language barriers to accessing healthcare resources in the region and increase the patient experience through delivery of high-quality, effective healthcare services.

Challenges:

Challenges facing the project include the current lack of knowledge regarding health literacy, and the assumption of culturally competency of staff due to Hispanic staff caring for Hispanic population.

5-Year Expected Outcome for Provider and Patients:

Organizational cultural competence is an important component of patient-centered care and has the potential to improve access to care, quality of care, and, ultimately, health outcomes. A patient’s own limited health literacy level, affected in part by cultural and ethnic barriers in language and understanding, can further impede communication. PMH believes it can serve as a catalyst for driving the development and maintenance of individual provider cultural competence by providing the leadership, policies, and systems to support the awareness of culturally competent care with our patients. SPEMC health professionals must provide clear, understandable, evidence based health information to the SPEMC patient population. With clear communication, Providence will expect to contribute to the patient’s understanding of their disease process, self-management concepts and what resources are available to them throughout their transitions. Through this project, the expectation is to improve the patient experience as well as to improve the patient’s understanding of their responsibility to their healthcare, thus, reducing preventable readmissions and improvement of their overall well-being.

Starting Point/Baseline:

A demographic evaluation will be made of all employees, to include, race, languages spoken, and education level. In addition, the facility will inventory all available training materials specific to cultural competency.

Rationale:

The 2010 US Census reported the United States population has become more diverse than ever before, and this trend is expected to continue over this century. In El Paso, the minority is the majority with 80.7 percent of the population being Hispanic, as compared to a 16.7 percent Hispanic population in the United States and a 37.6 percent Hispanic population in Texas. As El Paso becomes a more ethnically and racially diverse city, our health care systems and providers need recognize and address the unique culture and health literacy of a diverse patient population. Failure to understand and manage socio‐cultural differences may have significant health consequences for minority groups in particular. Systems lacking culturally and linguistically appropriate health education materials lead to patient dissatisfaction, poor comprehension and adherence, and lower‐quality care. Low health literacy creates difficulties in communicating with clinicians, poses barriers in managing chronic illness, lessens the likelihood of receiving preventive care, heightens the possibility of experiencing serious medication errors, increased risk of hospitalization, and results in poorer quality of life. Effective health communication is as important to health care as clinical skill.

Project Components:

This project will accomplish the following project components:

a)Develop cross-cultural training program that is a required, integrated component of the training and professional development of health care providers at all levels.

  • Providence will develop such a program under this project.

b)Conduct quality improvement for the project using methods such as rapid-cycle improvement. Activities may include, but are not limited to, identifying project impacts, “lessons learned,” opportunities to scale all or part of the project to a broader patient population, and key challenges associated with expansion of the project, including special considerations for safety-net populations.

  • Providence will continue to improve the program developed under this project by conducting quality improvement activities following the implementation of the program.

Unique community need identification numbers the project addresses:

  • CN-1: Primary Care
  • CN-2: Secondary and Specialty Care
  • CN-6: Other Projects

How the project represents a new initiative or significantly enhances an existing delivery system reform initiative:

Providence’s project for driving the development and maintenance of individual provider cultural competence by providing the leadership, policies, and systems to support the awareness of culturally competent care with our patients. This will be a new initiative for PMH.

Related Category 3 Outcome Measures:

OD-6: Patient Satisfaction

IT-6.1: Percent improvement over baseline of patient satisfaction scores

130601104.3.2

Reasons/rationale for selecting the outcome measures:

As this project is implemented and culturally competent care is enhanced, Providence believes that patients will receive more effective care, which will result in an improvement in patient satisfaction scores for the target population of the project. Specifically, Providence expects that the successful implementation of this project will be evidenced by an improvement in patients’ ratings of the communication skills of their health care providers.

Relationship to Other Projects:This project is part of Tenet’s larger plans to expand and develop primary care and specialty care services in the El Paso community, while improving access to care and containing the costs of care. Specifically, this project will complement Tenet’s Expand Primary Care Access project (130601104.1.1) and Enhance Interpretation Services and Culturally Competent Care project (130601104.1.2); each of these projects is intended to improve the patient experience by providing care in more effective and efficient ways.

Relationship to Other Performing Providers’ Projects and Plan for Learning Collaborative:

This project is congruent with an Enhance Interpretation Services and Culturally Competent Care project to be performed in RHP Region 15 by Sierra Providence East Medical Center (196829901.1.2).

Performing Providers, IGT entities, and the Anchor for Region 15 have held consistent monthly meetings throughout the development of the Waiver. As noted by HHSC and CMS, meeting and discussing Waiver successes and challenges facilitates open communication and collaboration among the Region 15 participants. Meetings, calls, and webinars represent a way to share ideas, experiences, and work together to solve regional healthcare delivery issues and continue to work to address Region 15’s community needs. UMC, as the Region 15 Anchor anticipates continuing to facilitate a monthly meeting, and potentially breaking into workgroup Learning Collaboratives that meet more frequently to address specific DSRIP project areas that are common to Region 15, as determined to be necessary by the Performing Providers and IGT entities. UMC will continue to maintain the Region 15 website, which has updated information from HHSC, regional projects listed by Performing Provider, contact information for each participant, and minutes, notes and slides from each meeting for those parties that were unable to attend in-person.

Region 15 participants look forward to the opportunity to gather annually with Performing Providers and IGT entities state-wide to share experiences and challenges in implementing DSRIP projects, but also recognize the importance of continuing ongoing regional interactions to effectuate change locally. Through the use of both state-wide and regional Learning Collaborative components, Region 15 is confident that it will be successful in improving the local healthcare delivery system for the low-income and indigent population.

Project Valuation

$4,617,986. In determining the value of this project, Tenet considered the extent to which providing more culturally competent care will address the community’s needs, the population which this project will serve, the resources and cost necessary to implement the project, and the project’s ability to meet the goals of the Waiver (including supporting the development of a coordinated care delivery system, improving outcomes while containing costs, and improving the healthcare infrastructure). Specifically, Tenet considered the needs of the large Hispanic population in the El Paso community, as well as the effort that will be required to develop a culturally competent care training program specific to the needs of this population and to implement it by training health care providers at Providence.

Tenet plans to implement a similar Category 1 project at its Sierra Providence East Medical Center location, serving a different geographic area of the city. The disparity in valuation between this Providence project and the similar Sierra East project is due to the fact that Providence is a much larger facility than Sierra East (with 508 beds, compared to 110 at Sierra East) and accounts for 270% more Medicaid and uninsured days than Sierra East.

130601104.1.2 / 1.4.4 / 1.4.4.X / Enhance Interpretation Services and Culturally Competent Care
Providence Memorial Hospital / 130601104
Related Category 3 Outcome Measure(s): / 130601104.3.2 / IT-6.1 / Percent improvement over baseline of patient satisfaction scores
Year 2
(10/1/2012 – 9/30/2013) / Year 3
(10/1/2013 – 9/30/2014) / Year 4
(10/1/2014 – 9/30/2015) / Year 5
(10/1/2015 – 9/30/2016)
Milestone 1:Establish baseline for metrics P-1.1, P-2.1, P-8.1, I-18.1, and I-18.2.
Metric 1: Establish baseline for future years.
Milestone 1 Estimated Incentive Payment: $1,129,396. / Milestone 2 [P-1]: Conduct an analysis to determine gaps in language access and culturally competent care.
Metric 1 [P-1.1]: Gap analysis.
Baseline/Goal: Completion of analysis.
Data Source: Gap analysis.
Milestone 2 Estimated Incentive Payment: $616,055
Milestone 3 [P-2]: Develop a program to enhance organizational, systemic, or clinical cultural competence as described in the project options.
Metric 1 [P-2.1]: Develop and implement program to improve cultural competence.
Baseline/Goal: Development and implementation of program.
Data Source: Program materials.
Milestone 3 Estimated Incentive Payment: $616,055 / Milestone 4 [P-8]: Develop program to improve staff cultural competency and awareness.
Metric 1 [P-8.1]: Increase number of champions/staff that are designated and trained in a population’s culture and unique needs.
Baseline/Goal: 75 employees.
Data Source: HR workforce training data; program materials.
Milestone 4 Estimated Incentive Payment: $617,846
Milestone 4 [I-18]: Implement intervention to increase access to language services and culturally competent care.
Metric 1 [I-18.1]: Increase percentage of target population reached.
Baseline/Goal: 10% increase.
Data Source: Documentation of target population reached, as designated in the project plan.
Metric 2 [I-18.2]: Increased scores on standardized and evidence-based cultural competence assessment tool.
Baseline/Goal: 15% increase.
Data Source: Assessment reports.
Milestone 4 Estimated Incentive Payment: $617,846 / Milestone 5 [I-18]: Implement intervention to increase access to language services and culturally competent care.
Metric 1 [I-18.1]: Increase percentage of target population reached.
Baseline/Goal: 20% increase.
Data Source: Documentation of target population reached, as designated in the project plan.
Metric 2 [I-18.2]: Increased scores on standardized and evidence-based cultural competence assessment tool.
Baseline/Goal: 25% increase.
Data Source: Assessment reports.
Milestone 5 Estimated Incentive Payment: $1,020,789
Year 2 Estimated Milestone Bundle Amount: $1,129,396 / Year 3 Estimated Milestone Bundle Amount: $1,232,110 / Year 4 Estimated Milestone Bundle Amount: $1,235,692 / Year 5 Estimated Milestone Bundle Amount: $1,020,789
TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD:$4,617,986

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