"21st Century Medicine: A Case for  Healthcare Diversity & Cultural Competency"

Presented By

Sonja Boone, M.D.

Director of Physician Health & Healthcare Disparities

American Medical Association

Presented To:Diversity Rx Conference

Seventh National Conference on Quality Health Care for Culturally Diverse Populations

October 19th, 2010

Agenda

• Learning Objectives

• Health Disparities & Patient Populations

• What Is Diversity & Cultural Competency?

• Efforts to Eliminate Disparities: The Commission

to End Health Care Disparities

• Summary and Discussion

Learning Objectives

Learning Objectives• Explain the different meanings of diversity,

cultural competency and disparities;

• Describe the impact and scope of health care disparities;

• Detail the importance of healthcare workforce diversity; and

• Outline various provider-based tools for skill-building in cultural competency and national efforts to eliminate healthcare disparities.

US Demographics

America’s Changing Demographics

Increasingly Diverse CommunityLargest Growth in Latino Population

Source: 1980, 1990 & 2000 - US Census; 2008 – Thirdwave 2003, Claritas 200313

Population in the City of Chicago & PSA by Race/Ethnicity, 1980-2008*

0

200

400

600

800

1,000

1,200

1,400

1980 1990 2000 Forecast2008*

Po

pu

lati

on

(T

ho

usa

nd

s)White

African-American

Hispanic

Asian

Health Care Disparities

What is a healthcare disparity?

• Disparities in health care describes the gap identified in the

health outcomes of Minorities when compared with non-

Minorities; because of long-standing racial bias and unequal

care, minorities experience poorer outcomes in every health

category and often have less access to care.*

*Source: 2002 IOM Report-Unequal Treatment

Why Is It Important to Address Disparities?

• This is one of the nation’s most serious health

problems

• Disparities are costly

• By 2050, nearly 50% of Americans will be Minority

Factors That Contribute to Disparities

• Language Barriers

• Cultural Barriers

• Literacy Levels

• Provider Bias

• Unequal Treatment

• Leadership

• Demographics

• Cultural Competence

• Commitment to Diversity

• Organization

• Processes

• Culture

More Factors That Contribute to Disparities

Patient Factors That Contribute to Disparities

• Mistrust of Providers

• Socially, Negative Racial Experience Within and Outside

Healthcare

• Age Discrimination Experienced Routinely by Elderly Patients

• Real and/or Perceived Mistreatment by Providers

Provider Factors That Contribute to Disparities

• Minorities such as Latinos, African

Americans and Native Americans are

underrepresented in healthcare,

representing…

• Less than 6% of Doctors

• Less than 9% of Nurses

• Less than 30% of the Workforce

• Less than 7% of Managers

Provider Factors Continued…

• Prejudice and Bias

• Misperceptions by Providers of Patient

Stamina

• Cultural and Communication Barriers

The Role of CME

• It is the responsibility of all medical professionals to deliver care that is always of the highest caliber to all patients.

• Education of all physicians—throughout their training and through continuing medical education (CME) credits should have goals

-to increase their awareness of disparities and, -to increase skills in delivering care to diverse patients

“It is imperative that there be a simultaneous process of self-reflection (realistic and ongoing self-appraisal) and commitment to a lifelong learning process. In this way, trainees are…flexible and humble enough to say that they do not know when they truly do not know and to search for and access resources that might enhance immeasurably the care of the patient as well as their future clinical practice.”

Tervalon and Murray-Garcia

Percentage of Patients Who Felt They Were Looked Down Upon/Treated With Disrespect by Their Doctors

Source: J. Blanchard and N. Lurie, “R.E.S.P.E.C.T.: Patient Reports of Disrespect in the Health Care, Setting and It’s Impact on Care”, Journal of Family Practice. 53(Sep.2004):721

5.4

14.115.4

20.2

0

5

10

15

20

25

Caucasian AfricanAmerican

Latino AsianAmerican

%

What is Diversity?

Diversity…

• Encompasses all of the ways that human beings are

both similar and different with respect to:

• Race, gender, age, sexual orientation, religious and

cultural beliefs, living with a disability, language,

and socio-economic status & veteran status

• “Any collective mixture characterized by similarities

and differences” -AIMD

Why Is Diversity Important?

Why Is Diversity Important?• It is a business imperative that is operationalized

• It’s a community responsibility

• It’s a moral issue

• It’s a legal issue

• There is a strong business case:

• Source of patients/market share-reflecting patients served

• To address workforce shortages

• Improve capabilities—more input/perspectives into what works

• Community relations improved

What is Cultural Competency?

Cultural Competency Is…

• Delivery of care that is both sensitive to and

respectful of the patient's cultural

background and health beliefs.

Diversity/Cultural Competency link to Disparities

• To eliminate disparities, diversity initiatives for healthcare staff and education for providers must take place to foster better communication

• Organizational culture shifts towards inclusion and cultural competency usually must take place for an organization to become more diverse and culturally competent in delivering care

• Diversity & Cultural Competency must be elevated to the level of Patient Safety and Quality in hospitals

• Diversity Goals must be incorporated into the Mission & Business Goals of the Medical School

Efforts to End Healthcare Disparities

Organizations Working to Eliminate Disparities

I. Institute of Medicine, Multiple Reports

II. Joint Commission Reports

III. Commission to End Health Care

Disparities

IV. Toolkits and Products

Institute of Medicine Recommendations to Enhance Healthcare Diversity

I. Pipeline - Mission/Admission/Training

II. Accreditation Body's to Formulate and Enforce Standards

that Increase Minorities in Healthcare

III. Institutional Climate that Values Diversity

IV. Institutional Objectives should be Consistent with

Community Benefit Goal of Increasing Workforce Diversity

Commission to End Health Care Disparities

CEHCD: Disparities Addressed

• Products of the Commission Workforce & Physician Awareness Committees:

- Speaker’s Bureau Slides

- Cultural Competency/Disparities Training Workshop

- Doctors Back to School-AMA Minority Affairs Consortium Program developed in 1999, adopted by CEHCD resulting in up to 17,000 students reached in 2 years

- Position Papers

Summary

Summary

I. Disparities are rooted in the system of healthcare leading to a complex

scope of issues to be addressed (cultural, organizational, process).

-Dedicated efforts to end disparities must start with the leadership

-Dedicated Clinical Research on the topic is imperative

II. Minority patients are often in more than one protected group,

compounding possible negative encounters with the healthcare system

and providers. More research may uncover solutions to disparity in

treatment of other populations such as the elderly.

III. Discussion Points

Question and Answer

Discussion

Information/Other Sources:

• American Medical Association website: www.ama-assn.org

• Commission to End Health Care Disparities website: www.ama-assn.org/go/end disparities

• The National Healthcare Disparities Report

• http://www.ahrq.gov/qual/nhdr03/nhdrsum03.htm

• Office Of Minority Health

• http://www.cultureandhealth.org/develop/ccdevelop/ccdevelop.asp

• Closing the Gap -http://www.healthgap.omhrc.gov

"21st Century Medicine: A Case for  Healthcare Diversity & Cultural Competency"

Presented By

Sonja Boone, M.D.

Director of Physician Health & Healthcare Disparities

American Medical Association

Presented To:Diversity Rx Conference

Seventh National Conference on Quality Health Care for Culturally Diverse Populations

October 19th, 2010