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Table 2 Background information on the six approaches

From: How should health service organizations respond to diversity? A content analysis of six approaches

Background information on model CLAS Standards (CLAS) Joint Commission Roadmap (JCR) Cultural Responsiveness Framework (CRF) Council of Europe Recommendations (COER) Equality Delivery System (EDS) Equity Standards (EQS)
origin US dept of Health and Human Services; Office of Minority health (U.S.) The Joint Commission (U.S.) Victorian Government; Dept. of Health (Australia) Council of Europe; The committee of ministers (Europe) The National Health Services (NHS); The Equality and Diversity Council (U.K.) Health Promoting Hospitals; Task Force on Migrant-Friendly and Culturally Competent Health care (Europe)
year 2001 2010 2009 2011 2011 2013
aim *ensure equitable and effective treatment in a culturally and linguistically appropriate manner
*correct inequities
*more responsive services
*elimination of racial and ethnic health disparities
*inform, guide and facilitate culturally and linguistically appropriate care
*improve overall safety and quality of care
*integrate concepts from communication, cultural competence and patient-centered care fields into hospitals
*better links between access, equity, quality and safety
*better health outcomes for culturally and linguistically diverse (CALD) populations
*enhance cost effectiveness of service provision
*track organizations' improvement; align cultural responsiveness (CR) with existing standards; develop benchmarks
*Equitable access to health care of appropriate quality *better outcomes for patients and communities, better working environments for staff
*improve equality performance
*review equality performance
*a tool to comply to the ‘public sector Equality Duty’.
*ensure equitable and accessible health care
*reduce disparity in health care*an Equity self-assessment by health care organizations
vision *cultural and linguistic competence
*culturally and linguistically appropriate services (CLAS)
*effective communication (EC)
*cultural competence (CC)
*patient- and family-centered care (PFCC)
*cultural responsiveness (CR) *improving the adaptation of health service provision to the needs, culture and social situation of migrants *equality for patients and staff
*personal, fair and diverse services and workplaces
*promoting equity
target population *inclusive of all patients
*especially racial, ethnic, and linguistic populations that experience unequal access
*no target group, recommendations address 'issues' in health care (e.g. language, culture etc.) *Culturally and linguistically diverse populations (CALD) *migrants *protected groups *migrants and all other vulnerable groups
target organization-type *health care organizations
*policymakers, accreditation agencies, purchasers, patients, advocates, educators, health care community in general
*hospitals *all Victorian health services *governments of CoE member states *NHS commissioners and providers *health care organizations
structure *14 standards in three types: mandates (4), guidelines (9), and recommendations (1)
*three themes: culturally competent care, language access services, and organizational supports for cultural competence
*54 recommendations structured around main points along the care continuum
*aspects of the care continuum: admission; assessment; treatment; end of life care; discharge and transfer; organization readiness
*six standards across four domains, divided in measures and sub-measures (both quantitative and qualitative)
*Standards: a whole organization approach; leadership; interpreters; inclusive practice; consumer/community involvement; staff.
*Four domains: organizational effectiveness; risk management; consumer participation; effective workforce
*14 recommendations, specified in 31 sub-recommendations. *18 outcomes grouped into four goals; nine steps for implementation
*EDS goals: better health outcomes for all; improved patient access and experience; empowered, engaged, and well-supported staff; inclusive leadership at all levels
*five main standards, divided in substandards and measurable elements *main standards: equity in policy; equitable access and utilization; equitable quality of care; equity in participation; promoting equity