Skip to main content

Table 3 The approaches inserted in the analytic framework

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

DOMAINS & dimensions

      

Organizational Commitment

CLAS

JCR

CRF

COER

EDS

EQS

 Policy and leadership

*a written strategic plan to provide culturally competent care

*strategic plan is integrally tied to the organization's mission, principles, service focus

*demonstrate leadership commitment to effective communication (EC), cultural competence (CC), and patient- and family centered care (PFCC)

*integrate concepts of EC, CC, PFCC into existing policies

*implement a Cultural Responsiveness (CR)-plan addressing the standards

*integrate CR-plan into existing services’ plans and processes

*demonstrate leadership

*have an advising structure with participation of culturally and linguistically diverse (CALD) populations

*allocation of financial resources

*employ a cultural diversity staff member when CALD population > 20 %

*organization as a whole must be ‘culturally competent’

*implement the recommendations in a sustainable, coordinated and evidence based way

*leaders conduct and plan business so that equality is advanced

*managers support and motivate staff to work culturally competent

*recruit, develop and support strategic leaders to advance equality outcomes

*integrate equality objectives into mainstream business planning

*a specific plan to promote equity, integrated with existing accountability systems

*all organization plans promote equity

 Measuring and improving performance

*initial and on-going self-assessment of CLAS-related care

*integrate CLAS-related measures into regular quality improvement programs (e.g. internal audits)

*use data on individual patients for needs assessment, service planning and quality improvement

*a baseline assessment whether organization meets unique patient needs

*obligatory reporting on CR performance (on defined measures)

*perform research in outcomes (e.g. emergency presentations) for CALD patients’ care needs

*analyze quality/risk management data for CALD patients

*report on CR performance in organization's regular performance reports

*include CALD stakeholders in performance review

*evaluate existing services, identify existing problems, develop good practices

*conduct research to identify problems, determine actions and evaluate interventions

*analyze performance, agree (with stakeholders) on results, and prepare equality objectives

*continually identify and monitor access and barriers in access, and evaluate interventions for reducing access barriers (e.g. communication support services)

*use data on equity performance to improve equity in accessibility and quality

Collecting data

CLAS

JCR

CRF

COER

EDS

EQS

 Data on the population at large

*maintain a current demographic, cultural and epidemiological profile, and a needs assessment of the community

*use available population-level demographic data of surrounding community

*monitor community profile and demographics

*governments (in partnership with other relevant organizations) collect background data and epidemiological data on migrants

*assemble evidence drawing on existing information systems (incl data on population level)

*collect or have access to data on health status and health inequalities of catchment area

 Data on the patient population

*collect data on individual patient's race, ethnicity, spoken/written language in health record *integrate CLAS-related measures into patient satisfaction assessments

*develop a system to collect patient-level data

*collect data on patient race and ethnicity in medical record

*collect data on patient's language and additional patient-level information (e.g. cultural, religious)

*Collect feedback from patients, families

*develop appropriate information strategies for data collection, reporting and sharing

*collect CALD patient satisfaction data

 

*assemble evidence including surveys of patient experiences

*organization's systems can measure equity performance

*identify patients' needs according to characteristics (health records include information on demographic characteristics e.g. language, health literacy level, ethnicity)

Staff/workforce

CLAS

JCR

CRF

COER

EDS

EQS

 Staff competencies

*all staff receive on-going education in providing CLAS

*new and existing training addresses issues of EC, CC, PFCC

*provide staff at all levels with opportunities to enhance their CR

*train staff

*CR references included in HRM policies and practices (e.g. position description)

*communication systems for sharing information on CR

*care professionals at various levels should be trained in accessibility issues and in cultural competence

*enable staff to be confident and provide appropriate care with support by training, personal development and performance appraisal

*all staff is aware and competent to address inequities due to education

*specific training on equity issues

*include equity issues in organization's core education

 Diversity in workforce

*strategies to recruit, retain and promote diverse staff, representative of demographic characteristics of service area *diverse staff at all levels, including diverse leadership

*recruitment efforts to increase a diverse workforce that reflects the patient population

*diverse workforce can increase ethnic and language concordance, which may improve communication

 

*recruitment policies should ensure that the diversity of general population is reflected in the workforce (mentioned as an example)

*fair selection processes to increase diversity of all workforce

*equality in levels of pay

*staff can work in a safe environment (e.g. free from abuse, harassment etc.)

*flexible working options

*fair and equitable workforce policies and practices

*promote respect for dignity of all staff and volunteers

Ensuring access

CLAS

JCR

CRF

COER

EDS

EQS

 Entitlement to care

   

*legislation concerning entitlement is properly implemented

*professionals at all levels are aware of eligibility rights

 

*monitor situations of people that are ineligible for care

*ensure health care to people ineligible for services by providing appropriate support

‘Understandable' information

*patient related materials and post signage essential for access should be made easily understood

*offer and provide language assistance services to all patients with LEP, at all contacts, in a timely manner during all hours of operation

  

*programs for migrants should include knowledge on health and illness, the way the health system works, and entitlements to health services

*promote interpretation and translated materials to improve accessibility

 

*in communicating with people and providing information on access issues, health literacy and language needs are taken into account

 Geographical accessibility

   

*inconvenient locations should be reduced as far as possible

 

*minimize architectural, environmental and geographical barriers to facilities

Other aspects of accessibility

   

*remove accessibility barriers and reduce practical difficulties (e.g. inconvenient opening times)

*patients, carers and communities can readily access services

*public health, vaccination and screening programs benefit all local communities/groups

*ensure access to care for disadvantaged people

*provide outreach information to disadvantaged people on outreach services

Care provision

CLAS

JCR

CRF

COER

EDS

EQS

 Care responsive to needs and wishes

*patients receive effective (positive outcomes), understandable and respectful (patients values taken into account) care

*care should be compatible with cultural health beliefs and practices, and preferred languages

Throughout the care continuum:

*ask for additional needs (e.g. cultural, religious)

*communicate information about unique patient needs to relevant providers

*start patient-provider interaction with an introduction

*identify and accommodate cultural, religious, spiritual beliefs/practices that influence care

*incorporate EC, CC, PFCC concepts into care delivery

*inclusive practice in care planning (including dietary, spiritual and other cultural practices)

*implementation and revision of policies for provision of appropriate meals

*use feedback/evaluation from patients to improve CR

*develop and use suitable instruments for assessment (e.g. clinical diagnosis) which incorporate cultural considerations

*improve relevance and appropriateness of health services

*offering the same services to everybody may result in users receiving lower quality of care

*services should be culturally competent (matched to needs of migrants from diverse backgrounds)

*culturally competent care goes beyond cultural factors, e.g. social position, history, legal situation should also be taken into account

*adapt existing diagnostic and therapeutic procedures or invent new ones if necessary

*assess individual patients' health needs and provide appropriate and effective services

*discuss changes across services with patients and make transitions smoothly

*strive for positive treatment experiences: being listened to, being respected, privacy and dignity are prioritized

*In needs assessments, delivery of care and at discharge, patients’ individual, family characteristics, experiences and living conditions are taken into account (incl. psychosocial needs)

*workforce is able to take into account individual patients' ideas and experiences of health and illness in clinical practice and at discharge

*care is considerate and respectful of patients' dignity, personal values, knowledge and beliefs regarding health care

Patient participation in the care process

 

*Involve patients, families, support persons in the care process along the care continuum.

*inclusive practice in care planning (including dietary, spiritual and other cultural practices)

*promote participation of migrants in all activities concerning the provision of health services, including decision making processes

*involve patients as they wish during the care continuum

 

Overcoming communication barriers in patient-provider contact

*offer and provide language assistance services (including bilingual staff, interpreter services) at no costs to all patients with LEP, at all contacts, in a timely manner during all hours of operation

*inform patients of their right to receive language assistance

*assure competence of language assistance by interpreters and bilingual staff

*identify patient's preferred language or other communication needs during admission

*identify and monitor patient communication needs/status during care continuum, document this in patient record

*ensure competence of language assistance

*develop a system to provide language services

*inform patients of their rights for an interpreter

*implement language services policy

*policies include directions about role of interpreters and family

*provide accredited interpreters to patients who need one

*match employment of in-house interpreters to community demographics

*evaluate interpreter services

*high quality interpreting should be promoted

*consider all available methods to reduce language barriers

 

*have a policy on overcoming language barriers

*make professional interpreting services available and promote it

*accommodate communication needs of patients with e.g. hearing, speech impairments

*monitor quality of interpreting services/communication support

*ensure staff ability to work with interpreter/communication support staff

‘Understandable’ patient information materials

*provide easily understood patient related materials (applications, consent forms) and post signage in diverse languages incl. directions to facility services (diverse language: languages of commonly encountered groups/groups represented in the service area)

*take into account culture and health literacy levels

*persons from small language groups have the right to oral translation

*provide patient education materials and instructions that meet patients' needs (health literacy, language) during assessment, treatment and discharge

*support patient’s ability to understand/act on health information

*determine needs for assistance with admission forms (health literacy)

*have appropriate translations of signage, patient forms, education materials for predominant language groups using services

*promote high quality translated written information

 

*provide easily understood written material and signage taking health literacy and language needs into account

Trust

Conflict & grievance

*conflict/grievance procedures are culturally sensitive

*conflict/grievance procedures can identify, prevent, resolve cross-cultural conflicts/complaints

*staff handling complaints should receive cultural competence training

*monitor culturally or linguistically related complaints Atmosphere

*create a welcoming and inclusive environment

Conflict & grievance

*accessible complaints system (language, non-writing)

*complaints are not being subjected to coercion, discrimination, reprisal, or unreasonable interruption of care Atmosphere

*create an environment that is inclusive of all patients

*patient has the right to be free of neglect, exploitation and abuse (regular JC standards, chapter: Rights and Responsibilities of the Individual)

Conflict & grievance

*monitor number of complaints lodged by CALD consumers/patients.

 

Conflict & grievance

*complaints should be handled respectfully and efficiently Atmosphere

*create a safe environment, without threat of dignity of denial of individual identity

Atmosphere

*create a safe environment, with respect for patient's dignity and identity

*create an environment inclusive for all patients

Patients’ rights

*provide notices in diverse language of a variety of patients’ rights (including right for language assistance)

*inform patients of their rights (interpreter, accommodation for disability, be free from discrimination, etc.)

*tailor the informed consent process to meet patient needs (related to low HL)

   

*accommodate patients' diverse needs in informed consent procedure

Patient and community participation at organizational level

CLAS

JCR

CRF

COER

EDS

EQS

 Involving patients and communities in the development of services

*utilize a variety mechanisms to facilitate community and patient involvement in designing and implementing services

*develop participatory, collaborative partnerships with communities

*be involved and engaged with patients, families and the community to identify needs for new/modified services

*collect feedback from patient, families and communities

*CALD consumer, carer and community members are involved in the planning, improvement and review of programs and services on an on-going basis

*advice of participation structures is taken into account

*facilitate different degrees of participation from CALD consumers, carers, community

*develop partnerships with ethno-specific community organizations

*promote participation of migrants in designing, evaluating, and carrying out research on migrant health and health care

*promote participation of migrants in developing and implementing new measures

*identify local interests (including patients, communities) that need to be involved in implementing EDS

*share assembled information with local interests so they participate in analyzing performance and setting objectives

*agree roles with local authority (e.g. services that share the same clientele)

*identify service users at risk for exclusion from participatory processes, promote their participation

*identify and overcome barriers to participation

*monitor and evaluate participatory processes

*use feedback to improve services and share results of participation with public

Promoting Responsiveness

CLAS

JCR

CRF

COER

EDS

EQS

 Sharing information on experiences

*make information available to public on progress and innovations in implementing CLAS *inform community, own organization (for institutionalizing CLAS) and other organizations to learn from each other

*share information with surrounding community about efforts to meet unique patients’ needs to demonstrate commitment

*undertake research to develop new and improved initiatives and resources for CR

*inform public adequately about issues concerning migrant health

*share assembled evidence on equality performance with local interests (e.g. patients, communities), so they can take part in analysing performance and set goals

*publish accomplishments (grades) and equality objectives so they are accessible for local interests

*be a participant in networks, research initiatives which promote equity

*disseminate results of research/practice related to equity

*build solid relationships/ networks with community-based service providers

*ensure that equity is reflected in all partnership and service contracts

Unique issues

CLAS

JCR

CRF

COER

EDS

EQS

  

*identify and address mobility needs (e.g. cane, guiding dogs)

  

*support workforce to remain healthy, focus on major health and lifestyle issues that affect individual and wider population

Â