Uniting health professionals and community members to improve
Uniting health professionals and community members to improve care Tonya Hampton, MBA, Ed. D Sr. Director, Diversity, Inclusion & Engagement Health. Partners Debra Bryan, MEd Director, Collaborative Learning Health. Partners Institute for Education and Research Dave Johnson, MBA Regional Clinic Director Health. Partners Medical Group Diversity RX March 12, 2013
Agenda • Health. Partners overview • Health. Partners’ employer approach to diversity & inclusion • Community strategies: The EBAN Experience™ • Implementing learnings in the clinics • Discussion, Questions 2
Health. Partners • Not-for-profit, consumer-governed • Integrated care and financing system – A team of 21, 000 people – Health plan • 1. 4 million health and dental members in Minnesota and surrounding states – Medical Clinics • 1 million patients • 1, 700 physicians – Health. Partners Medical Group – Stillwater Medical Group – Park Nicollet Health Services • 35 medical and surgical specialties • 40 primary care locations • Multi-payer – Dental Clinics • 60 dentists • Specialties: oral surgery, orthodontics, pediatric dentistry, periodontics, prosthodontics • 20 locations – Six hospitals • Regions: 454 -bed level 1 trauma and tertiary center • Lakeview: 97 -bed acute care hospital, national leader in orthopedic care • Hudson: 25 -bed critical access hospital, award-winning healing arts program • Westfields: 25 -bed critical access hospital, regional cancer care location • Methodist: 426 -bed acute care hospital, featuring the Jane Brattain Breast Center • St. Francis: 86 -bed community hospital
Diversity and Inclusion Strategy: Our Journey • Before 2000 – Compliance, AAP, EEO, Investigations – Some employee resource groups • 2000 -2006 – Focused on building inclusive environment and focus on employee development – All Employee Survey – Wellness and Culture 2006 -2011 – Monitoring, reporting and establishing accountability – Community and recruitment strategies – Leadership commitment • Incentive plan • Leadership Circles • It’s Time to Talk – Race Forum • Informational Interviews – Diversity Awareness Month – EBAN and Healthcare Disparities Gap – Diversity council and Ambassador Steering Committee meetings – Increase minority leaders pipeline and create development group 5
Definitions • Diversity – Health. Partners refers to human qualities that are different from our own and those of groups to which we belong; but that are manifested in other individuals and groups. Dimensions of diversity include but are not limited to: Dimensions of Diversity Age Educational background Ethnicity Geographic location Gender Income Physical abilities/qualities Marital status Race Military experience Sexual orientation Parental status Religious beliefs Work experience Job classification etc. Simply put, we are all diverse… 6
Definitions • Minorities or people of color – A person belonging to a racial or ethnic group which historically has been disadvantaged and underrepresented in the workforce Minority groups have been defined by the federal government to include: American Indians/Alaskan Natives, Asians/Pacific Islanders, African Americans/Blacks, Hispanics/Latinos and individuals who are of two or more races • Inclusion – involves bringing together and harnessing these diverse forces and resources, in a way that is beneficial • When referring to minorities/people of color and women/females, we say women and minorities/people of color Inclusion puts the concept and practice of diversity into action by creating an environment of involvement, engagement, respect, and connection—where the richness of ideas, backgrounds, and perspectives are harnessed to create business value. “Organizations need both diversity and inclusion to be successful, research show this impacts employee engagement and team/organizational performance. ” Diversity Inc. 7
124 different languages spoken 17% are patients of color 7% foreign-born; up 350% from 1990 8 80% of immigrants live in Twin Cities metropolitan area
2010 Health. Partners Active Patients *Active patients: a count of unique patients seen in the system from 7/1/2009 through 12/31/2010 3% 4% 6% 7 -County Metropolitan Area (2010 Census Data) 5% 4% 3% 6% 13% 74% White Asian American-Indian or Alaska Native 83% Black or African-American Hispanic or Latino Other
Physician Diversity • 18% of our physician group has listed a country of origin other than the USA • 63 languages spoken • 47 countries of origin
Overall Health. Partners Minority Workforce Trends
Shaping the Future… • Key Strategies – Moving to an enterprise-wide plan on diversity and inclusion to effectively drive employee engagement and leadership accountability • Strategic framework: excellence (recruiting top diverse talent), engagement (targeting development and retention), embracing diversity and inclusion, and equity ( i. e. , culture humility and equitable care) – Improving COE service delivery across the family of care – Defining key metrics and strategic structure for measuring progress – Continuing to build an environment that cultivates diversity and inclusion – Increase diversity of our workforce, direct focus on leadership and leadership circles – Equitable Care Council and Fellows 12
Organization Assessment Methodology Changing Dynamics + External Benchmarking Internal Assessment Creating an enterprise-wide diversity and inclusion strategic plan that aligns with and impacts our work in the People, Health, Experience and Stewardship dimensions also known as the Triple Aim. 13
Connecting the Dots Linking strategies/initiatives Diversity and Inclusion Workplace Strategies Engagement Strategies Equitable Care Strategies Healthy Workplace Strategies Our Patients, Families, Community 14
What’s Changed Future Focus – includes best practices + vision • Recruit • Retain • Develop • Excellence (includes recruitment strategies; recruiting diverse top talent) • Engagement (includes retention and development strategies) • Embrace and Equity (new) Goal: Create enterprise-wide plan, excitement and momentum while executing the necessary strategies/initiatives to establish a highly skilled, engaged, diverse and committed workforce 15
Strategic Framework 16
Structure Diversity & Inclusion Strategy Organization Structure People Council Enterprise Diversity & Inclusion Council Business Councils Taskforces/Groups Structure Details: • People Council – Provides input on D&I strategic goals and monitors enterprise wide progress. • Enterprise Diversity & Inclusion Council – Chaired by Sr. Director of Enterprise Diversity, Inclusion and Engagement who oversees execution of the diversity and inclusion enterprise plan and provides progress for People Council, Strategic Planning (S/P) and BOD. Comprises of business/company council members who share update on business/company diversity and inclusion goals/initiatives and best practices. • Business/Company Councils – (optional) Comprises of leaders and/or direct reports with influence, tasked with implementing and measuring company/business diversity and inclusion goals and initiatives. Current Diversity Ambassadors under the old structure may fill this role. Individuals are appointed by Sr. Leader of the company/business. • Taskforces/Groups – Assist with the execution of enterprise or business specific diversity and inclusion goals and initiatives. 17 Diversity and Inclusion Summit Annual Event – Open to enterprise-wide colleagues as well as diversity and inclusion ambassadors engaged in company diversity and inclusion education, awareness and goals implementation.
Leadership: Set Goals, Aim High Cross Cultural Care Taskforce Established 2001 Organization Assessment 2003 Cultural Competencies, Data Collection, Improvement Strategies 2004 Health Goals: specific aims to reduce racial and financial class disparities in health 2010 2014 Part of our organization’s culture: “Cross cultural care is not just about ‘other’ cultures. It’s about recognizing the effect of cultural values- which we all have- on health. ” – Mary Brainerd, Health. Partners CEO
Every encounter is a cultural encounter 2009 Site Visits across the Health. Partners Organization 10, 000 employees • Hmong Kitchen • Viewing of film followed by facilitated discussion – What barriers did you identify that prevented the patient or member from having the best care and best experience? – What can we do to improve this person’s outcome? – How is this, or situations like this, relevant to you and your everyday work? We don’t expect you to be an expert; just be respectful, humble, ask questions and listen… 19
2012 Equitable Care Fellows Program Options • Research & Write a Culture Roots Article • Present a Caring Across Cultures • EBAN or Straits Health Video & Discussion • Demo of Equitable Care & Service Website • One Self-Directed Activity
Culture Roots
Supports in place for ‘social movement’ • yum. Power: Finding tasty, good-for your foods that power your body and help you live the best life possible • Tools: website, text messages, phone app, school challenge
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Health. Partners yum. Power School Challenge
Community outreach
The Disparities Challenge… “The real challenge lies not in debating whether disparities exist, the evidence is overwhelming, but in developing and implementing strategies to reduce and eliminate them. ” Alan Nelson, MD Chairman, IOM Committee Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, 2003
The EBAN Experience™ Debra Bryan, MEd Director, Collaborative Learning Health. Partners Institute for Education and Research
What is the EBAN Experience™? learn collaborate improve
What Makes it Unique? Quality Improvement Teams Community Engagement Experiential Education Reduce Health Disparities
Soliciting Help from the Community
Joining a Team Clinical Improvement Opportunity Population Served Increase pediatric immunization rates Children from East Africa Improve diabetes health outcomes through education Ethiopian Patients Increase colorectal cancer screening rates Communities of color Decrease readmission rates Minority and limited English proficiency (LEP) patients Improve pain medication delivery time in the ER Minority and limited English proficiency (LEP) patients Increase colorectal cancer screening rates Patients of color Increase breast cancer screening rates Patients of color Increase rates of advance directives African American patients Increase fluoride varnish and sealant rates Children from publically insured families
Preparing Teams Packing the tool kit Webinars Orientation Monthly Conference Calls Checklists Ongoing QI Coaching
Basic QI Principles View: Which Exit Facilitated Discussion of Film Social Determinants of Health Measurement & Variation Team Presentations TPT Interviews View: Alberto’s Chicken Dinner Panel Discussion Variation and Data Display Case Study Team Presentations Somali Perspective View: From Head to Toe Facilitated Discussion Panel Discussion Team Presentations Reliability, Spread and Implementation February 2012 Team Building Latino Perspective December 2011 African American Perspective September 2011 June 2011 March 2011 Year-long Schedule Round Table Discussions: Best Practices & Lessons Learned Presentations of Final Projects and Recommendatio ns to
Theater as a Transformational Tool
How it Worked • Four screenplays • Each is about a patient from one of four • • • cultures: African American, Latino, Somali, Hmong Screenwriters are native to the culture Written with community collaboration Promote understanding of the effect of culture on health One person’s story A vehicle for discussion and reflection
Culturally Specific Stories ”Hmong Kitchen. ” A Hmong family experiences conflict between health beliefs and western medicine. Written by May Lee Yang. Directed by Jack Reuler. 8 min. “Which Exit. ” A story about an African American experience of health in North Minneapolis. Written by Syl Jones. Directed by Jack Reuler. 40 min. “Alberto’s Chicken Dinner. ” Four Latino immigrants with health issues. Written by Joe Minjares. Directed by Jack Reuler. 25 min. “From Head to Toe. ” A Somali family deals with intergenerational health issues. Written by David Grant. Directed by Jack Reuler. 28 min.
Factors contributing to success • Strong cultural knowledge and understanding • Ethnic-specific approaches • Persisted in reaching out to patients and offered different methods of interaction • Built relationships with patients in population • Recognized need to adjust level of detail taught to patients to reflect health literacy • Utilized educational tools that were more visual than written • Followed up continually to sustain outcomes • Passion for work
Lessons Learned Establishing rapport between community members and health professionals takes time and mutual respect. Trust and relationships are important to community members, especially early in team formation. For leadership support, try to select QI projects that are aligned with the long term health goals of the organization. Identify data streams that are already collected by your organization to support QI improvement goals or through routine quality surveys. Avoid lastly chart reviews or creating new, untried data gathering procedures.
Spreading the Word Healthy Acts: Setting a New Course www. EBANexperience. com ©Health. Partners 2012 “Healthy Acts: Setting a New Course. ” A documentary, created by Twin Cities Public Television(tpt), includes a montage of clips from the culturally-specific films; footage from the equitable health collaborative sessions; and interviews with key partners. 26 min. Premiered February 10, 2012, Twin Cities Public Television.
Spread and Sustainability • Embedded changes to the care system • Continued improvement within Health. Partners • New relationships with community organizations and leaders • Potential to share with other health systems nationally • Publishing and presentations
Implementation in clinics Dave Johnson, MBA Regional Clinic Director Health. Partners Medical Group 41
Patient-Centered Data Collection Mission driven State health reform Meaningful Use Understanding disparities Workforce needs – Our workforce should reflect the communities we serve • Measurement and transparency – MN Community Measurement, statewide transparency • • •
Demographic Data Collection 100% 99% - Language Collection goal 90% - Race/ethnicity Collection goal 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2004 2005 2006 Language collection rate 2007 2008 2009 Race/ethnicity collection rate 2010
Standardize, then Customize: Preventive Services by Race 2006 Our internal data indicates variation 100% 13 % point gap 90% 80% 15 % point gap 70% 60% 50% 40% 30% 20% 10% 0% Breast Cancer Screening Cervical Cancer Screening White Chlamydia testing Cholesterol screening Colorectal Cancer Screening Optimal Preventive Care Patients of Color *Patients of color: includes patients whose self-identified race is either American Indian or Alaska Native, Asian, Black or African. American, Hispanic or Latino, Some other race, and patients with more than one race documented (Multiple race)
Customize to Individual Patient Preferences and Values Formed multi-disciplinary team in 2007 Utilize small tests of change then spread Embed in Care Model Process Clinical Focus Areas: Breast Cancer Screening, Colorectal Cancer Screening • Input from community leaders and our patients • •
Reducing the Gap: How Breast Cancer Screening • Agree on best practices • Pre-visit planning/decision aid • Care Model Process • Same Day mammogram • Registry outreach • Local clinic initiatives- culturally-specific mammogram days
Reducing the Gap: Breast Cancer Screening GAP is 8. 2% points GAP is 3. 1 % points
Reducing the Gap: How Colorectal Cancer Screening • Agree on best practices • Pre-visit planning/decision aid • Registry-based outreach • Choice between colonoscopy or FIT • Embedding into Care Model Process
Reducing the Gap: Colorectal Cancer Screening GAP is 26. 2% points GAP is 13. 6% points *Black and Native American patients start screening at age 45, age 50 for all other races.
Minnesota’s Publically Reported Results on Socioeconomic Disparities (2011) MEDICAL GROUP Health. Partners Clinics (10 of 12) Park Nicollet Health Services (7 of 12) System X (3 of 12) Optimal Diabetes Care • • Optimal Vascular Care • System Y (3 of 12) Controlling High Blood Pressure • Optimal Asthma- Children 5 -17 • • Optimal Asthma Adult 18 -50 • • Appropriate Treatment for Children with URI • Appropriate Testing for Children with Pharyngitis • • Breast Cancer Screening • • Cervical Cancer Screening • • Colorectal Cancer Screening • • Chlamydia Screening • • Childhood Immunization Status • • Blank = Measure reported by rate was average or below average • • • = Medical Group had confidence intervals fully above the medical group average for patients enrolled in MHCP www. mnhe althscores. o rg
Future Goals 51
Collaborative Learning - Next Steps • • 3 D Collaborative (Defeating Diabetes Disparities) Begin January 2013 – run for a year Focus on populations with greatest disparities, Latino, African American and East African Involve communities in identifying best practices that will meet their cultural preferences and be successful. Health professionals from across the organization share their successes and failures in improving diabetes outcomes. Community members and health professionals on three teams, learning together to improve diabetes outcomes. – Gain a holistic view of managing diabetes across the organization – Develop a new “normal” for patient behaviors at home and when they engage in healthcare system Social Determinants of Health Collaborative Begin Fall of 2013
Clinics - Next Steps • Continue to partners across our organization – Specialties – Case & Disease Management – Institute for Education & Research • Support ethnicity-specific screening days • Same-day scheduling & access, where possible • Proactive outreach • Population Health Care 53
Where to start • Partner with the communities you serve; encourage patient collaboration • Create opportunities for inter-professional learning and sharing • Pilot small programs that can be scaled up • Identify and proactively outreach to patients who are due for preventive screenings 54
Thank You Questions? 55
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