consumer focus groups, analysis <strong>of</strong> outcomes data, and chart reviews or audits (NPHHI1998).Using various methods to monitor CLAS quality is a vital step toward improvingCLAS quality (Smedley et al. 2002). Equally important, however, is how organizationsuse the data they have collected through QMI studies. As such, this domain also includesinformation on the uses <strong>of</strong> QMI data, which may include: setting priorities for healtheducation and promotion, linking patient and provider data, and setting targets or goals forservice units.Domain 5: Management Information Systems (MIS)This fifth domain—which includes assessment elements related to an organization’sdata collection efforts for its staff and clientele—is closely related to Domain 4, QualityMonitoring and Improvement. In order to effectively understand, monitor, and improvequality <strong>of</strong> health care in general, and to promote consistent and similar standards <strong>of</strong> care forall patients regardless <strong>of</strong> demographic characteristics (e.g., race, ethnicity, language,gender, age), information must be collected on the demographic characteristics <strong>of</strong> healthplan staff and the service population (Perot and Youdelman 2001; Smith 1998). Inquirieswithin this domain include whether the organization collects and records such informationfor its staff and clientele. If management information systems are in place, actual data onthe racial, ethnic, cultural, and linguistic composition <strong>of</strong> the organization’s staff andclientele would be gathered under this domain.Domain 6: Staffing PatternsThe racial, ethnic, cultural, and linguistic composition <strong>of</strong> health care staff—bothclinical and non-clinical—should reflect and represent the diversity <strong>of</strong> its servicepopulation (Kim et al. 1992). This domain covers level <strong>of</strong> staff diversity within anorganization as well as organizational efforts to recruit, retain, and promote a diverse staff.Also important in an assessment <strong>of</strong> staffing patterns are the types <strong>of</strong> organizational effortsto make information on staff diversity available to its service population (again, for MCOs,its members), such as provider directories that publish languages spoken by physicians orshow photographs <strong>of</strong> physicians and other health care staff who “look like” their members.Domain 7: Staff Training and DevelopmentOne way to improve quality <strong>of</strong> health services for culturally and linguistically diversepopulations is to hire staff who represent the cultural composition and speak the languages<strong>of</strong> the population served, discussed above in Domain 6. Another way organizations canimprove CLAS quality is to provide ongoing staff training in cultural competence or “staffdiversity training” (Cultural and Linguistic Standards Task Force 1997; NLBHW 1996).Diversity training refers to any instructional effort that addresses and promotes greaterCOSMOS Corporation, December 2003 B-3
understanding <strong>of</strong> diversity issues in general (race/ethnicity; sex/gender; religion; region;sexual orientation; etc.), or more specifically, the unique needs and preferences <strong>of</strong>culturally and linguistically diverse groups in the health plan membership. 2 Participationin these programs <strong>of</strong>ten creates opportunities for staff to reflect on their own beliefs andbehaviors and how this background affects the way they deliver services(Dilworthanderson et al. 1993; Eliason 1993; May 1992).In an organizational assessment <strong>of</strong> CLAS, measures for examining this domaininclude topical components covered by the diversity training program, frequency <strong>of</strong>administration, staff types for whom training is available and/or required, and whether theorganization provides such training on a one-time, e.g., during employee orientation, orcontinuous basis. Other staff training and development issues covered by this seventhdomain include whether organizations provide opportunities for staff to learn non-Englishlanguages.Domain 8: Communication SupportThis domain examines language assistance services provided by health careorganizations. Translation and interpretation services are needed to reduce and eliminatecommunication barriers experienced throughout the continuum <strong>of</strong> care. Although theterms “translation” and “interpretation” are <strong>of</strong>ten mistakenly used synonymously,“translation” refers to written materials, and “interpretation” is related to oralcommunication. Areas <strong>of</strong> inquiry related to communication support include: types <strong>of</strong>translated materials and interpretation services utilized by the organization; characteristics<strong>of</strong> interpreters utilized by the organization; methods for determining types and levels <strong>of</strong>language assistance services needed; and points <strong>of</strong> service at which language assistanceservices are available. Perhaps the most critical component <strong>of</strong> quality health care is theability <strong>of</strong> both the provider and the patient to understand and be understood. Linguisticallyappropriate services—i.e., the provision <strong>of</strong> translated written materials, and oralinterpretation services—are vital to accurate physician diagnosis and appropriate treatment<strong>of</strong> presenting complaints or conditions, patient understanding, compliance with prescribedactions or treatment plans, and positive health outcomes (Manson 1988; Perez-Stable et al.1997).2 This definition <strong>of</strong> “diversity training” was developed by OMH for the purposes <strong>of</strong> this study.COSMOS Corporation, December 2003 B-4
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Developing a Self-Assessment Toolfo
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ContentsChaptersPage1. Introduction
- Page 5 and 6: Chapter 1Introduction
- Page 7 and 8: While many LPHAs currently provide
- Page 9 and 10: LPHAs include: adult and child immu
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- Page 13 and 14: Chapter 2Methodology for Developing
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- Page 17 and 18: assess their own beliefs and have k
- Page 19 and 20: communicate with, and clearly under
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- Page 23 and 24: Given these persistent disparities
- Page 25 and 26: (Exhibit 2-2, Continued)DOMAIN / KE
- Page 27 and 28: limited to the actual clinical enco
- Page 29 and 30: Chapter 3Project Results and Recomm
- Page 31 and 32: local board of health. PEP and PAG
- Page 33 and 34: numerous promising CLAS practices a
- Page 35 and 36: References
- Page 37 and 38: Becker, M.H., and L.A. Maiman, “S
- Page 39 and 40: Frye, B., “Health Care Decision M
- Page 41 and 42: Marin, G., “Defining Culturally A
- Page 43 and 44: Perkins, Jane, “Overcoming Langua
- Page 45 and 46: U.S. Bureau of the Census, “Censu
- Page 47 and 48: Appendix AMembership Lists of the P
- Page 49 and 50: Appendix A-1Developing a Self-Asses
- Page 51 and 52: Appendix A-2Developing a Self-Asses
- Page 53 and 54: Appendix B-1Overview of Eight CLAS
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- Page 61 and 62: Appendix CLPHA Director or Designee
- Page 63 and 64: Pre-Interview Script for LPHA Direc
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- Page 73 and 74: Appendix DStaffing Questionnaire
- Page 75 and 76: A. QUALITY MONITORING AND IMPROVEME
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- Page 79 and 80: 7. Please indicate, if you know, th
- Page 81 and 82: 1c. Please indicate for which categ
- Page 83 and 84: 6. Please indicate for which catego
- Page 85 and 86: 10. Which of the following topical
- Page 87 and 88: 17. Which of the following benefits
- Page 89 and 90: 4. Which of the following strategie
- Page 91 and 92: Appendix EClient Services Questionn
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Appendix FPilot Test Response Form
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RESPONDENT EVALUATIONOF THE QUESTIO
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Appendix GCLAS in MCOs Study Data C
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position, as titles will likely var
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complex and uncertain at the time t
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1. Incorporate a confirmation pre-c
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Exhibit 2DATA COLLECTION PROCESSSen