Integrating Health Literacy, Cultural Competence, and Language Access Services Workshop Summary (2016) / Chapter Skim
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2 Health System Transformation to Support Integration
2 Health System Transformation to Support Integration
Pages 5-26
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From page 5... ...
• What three things have changed over time that facilitate integration? The three panelists were Michael Wolf, professor of medicine and learning sciences and associate division chief of internal medicine and geriatrics, and director of the Health Literacy and Learning Program at Northwestern University's Feinberg School of Medicine; Guadalupe Pacheco, founder, president, and chief executive officer of the Pacheco Consulting Group; and Wilma Alvarado-Little, principal and founder of Alvarado-Little Consulting.
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From page 6... ...
and health literacy; • Penalties, or negative incentives, tied to readmissions, hospital acquired conditions, and other aspects of ineffective care; • New requirements, such as community health needs assessments, CLAS, and nondiscrimination in marketplace activities; • Support through grants and contracts, including research grants from the Patient-Centered Outcomes Research Institute (PCORI) ; and • Symbolic support though unfunded initiatives that, with their very inclusion or explicit mention in the law, have symbolically elevated their priority and may have prompted related state focus or ini tiatives, such as the development of model cultural competence curricula.
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From page 7... ...
Several states also implemented programs to use evidence-based, culturally sensitive wellness and prevention programs with their Medicaid populations. Andrulis emphasized the importance of finding a point of focus for bringing health literacy, cultural competence, and language access services together in a synergistic manner.
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From page 8... ...
One of the focus areas of the National Prevention Strategy is the elimination of health disparities, and toward this end, it has authorized a study of health literacy factors in patient safety; increased the use and sharing of evidence-based health literacy practices and interventions; mandated plain language patient information and labeling tailored to culture, language, and literacy; and required race, ethnicity; and language data collection. Looking back 10 years, there were pieces of these programs and ideas floating around, said Andrulis, but today, efforts to integrate health literacy, cultural competence, and language access skills in all aspects of health care are more energized, supported, and seen as being more relevant.
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From page 9... ...
Texas also pays for performance based on engagement of community health workers in evidence-based programs to increase the health literacy of targeted populations and on the success of navigators in programs aimed at populations with low English proficiency, immigrants, and populations with low health literacy. In addition, Texas is expanding language access and implementation of CLAS standards -- including some over and above those required by federal regulation -- through workforce cultural competence trainings, while California is paying health systems to redesign patient education materials to be at the appropriate reading level, as well as paying for translations of those materials.
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From page 10... ...
CONCEPTS IN HEALTH LITERACY2 What health literacy, cultural competence, and language access services have in common, said Michael Wolf, is stagnation and the challenge to have 2 This section is based on the presentation by Michael Wolf, professor of medicine and learning sciences, associate division chief of internal medicine and geriatrics, and director of the Health Literacy and Learning Program at Northwestern University's Feinberg School of Medicine, and the statements are not endorsed or verified by the National Academies of Sciences, Engineering, and Medicine.
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From page 11... ...
Health literacy has strong and obvious ties to socioeconomic status, race, ethnicity, and age that, according to Wolf, cannot be divorced from making changes in the health system and beyond. He then made three points with regard to how to best integrate health literacy, cultural competence, and language access services.
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From page 12... ...
Again, however, there needs to be a business case that links health literacy to behavior change and health outcomes, which is something he hoped the roundtable would explore further. CONCEPTS IN CULTURAL COMPETENCE3 One definition of cultural competence, said Guadalupe Pacheco, is the ability of an organization or an individual within the health care delivery system to provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs of the patient.
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From page 13... ...
Another game changer, said Pacheco, is the increasing recognition of the health disparities that affect many groups in the United States. "Why are we developing culturally competent programs and initiatives and health literacy initiatives?
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From page 14... ...
"If you pick up any report dealing with health equity, you will find reference to cultural competency trends and progress," he said in closing. LANGUAGE ACCESS SERVICES4 To illustrate the central challenge that language access presents in the health care environment, Wilma Alvarado-Little began her presentation with a quote from George Bernard Shaw, who said "The single biggest problem in communication is the illusion that it has taken place." She then addressed the difference between language access and language assistance.
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From page 15... ...
access is achieved when individuals with low English proficiency can communicate effectively with HHS employees and contractors and participate Figure 2-3 in HHS programs and activities. Language assistance refers to all oral and Raster, not editable written language services needed to assist individuals with low English proficiency to communicate effectively with HHS staff and contractors and gain meaningful access and equal opportunity to participate in the services, activities, programs, or other benefits administered by HHS.
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From page 16... ...
She recounted how she recently asked officials at a hospital in rural upstate New York if they were complying with The Joint Commission accreditation requirements on language access and their response was that they were not accredited by The Joint Commission so they were off the hook. Though not true, that response illustrates a glaring lack of knowledge about relevant regulations and policies concerning language access services.
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From page 17... ...
Some institutions, for example, attempt to turn English words into Spanish by adding an o to the end of the English word, with the English word exit becoming the Spanish word éxito, which actually means successful, rather than salido, the real Spanish word for exit. Turning to her third key concept, community engagement and empower ment, Alvarado-Little said that the main focus here is educating end users -- the patient, provider, workforce, and community member -- about the need to understand what is involved in providing or using language access services and the mandates to do so.
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From page 18... ...
These three documents, she said, enable her to say that this is not just about the health literacy community saying that providing language access services and culturally competent communications is something that health care systems should be doing, but that there is substance involved. What still needs to happen, she said, is for the health literacy community to get the message out about the importance of integrating health literacy, cultural competence, and language access services and for there to be con tinued enforcement and evaluation.
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From page 19... ...
"Analytics is driving policy and programs," he said. If health care systems started documenting how health literacy, cultural competence, and language issues are acting as barriers for patients getting to a clinical encounter and following care plans, it would provide the leverage to build a business case that more accurately reflects the larger value of health literacy, cultural competence, and language access services.
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From page 20... ...
"Of course, we know what happened to Humpty Dumpty, and I am worried that the same thing will happen to us." In some ways, she continued, integrating health literacy with culture and language services cannot happen without a lengthy, detailed explanation, negotiation, and respectful dialogue. Given that context, Rudd asked Alvarado-Little what she means by language access.
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From page 21... ...
Addressing Rudd's comments about culture, he said the culture of a federally qualified health center is much different from that of a typical hospital. The federally qualified health center has staff that represents the surrounding community, it has interpreters and materials translated into the languages used in the surrounding community, and it has community health workers and patient navigators who know about and understand the cultural and language diversity in the surrounding community.
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From page 22... ...
It is time for health care professionals to recognize that health literacy, cultural competence, and language access services have to be a part of the narrative around patient care. Bringing these elements to a discussion should not be an assumption, but a requirement that gets documented, which in turn would begin generating the data that Pacheco said are needed to develop more effective approaches for communicating with patients, families, and communities.
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From page 23... ...
Pacheco said what has been missing is the progressive element in health care, and looking at this issue in terms of civil rights is a promising approach. He called on the workshop attendees to push the Office for Civil Rights at HHS to start enforcing its guidance and laws that affect the civil rights of individuals who are trying to access health care but cannot because of issues involving health literacy, cultural competence, and language access services.
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From page 24... ...
Andrew Pleasant from the Canyon Ranch Institute commented that when it comes to making policy change, "numbers get you in the door, but stories win hearts and minds." The ACA and PCORI, he explained, "are providing fabulous opportunities to advance health literacy, language access, cultural competency, yet they go out of their way to defer people -- some would say prevent people -- from using metrics such as the qualityadjusted life year to achieve the ends this group is trying to achieve." He said that he has used the quality-adjusted life year metric to demonstrate clearly that health literacy and integrated health prevention interventions can create health at lower cost than most other medical interventions, but PCORI is prevented from funding research that makes cost comparisons. Given that situation, he asked the panelists how these fields can align strategically to change that discussion and enable the use of specific metrics to make the business case or show a return on investment.
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From page 25... ...
HEALTH SYSTEM TRANSFORMATION TO SUPPORT INTEGRATION 25 executive orders to address this issue strategically without harming entities such as PCORI. Alvarado-Little said the New York state legislature could not pass a language assistance bill, but the governor issued an executive order mandating supervision of language access services for the top six languages as identified by the 2010 U.S.
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