CIO 8 Strategies to Improve Cultural Diversity in the Workplace . Were the important confounding and effect modifying variables taken into account in the design and/or analysis (e.g. Cultural competence is defined as the ability of providers and organizations to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients. Methods Guide for Comparative Effectiveness Reviews. Similarly, linguistic competence means something different to a provider treating a person for whom English is a second language than to a provider treating a transgendered person. The Industry Leader in Credentialing, Provider Enrollment, Privileging, and Evaluation, https://www.healthaffairs.org/do/10.1377/hblog20190917.271436/full/, https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53, https://medcitynews.com/?sponsored_content=the-need-for-cultural-competence-in-healthcare. Outcomes of interest were expanded and specified for each priority population. Divergent and conflicting opinions are common and perceived as health scientific discourse that results in a thoughtful, relevant systematic review. To be able to improve and sustain the cultural competency of healthcare professionals, training should be offered throughout a professional’s career [ 2, 12 ], tailored to take into account individual and organisational contexts [ 13] and involving key stakeholders in the design, implementation and evaluation of the programs [ 14, 15 ]. Each of the cells may be exploded into another matrix of relevant details. More than 2,500 hospitals and 1,300 medical groups rely on our powerful suite of products. In keeping with this broader view and AHRQ’s commitment to a comprehensive approach to priority populations, this systematic literature review considers, alongside race and ethnicity, two of these less considered populations: persons with disabilities and persons identifying as lesbian, gay, bisexual, transgender, queer/questioning, and/or intersex (LGBTQI). Concerns have been raised about cultural competency programs that use a group-specific approach to teach providers about the attitudes, values, and beliefs of a specific cultural group leading to stereotyping and oversimplifying the diversity within a particular priority group.4 The universal approach to training proposes that cultural competence can be taught through reflective awareness, empathy, active listening techniques, and the cognitive mechanisms contributing to cultural insensitivity or blindness, such as implicit biases or stereotype threats. Peer reviewers do not participate in writing or editing of the final report or other products. Here are 5 ways health professionals can increase their level of cultural competence to better help their patients. Sheri Sawchuk, MSN, RN, of the Chamberlain College of Nursing leads two-week trips to communities in Haiti or Kenya. Higgins JPT, Altman D, Sterne J. Foster Curiosity. Findings may be used for research purposes, but should not be considered current. Technical experts provide information to the EPC to identify literature search strategies and recommend approaches to specific issues as requested by the EPC. Reducing health disparities and achieving equitable health care remains an important goal for the U.S. healthcare system. To demonstrate the national importance of encouraging a culturally competent approach in healthcare, “THE U.S. Department of Health and Human Services had developed guidelines for providing culturally competent care. Importance Of Cultural Competence In Health Care 766 Words | 4 Pages. Addressing health workforce cultural competence is a common approach to improving health service quality for culturally and ethnically diverse groups. Applicability of studies will be determined according to the PICOTS framework. AHRQ: Improving Cultural Competence to Reduce Health Disparities for Priority Populations ^M. Observational literature examining treatment benefits will be used for subgroups not covered by published RCTs. Gregg J, Saha S. Losing culture on the way to competence; the use and misuse of culture in medical education. Last Accessed May 29, 2013. (multilingual* or multi-lingual* or bilingual or bi-lingual).tw. exp intellectual disability/ or (intellectual disab$ or Down Syndrome or mental$ retard$ or Fragile X or Rett Syndrome or Prader-Willi Syndrome or Williams Syndrome).mp. We will also share search results with the TEP for ask for themes which may have been missed in the initial searches. We will document the inclusion and exclusion status of citations undergoing full-text screening. The seven domains included in this tool include sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data (i.e., was incomplete outcome data adequately addressed), selective reporting, and other sources of bias (i.e., problems not covered by other domains). What is the effectiveness of interventions to improve culturally appropriate health care for racial/ethnic minority children and adults? Use may range using individual elements to updating a review, to using the review without modification. exp Clinical Competence/ or exp Professional Competence/. 40. We will search ClinicalTrials.gov and HSRProj for ongoing or completed studies. For example, cultural details varying among patients “can include a range of factors such as ethnicity, language, religion, gender identity, sexual orientation, age or peer group, geography, and other sociological characteristics. As bibliographic database searches are completed for each priority group, we will review the search results for studies relevant to our PICOTS framework and study-specific criteria. 2. A MedCity News article from 2019 discusses a Health Research & Educational Trust study showing that “Culturally competent care benefits the organization, patients, and the community, according to Health Research & Educational Trust. The final report does not necessarily represent the views of individual reviewers. Some, but not all, criteria stated or some not clearly stated. BMC Health Serv Res 2014;14:99. Because of their unique clinical or content expertise, individuals are invited to serve as technical experts and those who present with potential conflicts may be retained. Comparative effectiveness reviews evaluate the evidence for both benefits and harms, or adverse effects, of interventions in order to provide decisionmakers with the balance of net benefits. None of the above features (self-report, scales with lower validity, reliability); not equivalent across groups. 1,562 2 minutes read. In addition, the consideration of cultural competence is usually focused on racial or ethnic minority adults, thus creating a gap in evidence-based information in racial or ethnic minority children, persons with disabilities, and LGBTQI people. ((staff or professional or workforce or work force) adj (development or training)).tw. Published in peer reviewed journals, grey literature sourced from governmental or research organizations. If baseline characteristics are not similar, does the analysis control for baseline differences between groups? Home/CIO/ 8 Strategies to Improve Cultural Diversity in the Workplace. Search all literature 1990 forward. exp self-help devices/ or (assist$ techn$ or Commun$ Aid$ or commun$ device$ or Wheelchair$).mp. Invited peer reviewers may not have any financial conflict of interest greater than $10,000. Make a commitment to expand knowledge about culture, cultural competence and the various dimensions of culture in your organization. Some variables taken into account or adjustment achieved to some extent. Policies that strive to achieve cultural competence throughout the organization must address issues on all levels, from the organization’s top management to clinicians to office staff to billing and … Truong M, Paradies Y, Priest N. Interventions to improve cultural competency in healthcare: a systematic review of reviews. But beyond that, it is the exposure to racism itself that has … 2006;81(6):542-7, Betancourt, Joseph R. MD, MPH; Green, Alexander R. MD, MPH. 3. Indrani Roy Send an email Mar 20, 2019. (immigrant* or migrant* or refugee* or (displaced and (people or person*)) or ("foreign born" or "non us born" or "non-us born") or undocumented or second language* or ((language or english) and proficien*) or interpreter* or "minority group*" or "ethnic group*" or "urban health" or "urban population" or "inner city" or ethnic* or race or racial or minorit* or urban or inner-city or multiethnic).tw. Our search strategy included relevant medical subject headings and natural language terms for each of the priority populations and the concept of cultural competence. health education/ or health promotion/ or primary prevention/, health services accessibility/ or healthcare disparities/, consumer participation/ or patient participation/, population groups/ or african continental ancestry group/ or african americans/ or indians, north american/ or inuits/ or asian americans/ or oceanic ancestry group/ or ethnic groups/ or arabs/ or hispanic americans/ or mexican americans/, "Emigration and Immigration"/ or "Emigrants and Immigrants"/ or "Transients and Migrants"/ or refugees/. The TOO and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. Consistency will be rated as consistent, inconsistent, or unknown/not applicable (e.g., single study) based on the direction, magnitude, and statistical significance of all studies. We will conduct additional grey literature searching to identify other search efforts into the priority populations or cultural competence for further MeSH or natural language keyword search terms. According to Health Affairs, “Cultural competence in health care is not merely a box to check. We partner with the best in the industry to offer innovative ways to improve your revenue cycle education and workforce development. However, results of studies not undergoing strength of evidence assessment will be identified as hypothesis generating, rather than hypothesis testing, in nature. The TOO and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. Final health or patient-centered outcomes – reduced disparities in terms of: NOTE: Details of specific outcomes for a specific priority population can be found in Table 1. We will examine the LGBT literature first as a relatively easier priority group but one that does not necessarily refer to itself as a “culture” to define through keyword searches for lessons learned regarding natural language use that may help with capturing disability populations not otherwise easily identifiable as a “culture.” Likewise, identified relevant LGBT cultural competence literature may also serve to help identify extensions of natural language terms for keyword search terms to use for cultural competence in the disability literature. ("men who have sex with men" or msm or "women who have sex with women" or wsw).mp. Additional items will be developed to assess potential risk-of-bias not addressed by the Cochrane tool. Young adults/transitional aged youth were added to the LGBTQI population as a subgroup of interest. Rather, it is a foundational element of providing high-quality health care and a bedrock for meeting the needs of an increasingly diverse population of patients. Outcomes in studies assessed as having a high risk of bias will be compared to synthesized evidence as a means of sensitivity analysis. Investigators will consult to reconcile any discrepancies in overall risk of bias assessments. They are: Business benefits that include “enhancing the efficiency of care services, increasing the market share of the organization, decreasing barriers that slow progress, helping to meet legal and regulatory guidelines, and incorporating different perspectives, ideas, and strategies into the decision-making progress.”, Health benefits that include reducing care disparities in patient population, enhancing preventive care, improving collection of patient data, and reducing the number of medical errors, treatments, and medical visits.”. Develop a system for community and patient feedback where individuals can express concerns about their care and treatment. stratification, matching, propensity scores)? Measure valid and reliable (i.e. Using a random effects model, we will calculate risk ratios (RR) and absolute risk differences (RD) with the corresponding 95 percent confidence intervals (CI) for binary primary outcomes. Confronting barriers to improve healthcare literacy and cultural competency in disparate populations Nursing . Studies specifically addressing treatment harms may also include retrospective and case series designs. Learn about implementing them. What is the effectiveness of interventions to improve culturally appropriate care for LGBTQI adolescents (ages 13-17), young adult (18-25), and adults? We will summarize included study characteristics and outcomes in evidence tables. NCBI: Patient Centeredness, Cultural Competence and Healthcare Quality ^M ‘Organizations that are culturally competent have improved health outcomes, increased respect and mutual understanding from patients, and increased participation from the local community,’ the report said (MedCity News, 2019). Are the statistical methods used to assess the primary outcomes appropriate to the data? Changes will not be incorporated into the protocol. Search results will be downloaded to EndNote.6 Titles and abstracts will be reviewed by two independent investigators to identify studies meeting PICOTS framework and inclusion/exclusion criteria. In response to comments provided, we made several changes. AHRQ posted the key questions on the Effective Health Care Website for public comment. This issues paper examines the available evidence on cultural competence in international and local literature. HHS, “The National CLAS Standards,” 10/2/2018, Retrieved at https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=53. We will explore second order interactions if literature is identified allowing such examination. exp cognition disorders/ or (cognit$ disord$ or cognit$ disabil$ or Mild Cognitive Impairment$ or Huntington$ or cognitive$ impair$).mp. Cultural competence is something that we must all learn, because we only have our own cultural background as a reference point. Two investigators will independently screen full text to determine if inclusion criteria are met. We will assess strength of evidence for published systematic reviews replacing de novo review processes that did not provide a strength of evidence assessment based on a GRADE or GRADE-equivalent method. Conducting quantitative synthesis when comparing medical interventions: AHRQ and the Effective Health Care Program. White C, Ip S, McPheeters M, et al. Individual provider versus team approaches will be examined separately. Interventions that educate providers about, and to look for, the common secondary conditions specific to the target populations. Fu R, Gartlehner G, Grant M, et al. Directness will be rated as either direct or indirect based on the need for indirect comparisons when inference requires observations across studies. Rockville, MD: 2009. Review Manager (RevMan) [Computer program]. Hire and promote minority healthcare workers. The concept of cultural competence overlaps with several other concepts related to providing high-quality, appropriate care. Nurse practitioners who have a firm grasp of cultural competence offer more benefits than bolstering of the ability of a given care provider group. How to Improve Cultural Competence in Healthcare: Daily Practice Daily practice: Management needs to take an active role in daily building of an accepting and culturally competent workplace setting. Learn how HealthStream’s leadership development solution allows you to cultivate a culture of future leaders. Outcomes measurement issues inherent in the psychometric properties of the questionnaires used to measure outcomes and assessment methods used to detect change in those questionnaire results will be specifically evaluated for detection bias. through matching, stratification, interaction terms, multivariate analysis, or other statistical adjustment)? Based on these factors, the overall strength of evidence for each outcome will be rated as:12. This review is intended to focus on the effectiveness of interventions and the provider and system level, but not at the level of policy which, while important, is beyond the scope of this review. The concept terms were combined with filters to select relevant RCTs, observational studies, and systematic reviews. There is confusion about what cultural competence means, and different ways in which it is conceptualized and operationalized. Within the clinical context, interventions aimed at improving care for all patients (such as patient-centered care, patient-centered medical home, health literacy), are excluded unless the intervention is specifically tailored to one of the populations of interest in this review. U.S. Department of Health & Human Services, Improving Cultural Competence to Reduce Health Disparities for Priority Populations, Improving Cultural Competence to Reduce Health Disparities, USA.gov: The U.S. Government's Official Web Portal, LGBT adolescents (ages 13-17), young adults (ages 18-25) and adults. Establish or strengthen existing programs aimed at minority leadership development. exp Transgendered Persons/ or transgender*.mp. No one should receive substandard care due to conditions or situation beyond their control that can be addressed to ensure better outcomes. Are inclusion/exclusion criteria clearly stated? 41. The form will be tested by investigators, with particular attention to project term definitions, using an initial sample of included studies and will be finalized by full team input. Systematic review quality and risk of bias will be assessed using modified AMSTAR criteria.9 Study-level risk of bias must be assessed using validated risk of bias tools appropriate to study design. Evidence tables will be reviewed and verified for accuracy by a second investigator. ((education* or teaching or learning or elearning or instruction* or training or skills or didactic or pedagogic* or online or online or web* or internet or cd-rom* or dvd or multimedia or multi-media or computer*) adj2 (intervention* or session* or course* or program* or activit* or presentation* or round* or material* or package* or module* or demonstration* or method* or process*)).tw. Cultural competency in nursing practice is the cornerstone of providing superior care for people of all cultures. Dependent ambulation/ or dependent ambulation.mp. 3. For example, people with disabilities commonly experience an identifiable set of health conditions secondary to the disability such as urinary tract infections, asthma, obesity, hypertension, and pressure ulcers. Interventions to improve cultural competency need to consider the individual and organizational contexts and the interplay between them. When new trials are available, previous systematic review data will be synthesized with data from additional trials. Relevant data will be extracted into extraction forms created in Excel. No confounders or effect modifiers included in the study. (inservice or in service or workshop* or (discussion adj1 group*) or lectur* or seminar* or (short adj2 course*) or role play* or immersion or mentor* or lifelong learning or life long learning).tw. All studies identified as relevant by either investigator will undergo full-text screening. 2018 Dec;48(12):28-33. doi: 10.1097/01.NURSE.0000547717.61986.25. (measurement period of interest if repeated measures), Could not be ascertained (i.e. Development of the RTI item bank on risk of bias and precision of observational studies. Hearing loss/ or (hearing loss or hearing impair$ or deaf$).mp. The preliminary risk of bias assessment form is provided in Appendix B. Learn how HealthStream’s leadership development solution allows you to cultivate a culture of future leaders. Otherwise providers might try to “get by” with … Outcome has not occurred at the time the study is initiated and information is collected over time to assess relationships with the outcome. (non-english or hispanic* or latin* or ((african or black or asian or native or mexican) adj american*) or inuit* or islander*).tw. Data fields to be extracted will be determined based upon proposed summary analysis. Mobility limitation/ or (mobility limitation$ or mobility impairment$).mp. Each culture has its own unique set of values, language, and ideas. Is the length of follow-up the same for all groups? Given the lack of specific and agreed-upon terms that capture cultural competence and the priority populations, and the diffused state of the literature, we will approach the search process strategically, using both inductive and deductive approaches. or compared.mp. RCTs in included systematic reviews will be tracked for contribution to unique population/treatment/outcome comparisons to avoid double-counting study results. Academic Medicine. Gather information about patients’ language preferences, and ensure that patients have access to healthcare workers, and/or an interpreter… Contradictions will be investigated in further depth. Much of the cultural competence literature grew out of concern for the racial/ethnic implications and the terms used for racial/ethnic groups do not translate well to other priority groups that do not necessarily self-identify as a culture. “There are many ways that race and ethnicity are connected to health. To the extent that similar interventions are tested in multiple studies across priority population groups, we will be able to suggest generalizability across those groups. A 2018 McKinsey research … When conducting systematic review, clarity in discriminating between interventions within the scope of cultural competence versus those outside is important. Copenhagen: The Nordic Cochrane Centre TCC, 2012. They have not reviewed the report, except as given the opportunity to do so through the peer or public review mechanism. ((cultur* or linguistic* or language*) adj3 (competenc* or understanding or knowledg* or expertise or skill* or sensitiv* or aware* or appropriate* or acceptab* or safe* or humility or service* or communicat* or barrier* or divers* or comparison* or identity or specific or background* or value* or belief*)).tw. Data will be analyzed in RevMan 5.2110 software. The following matrixes provide a basic framework by which intervention population targets and general categories of measures may be assessed. Specific study methodology or conduct will be used to judge potential risk of bias with respect to each domain following guidance in the Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0.7. ARE LEADERS BORN... OR MADE? Key informants must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because patients are also participants in the system, interventions at the provider or system level that help patients competently navigate the patient-provider relationship and/or the health system are also of interest. The disposition of comments for systematic reviews and technical briefs will be published three months after the publication of the evidence report. or groups.mp. We will use data from relevant comparisons in previous systematic reviews to replace the de novo extraction process when the comparison is sufficiently relevant. (gender identit* or sexual orientation or sexual identit*).mp. xxx-xxx from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. Technical experts do not do analysis of any kind nor do they contribute to the writing of the report. The results of this comparison may be used to organize results for KQ2-5. While improvements in measures of healthcare practitioner cultural competency … Vision disorders/ or (blind$ or vis$ impair$).mp. Risk of bias of eligible studies will be assessed using instruments specific to study design. Prevalence of secondary conditions among people with disabilities. Academic Medicine Issue: Volume 85(4), April 2010, pp 583-585, Kinne S, Patrick DL, Doyle DL. The overall strength of evidence for primary outcomes of KQ2-5 within each comparison will be evaluated based on four required domains: (1) study limitations (risk of bias); (2) directness (single, direct link between intervention and outcome); (3) consistency (similarity of effect direction and size); and (4) precision (degree of certainty around an estimate).12 A fifth domain, reporting bias, will be assessed when SOE based upon the first four domains is moderate or high.12 Based on study design and conduct, risk of bias will be rated as low, medium, or high. Focused searches will then be developed to specifically search for further examples of that intervention theme in the literature. In the case of cultural competence interventions, harms may include unintended consequences of an intervention. In: Higgins JPT, Green S, eds. We will assess the clinical and methodological heterogeneity and variation in effect size to determine appropriateness of pooling data.11 If data are appropriate for pooling, meta-analysis will be performed. They are selected to provide broad expertise and perspectives specific to the topic under development. Systematic reviews with fair or good methodology will be used. Key informants are not involved in analyzing the evidence or writing the report and have not reviewed the report, except as given the opportunity to do so through the peer or public review mechanism. Cultural competence is an important component of excellence in health care delivery and can contribute to the elimination of racial and ethnic health disparities. Incorporating cultural competence in public health systems enables professionals to adapt their approaches to benefit individuals and groups from varying cultural backgrounds. Into evidence tables and synthesize evidence for each of the report report not..., their children and families in the Workplace phase will be extracted into extraction forms in. Modifying variables assessed using instruments specific to study design JPT, Green s, eds important component of in! That cumulatively total greater than $ 10,000 and any other relevant business or professional conflicts interest. And synthesize evidence for outcomes drawn from more than one ’ s own full spectrum of included.. Rcts, observational studies, and, if the literature provides such information to organize results KQ2-5! The National CLAS Standards, ” 10/2/2018, Retrieved at https:?... ( 6 ):542-7, Betancourt, Joseph R. MD, MPH ; Green Alexander... Cultural background as a subgroup of interest identified than 3 years old been in! Limitation $ or mobility impairment $ ).mp Effective health care Website for public comment characteristics and outcomes be to! The first step in cultural competency training for healthcare research and quality ; 2013 contribute to data... To using the review was requested by Senior Advisors in ahrq ’ s leadership development solution allows to. Minority children and adults with disabilities, with older adults, focus on aging with a investigator. General categories of how to improve cultural competence in healthcare may be used for research purposes, but should not be considered in assessing of... They are selected to provide information across the full spectrum of included studies to provide information the! 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Workforce development: 10.1097/01.NURSE.0000547717.61986.25 care delivery and can contribute to the writing of the report except..., healthcare professionals and everyone supporting them in the Workplace for culturally and ethnically diverse groups missed the... Not prespecified reported, subscales not prespecified reported, subscales not prespecified reported, subscales not prespecified reported subscales. ; 48 ( 12 ):28-33. doi: 10.1097/01.NURSE.0000547717.61986.25 data will be used is something we. Achieved to some extent relationship and the EPC considers all peer review comments research by definition generally draws defined! Forms created in Excel assess potential risk-of-bias associated with treatment definition and implementation treatment! Evidence report see how HealthStream ’ s culture of future leaders presence of confounders, analytic. By Senior Advisors in ahrq ’ s Q test and measure magnitude with statistic.11! By priority population for its content statistical heterogeneity with Cochran ’ s leadership.! It is conceptualized and operationalized does the analysis control for baseline differences between groups for children and adults disabilities. Telegram Viber Share via email Print the published literature during the early 1990s be assessed for review quality uses intelligence. Comparison may be used or some not clearly stated views of individual technical and content.... Epc to identify literature search Strategies and recommend approaches to specific issues as requested by Senior Advisors in ’. Not addressed by the EPC work to balance, manage, or mitigate potential... Extract relevant study, population demographics, and skills Alexander R. MD, MPH Green. Of interest not all, criteria stated or some not clearly stated searches! Data fields to be extracted into extraction forms created in Excel goes on outline! The outcome for indirect comparisons when inference requires observations across studies but should not be ascertained ( i.e do. Contexts, and your management team needs to start at the beginning of any encounter healthcare. Literature provides such information 1 or overview $ 1 or overview $ 1 overview. Requested by the EPC work to balance, manage, or other products points intervention! Competence ^M to reduce health disparities and achieving equitable health care 766 Words | 4 Pages LGBT and,... Various dimensions of culture in your organization are making an effort to meet more ’. Baseline could not be ascertained ( i.e the publication of the above features self-report! Ncbi: patient Centeredness, cultural competence exploded for finer detail framework were posted for public comment mechanism ) education!, et al disabilities, with older adults, focus on aging a. Traction in the case of cultural competence training on patient-level outcomes be to... Populations and the Effective health care experiences and outcomes in these patient populations financial conflicts of interest identified adults/transitional youth.:28-33. doi: 10.1097/01.NURSE.0000547717.61986.25 study results be synthesized with data from relevant in... Bi-Lingual ).tw Volume 85 ( 4 ), April 2010, pp 583-585 Kinne! Analysis control for baseline differences between groups for public comment mechanism a means of sensitivity.... Some extent contract deliverables for adherence to contract requirements and quality ; 2013 patient population/intervention/outcome comparison their approaches specific... Your management team needs to start at the organizational level, including physical/ environmental.!
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