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From YouTube: Webinar: Best Practices for Improving Cultural Competency in the Health Care Workforce
Description
Original Webcast May 24, 2013 | Culturally appropriate health care may improve the quality and potentially reduce the cost of care for a diverse array of patients—and can contribute to the elimination of racial and ethnic health disparities. Over the last decade policymakers have explored options to increase cultural competency among health care providers. The Patient Protection and Affordable Care Act, for example, requires federal loan repayment preference be given to individuals who have cultural competency training or experience. This webinar reviews best practices for improving cultural competency among a state’s health care workforce.
A
Welcome
to
today's
webinar
best
practices
for
improving
cultural
competency
in
the
healthcare
workforce
brought
to
you
by
NCSL.
All
lines
have
been
placed
on
a
listen-only
mode
to
provide
favorable
sound
quality.
During
today's
presentation
it
is
now
my
pleasure
to
turn
the
floor
over
to
Megan
ma'am.
The
floor
is
yours.
Thank.
B
You
and
good
afternoon
everyone,
I'm
Megan
Kumasi
from
the
National
Conference
of
State
Legislatures
and
on
behalf
of
ncsl
I,
would
like
to
welcome
all
of
you
to
today's
webinar
best
practices
for
improving
cultural
competency
in
the
healthcare
workforce.
Before
we
begin,
I
would
like
to
thank
the
region,
two
health
equity
council
for
co-sponsoring
today's
webinar
today
we're
very
fortunate
to
have
three
experts
joining
us
to
discuss
best
practices
for
improving
cultural
competence
in
the
healthcare
workforce.
B
Oregon
representative,
ELISA,
Kenny,
Dyer
and
Tricia
Tillman
of
the
Oregon
Health
Authority
will
open,
followed
by
dr.
Robert,
like
of
the
UMDNJ
Robert
Wood
Johnson
medical
school.
Our
webinar
today
will
conclude
with
a
question
and
answer
session.
You
may
ask
a
question
at
any
time
by
clicking
on
the
Q&A
button
on
the
right
hand,
side
of
your
screen
and
typing
a
question.
Please
note
that
you
will
not
be
identified
when
you
ask
a
question.
Nor
can
other
participants
see
what
you
have
typed.
B
B
like
at
this
point,
I'm
pleased
to
introduce
our
first
speaker,
representative,
Alyssa
cannon
Dyer,
has
spent
over
30
years
working
to
eliminate
poverty,
promote
cross-cultural
understanding,
invest
in
youth,
protect
the
environment
and
promote
civil
rights,
since
graduating
from
Stanford
are
earning
her
master's
in
public
health
in
Hawaii
and
working
in
Indonesia.
For
three
years
representative
Kenny
Dyer
has
devoted
most
of
her
professional
and
volunteer
time
to
her
community,
where
for
nearly
20
years,
she
has
worked
with
parents,
activists
and
policymakers
to
invest
in
early
childhood,
public
education
and
healthy
neighborhoods.
B
She
was
a
vocal
advocate,
nonprofit
sector
and
under
representative
under
represented
communities,
and
she
continues
to
serve
on
the
Northwest
Health
Foundation
board.
In
2011,
she
was
appointed
by
the
Moulton
Multnomah
County
commissioners
to
replace
representative
Ben
cannon
in
House
District
46,
which
covers
parts
of
southeast
in
Northeast,
Portland.
Last
November,
representative,
Ken
and
I
are
when
her
first
general
election
to
continue
serving
her
districts
in
all
of
Oregon's.
B
Tricia
Tillman
is
director
for
the
office
event,
equity
and
inclusion
in
the
Oregon
Health
Authority
throughout
her
career,
miss
Tillman
has
worked
to
promote
a
highly
qualified,
diverse
workforce,
to
engage
communities
experiencing
disparities
in
promoting
health
and
well-being
and
to
reduce
social
inequities.
She
has
worked
in
various
capacities
in
maternal
child
and
community
health
over
the
last
19
years.
B
C
C
We're
giving
you
more
information
than
we're
able
to
present
in
this
just
so
that
you
would
have
it
for
the
future,
but
we'll
go
over
it
as
quickly
as
we
can
so
to
begin
with,
our
objectives
of
this
webinar
are
to
provide
a
history
of
the
efforts
leading
up
to
the
passage
of
our
recent
cultural
competency.
Continuing
education
bill
to
just
pass
the
House
and
Senate
and
is
on
its
way
to
be
signed
by
the
governor,
will
provide
an
overview
of
that
bill.
C
House
bill,
26
11,
as
well
as
an
overview
of
two
kind
of
complementary
health
equity
bills,
and
then,
finally,
we
will
share
our
next
steps
for
advancing
cultural
competence
in
Oregon's
health
systems.
So
with
that
I'm
going
to
turn
it
over
to
Tricia
Tillman,
who
has
really
done
the
lion's
share
of
work
in
our
state
for
advancing
this
over
the
last
few
years.
Okay,.
D
Great
thanks
Alyssa.
So
there
are
our
objectives
and
now
I
just
want
to
start
by
sharing
the
vision
and
mission
statement
for
the
office
of
equity
and
inclusion,
and
what
I
want
to
highlight
is
that
we
focus
on
both
the
active,
co-creation
and
enjoyment
of
a
healthy
Oregon
and
that
part
of
co-creation
is
really
grounded
in
engaging
diverse
community
voices
and
so
you'll
see
that
play
out
throughout
this
presentation
and
its
really
played
out
throughout
the
passage
of
House
bills.
2011.
D
It
started,
as
you
can
see,
with
the
governor's
racial
and
ethnic
health
task
force,
which
was
convened
in
1999
and
presented
a
report
to
then
Governor
Kitzhaber,
who
is
our
now
Governor
Kitzhaber
and
in
identified
cultural
competence
as
a
priority,
then,
and
then
in
2008,
with
the
Oregon
Health
Fund
board,
which
was
a
precursor
to
Oregon's
health
systems
transformation.
The
health
equities
workgroup
also
made
recommendations
related
to
the
importance
of
cultural
competency,
continuing
education
for
healthcare
providers,
I'll.
D
So
in
2010,
the
office
of
equity
and
inclusion
convene
commune
of
color
to
help
us
identify
policy
priorities
moving
forward
into
this
2011
legislature,
and
these
were
the
the
priorities
that
were
identified
then
so.
Equal
access
to
health
care,
culturally,
sensitive,
culturally
competent
health
care
and
diverse
and
culturally
competent
to
health
care
providers.
So.
B
D
There's
been
this
seem
that
our
work
has
been
really
grounded
in
and
as
a
result,
when
the
Oregon's
past
this
initial
health
systems,
transformation,
loss
of
the
Oregon
Health
Policy
Board
then
developed
an
action
plan
in
2010
that
included
recommendations
again
related
to
health
equity,
which
included
and
we'll
talk
a
little
bit
about
all
of
this,
because
it's
very
excited
how
quickly
it's
moved
forward.
The
recommendations
included
more
granular
data
by
race,
ethnicity
and
language,
the
use
of
community
health
workers
and
cultural
competence,
continuing
education
for
health
care
providers.
D
The
history
so
because
of
all
the
community
support
in
the
history,
a
legislative
concept
was
developed
in
2010.
It
was
shared
with
multiple
facets
of
the
Health
System.
It
felt
like
peeling
away
the
layers
of
an
onion
and
recognizing
that
there
were
just
many
many
stakeholders
to
engage
with,
including
the
licensing
boards
professional
associations
and
then,
as
we
were
doing,
that,
we
continued
to
build
partnerships
with
community-based
organizations
to
help
us
carry
that
message
forward.
In
2011
we
were
able
to
introduce
Senate
bill
97
as
an
agency.
D
It
was
part
of
the
governor's
agenda,
so
we
were
able
to
work
that
through
the
legislative
process
and
again
with
community
at
the
center,
we
were
able
to
identify
many
many
endorsing
organizations
which
included
health
systems,
provider,
group,
large
advocacy
organizations,
academics
and
community-based
organization.
I
think
all
told
there
were
over
and
the
endorsing
organizations
in
2011.
C
D
So
that
this
bill
passed
with
bipartisan
support
on
the
Senate
side
and
then
at
the
time
the
house
was
split
50/50
or
it
happened,
half
Republican
and
Democrat,
and
so
it
died.
One
vote
short
of
passage
in
that
first
time
through,
but
actually
that
created
an
opportunity
to
include
really
strong
health
equity
language
in
Oregon's
health
systems,
transformation
legislation,
so.
A
D
Up
many
more
opportunities
than
it
would
have
so
this
sort
of
sort
of
shows
how
multiple
entities
have
identified
the
importance
of
cultural
competence.
Continuing
continuing
education,
just
within
Oregon
I
think
Bob
leader
will
talk
about
more
national
effort,
so
you
may
want
to
look
but
okay,
so
the
office
of
equity
and
inclusion,
community
policy
forums.
We
talked
about
that
wearing
an
action
plan
for
health.
The
Oreo
HPV
is
the
Oregon
Health
Policy
Board
Workforce
Committee,
which
also
identified
the
importance
of
cultural
competence
in
the
workforce,
and
then
CCO
requirements
are
coordinated
care
organizations.
D
Many
of
you
are
familiar
with
accountable
care
organizations
as
a
result
of
the
ACA,
but
our
coordinated
care
organization
actually
predated
the
national
into
sation
so
moving
forward
once
the
bill
did
not
pass
in
2011
one
of
the
legislature,
legislators
actually
said
you
don't
need
legislation
to
do
what
your
bill
is
proposing.
So
we
said
you
know
what
you're
right.
So
in
2012,
we
formed
a
cultural
confidence,
continuing
education
committee
and
this
committee
has
three
tasks
again:
very
diverse
membership,
both
professionally
geographically
racially
ethnically
linguistic.
D
We
had
three
tasks:
one
was
to
identify
definitions
of
cultural
competence
and
standards
for
cultural
competence,
continuing
education.
The
second
was
to
explore
existing
continuing
education
options,
and
this
was
amazingly
challenging,
and
it
was
a
wonderful
thing
that
we
just
couldn't
get
our
arms
around
all
the
continuing
education
options,
because
so
many
are
being
developed
every
day.
E
D
So
after
we
landed
on
the
definition,
we
identified
the
cultural
competency
standards
which
include
that
self-awareness
and
self-reflection
acquisition
of
knowledge,
those
specific
knowledge
and
information,
and
then
educational
approaches
for
trainers.
How
we
provide
information
and
then
also
the
acquisition
of
skill,
and
some
of
these
things
include
how
healthcare
professionals
engage
with
healthcare
interpreters
to
assure
linguistic
access.
D
So
the
committee
made
recommendations
for
licensing
board
for
the
Oregon
Health
Authority
for
our
coordinated
care
organizations
and
curriculum
developers.
We
learned
that
some
of
the
licensing
boards
would
be
interested
in
requiring
that
their
licensees
have
cultural
competence,
continuing
education
and
that
others
would
support
a
more
voluntary
approach.
D
C
Great,
so
thank
you,
the
our
legislative
session
and
meets
in
the
odd
years
like
this
is
our
main
session
and
it
meets
from
February
through
beginning
of
July,
so
we're
you
know
about
two-thirds
of
the
way
through
it.
At
this
point,
we
started
out
with
hospital
26/11,
which
was
very
much
like
the
same
one
that
we
had
offered
two
years
ago
that
had
lost
around
mostly
around
party
lines.
C
So
it
was
great
to
have
that
support
he's
had
on
all
the
same
stakeholders
that
we
had
last
time
around
and
the
licensing
boards
who
have
now
spent
several
years
at
this
as
opposed
to
being
fairly
new
to
it
and
the
licensing
boards.
You
know
huge
number
of
boards,
the
Oregon
Medical
Association,
there's
associations,
social
workers.
You
know
all
there,
but
I
think
nineteen
that
are
included
in
our
bill.
So
we
started
with
the
idea
of
making
this
a
requirement
for
licensure.
C
We
ended
up
removing
that
and
we
had
a
compromise
that
said
that
we
would
not
mandate
licensees
to
take
it,
but
that
if
we
would,
we
still
mandate
that
that
the
licensing
boards
have
to
offer
this
as
at
least
an
elective,
and
they
can
choose
whether
they
want
to
make
it
a
requirement
for
their
own
licensees.
But
they
still
have
to
offer
this
in
conjunction
with
Trisha
Pillman's
office.
To
see
what
are
the
you
know.
C
So
Trisha
can
offer
technical
assistance
in
what
kinds
of
programs
are
out
there
and
they're
a
question
of
cost
came
up.
It's
just
going
to
be
really
expensive
for
licensees,
but
because
there's
a
lot
of
online
offerings
that
are
free.
That
made
a
lot
of
the
licensing
boards
more
favorable
to
this
legislation
and
in
terms
of
the
Oregon
universities.
C
These
are
the
stakeholders
oregon
health
equity
alliance
is
emerged,
is
a
very
strong
group
supporting
DIF
and
other
related
legislation
and
then
on
the
right.
You'll
see
that
the
primary
groups
that
fat
around
the
table
to
help
really
develop
this
legislation
and
then
negotiate
some
of
the
compromises.
C
So
it
started
on
the
house
side
and
the
a
in
gross
version
which
you
can
see.
You
can
read
the
whole
thing.
If
you
go
google
oregon
legislative
information
system
oregon
legislature,
information
system,
you
can
actually
get
the
text
there
of
the
a
in
gross
version.
I
carry
that
it
passed
with
fairly
good.
C
You
know
bipartisan
support
and
then
went
over
to
the
senate
side
past
the
health
care
committee
there
and
went
on
to
passed
the
house
just
this
week.
I
mean
the
Senate
floor.
Just
this
week
it
was
carried
by
Senator
winners.
Republican
she
happens
to
be
the
only
African
American
member
of
the
Senate
in
Oregon,
and
is
going
to
be
talking
about
this
bill
on
June
8th
at
the
National
caucus
of
black
legislators.
So
very
strong
support
there.
Twenty
six
to
two.
C
So
it's
really
picked
up
more
and
more
support,
as
we've
gone
through
and
having
it
carried
by
a
Republican
in
the
Senate,
was
really
helpful
to
gain
almost
unanimous
support
on
the
Senate
side,
one
of
the
other
pieces
of
legislation,
that's
very
complementary.
House
bill
21
34
establishes
uniform
standards
for
collection
of
data
on
race,
ethnicity,
preferred
languages
and
disability
status,
so
this
is
primarily
an
Oregon
Health,
Authority
and
Department
of
Human
Services.
C
The
idea
behind
it
was
that
we,
if
we
need
to
disaggregate
our
data
so,
for
instance,
we're
not
wanting
all
Asian
Pacific
Islanders
into
our
data
collection,
which
really
gives
us
very
poor
information
on
what
are
the
health
challenges?
What
are
you
know?
What
is
teen
pregnancy,
water
cancer
rates,
all
those
kinds
of
things
and
make
it
much?
It
makes
it
much
harder
for
us
to
develop
specific
strategies
to
meet
the
needs
when
we're
not
even
clear
about
what
the
needs
are.
C
So
this
was
very
complementary
again
supported
by
the
Oregon
Health
equity
Alliance,
primarily-
and
this
one
had
a
lot
of
port,
very
strong
on
the
house
55
to
4
and
been
carried
by
the
chair
of
the
Health
Committee
on
the
Senate
side,
Laurie
Moniz
Anderson
and
passed
unanimously
over
there.
So
very
strong
legislation.
It's
not
going
on
to
be
signed
by
the
governor,
yet
because
there
was
a
very
small
technical
tweak,
which
means
it
has
to
come
back
over
the
house
side
for
concurrence.
C
But
that
should
happen
this
week
and
both
those
bills
should
be
signed
by
the
governor
very
soon
and
then
the
other
legislation
again.
This
is
the
third
piece
of
what
Tricia
mentioned
before,
and
the
report
that
had
come
out
establishing
a
traditional
health
care
workers
commission
within
Oregon
Health
Authority.
There
has
been
an
informal,
more
informal
advisory
groups
of
traditional
health
care
workers
that
have
been
meeting
to
start
developing
ideas
about
peer
navigators,
pure
I,
guess,
personal
navigators,
pure
wellness,
doulas
and
community
health
workers.
C
So
these
are
the
unlicensed
professions
that
we're
really
trying
to
build
up
in
our
in
our
new
coordinated
care
organization
and
integrated
health
care
model.
Really
relying
on
the
primary
care
workforce
and
those
that
are
working
in
the
community
are,
you
know,
are
the
ones
that
are
traditionally
more
from
the
communities
that
we're
trying
to
serve
and
cultural
competency.
You
know
we're
hiring
them
because
of
their
cultural
competency,
but
it
ties
very
well
with
the
whole
effort
of
really
recognizing
where
people
come
from
their
cultures.
C
So
this
one
I'm
past
the
house
Health
and
Human
Services
Committee
and
was
referred
to
way
to
meand,
there's
not
a
cost
to
it,
so
there
should
not
be
any
problem
in
Ways
and
Means,
but
everything
is
being
held
up
right
now.
Always
it
means
just
because
we
don't
have
our
budget
numbers
yet,
but
we
are.
We
are
very
hopeful
that
this
will
pass
ways
and
means
and
then
go
on
to
the
House
and
Senate
floors
and
be
signed
into
legislation
as
well.
D
All
right
back
to
Tricia,
so
in
the
remaining
two
minutes,
what
I
just
want
to
share
is
so
now
what
the,
beyond
our
little
time
we're
going
up
beyond
2013.
What
are
we
going
to
do
now
with
the
legislative
session
coming
to
close
in
the
end
of
June?
Hopefully,
so
our
next
steps
are
really
around
implementing
the
cultural
competence
and
continuing
education
committees,
recommendations
so
we'll
work
with
our
coordinated
care
organizations
and
their
innovator
agents
to
make
continuing
education
for
cultural
competence
available
within
our
Medicaid
system
of
delivery.
D
But
we'll
now
go
back
to
our
committee
to
look
at
how
we
now
identify
the
best
cultural
competence,
continuing
education
options
and
make
those
available
to
the
licensing
boards.
We
also
heard
from
our
committee
that
they
want
us
to
look
at
organizational
cultural
competence,
so
it's
important
to
have
individual
providers
be
culturally
competent,
but
if
the
organizational
structure
that
they
work
in
is
not
cultural
competence,
culturally
confident
and
it's
challenging
for
them
to
be
effective.
D
Bruce
Goldberg,
has
been
really
consistent
and
saying
that
it
doesn't
make
sense
for
us,
as
the
Oregon
Health
Authority,
to
make
these
requirements
of
our
external
health
system
partners
and
not
have
the
same
internal
policy
for
our
own
leadership
and
staff.
So
we'll
be
working
over
the
next
year
on
cultural
competence,
continuing
education
requirements
for
the
Oregon
Health
Authority,
so
advancing
beyond
house
built
26:11.
D
Of
course,
we
now
have
the
mandate
of
getting
a
system
in
place
for
that
health
licensing
board,
but
because
of
Oregon's
health
reform,
there
are
many
opportunities
for
advancing
cultural
competence,
including
working
with
the
coordinated
care
organizations
and,
as
Alissa
mentioned,
looking
at
how
we
embed
community
health
workers
and
pro
medoras
into
the
health
system,
making
sure
our
data
collection
is
more
granular
and
relevant.
And
then
we
have
a
number
of
things
that
we're
building
in
terms
of
leadership
development.
Our
Delta
cohort
is
a
learning
collaborative.
D
D
So
that
concludes
our
presentation.
I
would
encourage
you
to
take
a
look
at
our
website.
We
do
have
the
report
of
the
cultural
competence,
continuing
education
committee
online
and
if
you
have
any
problems
finding
that
or
even
if
you'd,
like
a
report
of
our
effort
in
2011
and
our
lessons
learned
from
the
2011
process,
that's
something
that
we
can
share
with
you
so
feel.
Free
to
email
me
and
I
will
connect
you
with
the
appropriate
people.
B
Thank
You
representative
Kenny
Guyer
and
miss
Tillman.
Now
we
will
hear
from
dr.
like
who
is
professor
and
director
of
the
Center
for
Family
Health
II
families
and
cultural
diversity
in
the
department
of
family,
medicine
and
community
health
at
the
UMDNJ
Robert
Wood
Johnson
medical
school.
Dr.
Lake
has
a
background
in
medical
anthropology
received
his
MD
from
Harvard
Medical,
School
and.
D
B
Medicine
residency
and
fellowship
training
at
Case,
Western,
Reserve
University.
He
has
served
on
numerous
expert
panels
and
task
forces,
including
the
Department
of
Health
and
Human
Services
OMH
office
of
minority
health
class
standards,
national
advisory
committee,
the
NPA
regional
health
equity
Council
for
region
2
and
the
AMA
n
ma
n
HMA
Commission
to
end
health
care
disparities.
He
has
also
co-chaired
the
SPF
M
group
on
multicultural
health
care
and
education.
Dr.
B
E
Thank
you
very
much
and
my
thanks
to
ncsl
for
the
very
kind
invitation
to
present
today
and
to
share
the
webinar
with
our
colleagues
from
Oregon.
It's
really
an
honor
and
privilege
to
do
so
as
a
practicing
family
physician
with
a
background
in
medical
anthropology.
This
subject
has
really
been
a
passion
of
mine
for
more
than
25
years,
it's
relevant
to
my
day-to-day
work,
caring
for
patients
and
in
teaching
the
next
generations
of
physicians
and
other
healthcare
providers.
E
Needless
to
say,
it's
a
very,
very
large
subject,
and
so
again
we
won't
be
able
to
spend
a
lot
of
time
on
the
different
slides.
But
there
is
an
extensive
I
think,
five
or
six
page
resource
list
that
I've
shared
with
NCSL,
which
hopefully
will
be
things
that
people
can
make
use
of
in
your
own
work
in
the
different
states
and
I've,
been
asked
to
really
focus
and
provide
a
national
and
a
bit
of
a
New
Jersey
perspective.
So
what
I'll
do
briefly
will
again
revisit
the
concept
and
rationale
for
culturally
competent
care?
E
Look
a
little
bit
at
state
legislation
and
accreditation
standards
that
require
education,
about
health
disparities
in
culturally
competent
care
share.
Some
of
our
experience
in
New
Jersey
talk
a
little
bit
about
the
recently
launched
enhanced
national
clas
standards
and
their
relevance
for
healthcare
reform
efforts
and
then
finally
offer
some
examples
of
suggest,
selected,
legislative
policy
options,
actions
and
best
practices
that
can
help
educate
the
culturally
competent
health
professions,
workforce
and
the
delivery
of
care
to
our
diverse
populations.
A
lot
to
cover.
Now
we've
heard
some
definitions
of
cultural
competence.
What
is
it
well?
E
First
of
all,
what
is
it
not?
Cultural
competence
is
not
about
being
PC
politically
correct.
It
really
is
about
being
professionally
and
personally
caring.
It's
about
providing
personalized
care,
patient-centered
care
for
everyone,
no
matter
what
their
background
as
I
work
in
clinics
and
hospitals
and
emergency
rooms
in
different
settings.
It
comes
up
every
single
day
in
my
work
with
people,
no
matter
what
their
background
and
as
was
mentioned
in
the
previous
presentation.
E
It
not
only
occurs
in
our
interactions
with
each
other
at
the
staff
level
or
with
patients
and
clients,
but
in
organizations
and
systems
of
care
and
cultural
competence
is
not
limited
to
the
healthcare
sector.
My
colleagues
in
the
business
sector
and
global
commerce
really
know
that
in
a
changing
multicultural
world,
we
all
have
to
be
culturally
competent.
Now
this
is
a
definition
slide
from
the
Commonwealth
Fund
that
talks
about
it
being
systems
that
provide
care
to
people
with
diverse
values,
beliefs
and
behavior,
about
individualizing
and
tailoring
that
care
to
meet
people's
needs.
E
It's
a
health
care
system
and
workforce
that
delivers
the
highest
quality
care
to
everyone,
regardless
of
race,
ethnicity,
cultural
background,
language,
proficiency,
literacy,
age,
gender,
sexual
orientation,
disability,
religion
or
socioeconomic
status.
It's
really
about
the
human
condition
over
the
25
years,
I've
had
the
privilege
of
working
in
this
area
and
where
I
go
around
the
country
at
different
to
different
hospitals
and
clinics.
These
are
the
factors
that
the
Georgetown
National
Centre
for
cultural
competence
identified
as
some
of
the
levers
that
are
bringing
about
change,
they're
the
demographic
aspects
with
40%
of
the
u.s.
E
being
populations
of
color
by
2030
ingre
influx
of
new
immigrants,
migrants
from
different
backgrounds-
and
this
is
really
in
all
states-
in
urban,
suburban
and
rural
areas.
It's
about
dealing
with
health
disparities
that
affect
people
of
diverse
backgrounds
and
I'll,
say
a
little
bit
more
about
that
in
a
moment.
Fundamentally,
as
a
clinician,
it's
about
improving
the
quality
of
the
services
and
outcomes
that
I
provide,
and
hopefully
hopefully
you
don't
have
to
be
a
patient.
But
if
you
do
you
want
to
receive
the
best
quality
care
you
can.
E
We
will
focus
more
now
on
legislative,
regulatory
and
accreditation
requirements
and
I'll
say
more
about
that
in
a
moment.
There's
a
business
case
increasingly
being
made
with
some
estimates,
saying
that
the
populations
of
color
will
have
four
trillion
dollars
in
purchasing
power
in
the
coming
years
and
then
from
a
legal
risk
management
standpoint.
You
don't
want
to
be
sued.
If
people
don't
understand
what's
happening,
if
they
take
medications
the
wrong
way,
so
there's
liability
and
malpractice
aspects
to
this.
So
as
we
talk
with
people,
there
are
different
reasons
that
drive
people
to
do
this
work.
E
Now
the
Institute
of
Medicine
is
mandated
by
the
Congress
to
look
at
different
issues.
These
are
a
couple
of
reports.
People
may
be
familiar
with
mm
to
the
unequal
treatment
report,
many
recommendations,
one
of
them
being
that
all
health
care
providers
should
be
made
aware
of
these
disparities
in
health
care
and
that
everyone
can
benefit
from
cross
cultural
education
and
then,
just
last
year,
a
progress
report
showing
that
there
are
some
areas
of
improvement.
People
are
making
change,
but
there
are
there's
still
a
lot
of
work
to
be
done.
E
Similarly,
the
agency
for
Healthcare,
Research
and
quality
since
2003
has
issued
reports
and
again
some
improvement,
but,
alas,
healthcare
quality
and
access
are
suboptimal,
especially
for
minority
and
low-income
groups.
Quality
is
improving,
but
access
and
disparities
are
not
improving
across
all
groups.
Urgent
attention
is
warranted
to
ensure
continued
improvements
in
quality
and
progress,
and
not
just
looking
at
populations
but
looking
at
different
geographic
areas,
particularly
in
our
rural
areas,
and
then
progress
is
uneven
with
respect
to
many
of
the
national
priorities.
E
So
again,
the
data
that
people
may
need
for
different
conditions
like
cardiovascular
disease,
diabetes,
asthma,
depression,
you
name
it
they're
being
looked
at
in
a
very
granular
way
in
these
reports.
Now
one
of
the
key
issues,
of
course,
given
the
deficits
and
our
economic
concerns
is
the
economic
burden
of
health
disparities
and
dr.
Thomas
LaVista
and
colleagues
at
Johns.
Hopkins
present
this
important
information
between
2003
and
2006,
the
combined
costs
of
health
inequalities
in
premature
death,
one
point
to
four
trillion
dollars.
E
It's
estimated
eliminating
disparities
for
minorities
would
reduce
direct
medical
care
expenditures
by
229
point
four
billion
30
point.
Six
percent
of
direct
medical
expenditures
for
african-americans,
Asians
and
Hispanics
were
excess
costs
due
to
health
inequalities
and
eliminating
health.
Inequalities
for
minorities
would
have
reduced
the
indirect
costs
associated
illness
and
premature
death
by
more
than
one
trillion
dollars.
So
as
we
talk
about
bending
the
cost
curve,
not
only
at
the
national
level
but
in
our
states
or
municipalities
or
local
communities,
this
this
is
one
major
area
that
we
need
to
really
take.
E
A
look
at
and
cultural
competency
will
play
a
role,
but,
as
I'll
say
later,
it
may
be
necessary,
but
it's
not
sufficient
to
do
the
job
here
now.
These
are
these
are
the
many
different
groups
that
are
forming
around
the
entry
constituencies,
stakeholders
that
are
really
moving
actively
forward,
so
the
office
of
minority
health
has
the
National
Partnership
for
action
to
end
health
disparities,
a
national
action
plan
and
a
stakeholder
strategy
region.
E
Health,
regional
health,
equity
council,
to
which
I
have
the
privilege
of
serving
on,
represents
New
Jersey,
New,
York,
Puerto
Rico
and
the
Virgin
Islands.
But
there
are
nine
additional
recs
around
the
country
and
some
of
them
have
people
from
legislative
positions
as
well
as
the
business
sector
involved,
as
well
as
community
nonprofits
and
other
groups
and
they're
all
working
together
to
say
what
can
we
do
to
address
these
issues?
But
there
are
five
goals.
E
Cultural,
linguistic
competency
is
one
of
them,
but
the
other
four
include
increasing
awareness
about
disparities,
spawned
strengthening
and
broadening
leadership
for
addressing
this,
improve
the
health
system
and
life
experience,
improving
health
and
health
outcomes
for
different
groups
and
collecting
the
data
necessary,
researching
it
and
evaluating
impact.
So
this
is
a
very
important
you
know
initiative
that
I
would
hope
more
people
around
the
country
can
get
involved
with
oh
see,
we
lost
the
slide
here.
Just
a
moment
need
help
from
NCSL.
B
E
We
need
to
do
something
about
it
and
there
are
three
major
parts
to
this:
there's
increasing
the
collection
and
use
of
race,
ethnicity,
language,
preference,
data,
it's
also
about
increasing
cultural
competency
training
and
it's
increasing
diversity
in
leadership.
So
again
this
they
have
a
website
and
talk
about
many
important
areas
where
again,
I
think
legislators
and
staff
can
get
more
involved
in
activities.
E
The
next
slide
relates
to
the
AMA,
NMA
and
nhm,
a
commission
to
end
health
care
despair,
and
this
has
been
around
for
more
than
five
to
six
years
and
represents
70
leading
medical
organizations
from
the
private
sector
that
and
the
private
practice
of
medicine.
That
say,
we
need
to
do
away
with
healthcare
disparities.
We
need
to
improve
health
outcomes,
and
so
again
this
is
another
very
important
initiative.
I
think
we're
still
a
little
bit
ahead
on
slides.
Are
we
able
to
go
back
at
all?
E
Okay?
Hopefully
those
will
be
up
on
the
final
version.
The
next
slide,
which
would
appear,
is
called
legislative
initiatives
to
foster
health,
equity
and
cultural
competency,
and
this
is
an
important
slide.
It
includes
a
document
that
Dennis
and
rulest
developed,
which
looks
at
the
Affordable
Care
Act,
and
the
variety
of
provisions
relating
to
the
healthcare
workforce,
as
well
as
health
disparities
and
cultural
competence,
and
there
are
many
many
important
provisions
in
there
that
some
have
been
funded.
Some
have
not
been
funded,
but
they
represent
the
directions
that
we
can
be
going.
E
The
next
document
in
there
was
developed
by
Torah
good
at
the
Georgetown
national
center
for
cultural
competence,
funded
by
the
Robert
Wood
Johnson
Foundation,
and
that's
called
state-level
strategies
to
address
health
and
mental
health
disparities
through
cultural,
linguistic
competency,
training
and
licensure,
and
what
they
did
is
they
analyzed
the
efforts
of
14
states
to
integrate
cultural
linguistic
competence
into
their
CM
e
requirements
and
what
were
the
barriers
and
the
facilitators
to
doing
so?
So
again,
all
of
this
is
available
online.
The
third
article
is
actually
one
that
Darcy
graves,
I
and
others
wrote.
E
I
think
we're
now
at
the
slide
which,
in
my
presentation,
called
standards,
accreditation
requirements
and
guidelines,
and
it
speaks
to
the
fact
that
efforts
in
this
area,
even
before
legislation
came
on
to
has
come
on
board
work
in
place
by
groups
like
the
Joint
Commission,
the
National
Committee
for
Quality
Assurance,
the
National
Quality
forum.
Looking
at
what
can
healthcare
organizations
manage
care
plans
and
other
delivery
groups?
E
Now
we're
back
online
now,
hopefully
with
the
slides.
The
this
slide
is
about
the
healthcare
workforce
and
the
need
for
interprofessional
training.
One
of
the
challenges
is
that
often
the
training
takes
place
in
silos,
so
nurses
train
with
nurses
and
physicians
with
physicians
and
psychologists
with
psychologists,
but
we
know
with
chronic
illness
and
the
fact
that
to
reduce
costs,
that
really
requires
an
interdisciplinary
interprofessional
team
model
who
are
beginning
to
see
things
develop
that
bring
together
the
different
Health
Professions
and
say
how
do
we
learn
together?
E
Just
as
an
example
in
our
own
Medical
School,
we're
working
in
the
area
of
the
joining
forces
initiative
that
came
out
of
the
White
House,
looking
at
the
needs
of
our
veterans
warriors
and
returning
service
members
who
are
dealing
with
post-traumatic
stress
disorder
and
traumatic,
brain
injury
and
the
impact
on
their
families?
And
this
really
requires
bringing
together
the
medical
sector,
the
behavioral
health
sector,
the
nursing,
the
social
work
to
really
learn
about
military
cultural
competence.
E
If
you
will-
and
so
that's
just
one
example,
but
also
when
we
begin
to
look
at
cardiovascular
disease,
diabetes,
cancer,
mental
health
conditions,
oral
health
conditions,
it
requires
a
team
effort,
and
so
it's
really
critical
to
begin
to
connect
the
silos
and
again
it
will
be
helpful
to
move
more
of
our
training
in
this
direction.
Okay,
we
seem
to
have
lost
the
slide
again.
This
slide
is
called
state
initiative
is
best
in
promising
practices.
E
The
aah
CPR
I
had
a
chance
to
participate
this
and
what
this
did
is
it
brought
together
their
states
from
across
and
people
from
across
the
political
spectrum
to
share
initiatives
that
were
going
on,
and
these
were
initiatives
about
about
the
data
being
collected,
real-world
examples
of
innovative
approaches
to
promote
cultural
competence
at
the
health
plan,
health
system
and
community
level,
and
to
identify
strategies,
and
so
again
you
know,
what's
the
old
saying,
sometimes
things
are
not
new.
It's
sort
of
back
to
the
future.
E
E
I'll
talk
about
New
Jersey
in
a
moment
which,
because
we
were
the
first
state
to
require
this
but
California
Washington,
New,
Mexico
and
Connecticut-
were
the
next
states
with
requirements
Maryland
as
voluntary
Oregon
set,
looks
like
it's
poised
to
be
next
and
I
understand
that
Texas
has
a
bill
pending
HB
1045,
which
would
develop
a
task
force
to
design
cultural
compensation
requirements
for
selected
health,
education
programs
and
disciplines.
The
important
point
is
that
the
states
are
the
natural
laboratories
for
this
work.
One
shoe
will
not
fit
all
some
states
are
using
a
mandate
approach.
E
E
Others
are
developing
task
forces
to
sort
of
look
probably
what
the
other
states
are
doing,
so
they
don't
make
the
same
mistakes
or
at
least
build
on
the
best
practices
so
what's
happening,
and
there
are
some
states
which
had
bills
that
either
didn't
make
it
out
of
committee
or
others
that
were
vetoed
so
I
think
that
there's
a
lot
of
activity
that
continues
to
move
forward
and
I
personally
believe
that
this
is
only
going
to
escalate,
given
our
changing
demographics.
Next
slide.
Oh
that's
for
me
to
do
sorry.
E
So
a
little
bit
about
New
Jersey
in
2005
we
had
a
and
the
story
of
our
legislation
is
included
in
an
article
in
the
resource
list.
So
I
won't
get
into
that
in
detail,
but
it
was
enacted
by
the
New
Jersey
Board
of
Medical
Examiner's
in
consultation
with
the
Commission
on
Higher
Education.
It
included
physician
and
podiatry
training.
It
requires
that
all
medical
schools
in
our
state
provide
instruction
to
their
current
and
future
students.
E
It's
a
condition
to
receiving
a
diploma
from
a
College
of
Medicine
in
New,
Jersey
and
I
should
say
that
most
of
the
schools
were
already
doing
this.
Anyways
to
meet
the
needs
of
our
communities,
but
this
helped
to
really
give
it
additional
thump.
The
New
Jersey
medical
schools
were
also
required
to
provide
cultural
competency.
Cme
instruction
for
licensed
physicians
and
the
board
of
medical
examiners
decided
on
six
CME
credits.
I
can
tell
you.
There
were
earlier
discussions.
E
I
believe
that
my
memory
serves
me
as
much
as
14
to
16
credits,
and
there
are
others
who
wanted
no
requirement
or
one
or
two
credits.
This
I
suspect
was
a
compromise,
but
it
was
a
one-shot
deal.
It
was
not
an
ongoing
requirement.
As
such
it's
different
than
some
other
states.
It
looks
like
we're
off
the
slides
again.
Sorry.
The
next
slide
says
that
the
majority
opted
for
online
CME
programs,
and
there
are
some
examples.
The
majority
of
folks
went
to
the
office
of
minority
health,
physicians,
practical
guide
to
culturally
competent
care.
E
The
statistics
I've
received
is
that,
as
of
December
2004,
there
were
more
than
35,000
registrants
nationally
and
150
thousand
credits
offered
in
New
Jersey
prior
to
2008.
There
were
35
reporter
that
would
sign
up
after
the
legislation
went
into
effect.
More
than
2,400
took
the
per
quarter
and
that
continues
to
increase,
and
not
just
physicians,
but
also
this
as
well
as
training
programs
for
nurses
for
first
responders,
and
the
emergency
health
system
also
are
available
online.
There's
another
program
from
the
health
resources
and
Services
Administration
called
effective
communication
tools
for
health
professionals.
E
We
formerly
unified
health
communication
101,
which
deals
with
language,
literacy
and
cultural,
and
that
has
actually
been
accredited
by
the
National
Committee
for
Quality
Assurance
and
the
American
Board
of
Family
Medicine
includes
that
as
part
of
maintenance
of
certification
options
for
physicians.
So
again
we're
beginning
to
see
specialty
organizations
increasingly
picking
up
on
this
I
guess
you
can
take
the
slides
back,
I'm,
not
able
to
advance
successfully
apologies.
But
again,
hopefully
this
will
be
online
for
you
later.
E
The
next
slide
talks
about
an
example
of
a
program
that
we
offered
through
our
Center
for
healthy
families
and
cultural
diversity,
which
was
tied
to
the
American
Association
of
medical
colleges
requirements,
and
it
talks
about
some
of
the
specific
educational
modules.
What
was
exciting
about
this
program
is
that
not
only
did
it
talk
about
knowledge,
skills
and
attitudes,
but
the
clinicians
would
get
together
and
share
real-life
clinical
stories
from
the
settings
that
they
worked
in
the
struggles
of
their
patients
and
their
successes,
as
well
as
their
own
and
practical
strategies
that
make
a
difference.
E
In
addition,
it
was
an
opportunity
for
people
to
check
their
own
pulse
and
to
look
at
could
I
carry
unconscious
bias
or
prejudice,
as
well
as
the
different
isms,
whether
it's
racism,
sexism
ageism,
homophobia
and
all
the
other
things
that
often
cause
difficulties.
So
you
know
again,
there
are
benefits
of
both
live
programs
as
well
as
web-based
programs,
and
many
people
prefer
blended
programs
the
next.
E
Now
we
don't
have
time
to
get
into
the
quantitative
results,
but
we
actually
had
very
positive
responses
from
many
of
the
people
who
took
this
program,
despite
this
being
an
unfunded
mandate
in
the
state,
but
we
also
in
our
qualitative
results.
There's
a
slide.
That's
called
the
good
bad
and
ugly
of
this
work,
and
so
we
heard
opposition
to
mandated
training
requirements.
Anger
toward
the
subject
area.
E
Is
this
a
waste
of
time
also
frustration
with
the
health
care
system,
reimbursement
not
being
enough
liability,
but
others
who
were
pleasantly
surprised,
who
found
it
relevant
and
useful
who
felt
that
other
topics
needed
to
be
covered?
And
actually
some
said
why
just
the
physicians?
This
really
should
go
to
the
nurses,
the
social
workers,
the
medical
administrators,
in
fact
everyone.
But
they
also
said
cultural
competence.
Education
is
important,
but
not
sufficient
to
eliminate
disparities
in
health
and
healthcare.
If
we
can
go
that
slide,
that
says
the
Maryland
health
improvement
and
disparities
reduction
Act.
E
Here's
an
example
of
another
state,
that's
worth
taking
a
look
at
doing
expansive
things
much
like
Oregon.
This
is
was
presented
by
dr.
Coletti
'his
sane,
who
worked
very
closely
with
the
Maryland
legislature
and
had
champions
within
their
and
in
their
Maryland
health
improvement
disparities
reduction,
Act
you'll
notice.
E
Please
also
asking
institutions
with
regarding
licensing
to
report
on
what
they're
doing
to
reduce
disparities
commissions
and
then
the
sixth
part
is
develop
standards
and
criteria
for
cultural
competence
in
medical
and
behavioral
health
and
treatment
settings
they're,
also
working
in
the
area
of
health
literacy.
So
this
didn't
happen
overnight.
It
took
lots
of
work
by
different
groups
and
again
having
champions
in
the
legislature
to
say
this
is
important
for
everyone
next
slide,
please.
E
So
what
are
the
lessons
we've
learned
from
this?
We
need
to
create
learning
environments
that
foster
safety,
trust
and
respect.
There's
no
cookbook
approach.
We
need
to
look
at
the
diversity
we
need
to
deal
with
stereotyping
and
over
generalization.
We
also
need
to
take
an
assets
and
strength
based
approach
to
look
at
not
cultural
competence,
cultural
issues
as
a
barrier
or
pathology,
but
are
things
that
people
can
benefit
from
that
every
encounter
is
cross-cultural,
no
matter
what
our
background
and
that
it's
a
lifelong
journey,
not
a
final
destination.
Next
slide.
E
So
the
office
of
minority
health
issued
the
national
standards,
the
class
standards
which
advances
health
equity,
improves
quality
and
helps
to
eliminate
disparities
by
providing
a
blueprint
to
implement
these
services
in
2010.
Just
a
few
weeks
ago,
they
launched
the
National
clas
standards,
enhancement
initiative,
so
that's
a
few
years
ago
to
revise
the
standards
and
the
new
ones
were
just
released
next
slide
and
there
were
previously
fourteen
standards.
Now,
what
they've
done
is
they
have
a
principal
standard?
They
have
a
new
thematic
standard
relating
to
governance,
leadership
and
workforce.
E
One
of
the
key
points
being
that
training
the
workforce
is
not
enough.
It
also
has
to
get
to
the
c-suite
to
the
boards
of
Trustees
to
the
leaders
to
the
administrators.
There
is
an
increased
focus
not
just
on
language
but
on
other
forms
of
communication.
People
with
disabilities,
low
health,
literacy
challenges,
other
special
communication
needs,
and
it's
also
about
quality,
improvement,
patient
safety
and
engagement
with
communities.
So
this
information
is
all
available
at
the
website.
Next
slide,
as
is
a
blueprint
and
so
a
lot
of
in
the
one.
E
The
first
standards
were
issued
a
decade
plus
ago.
People
said
great:
the
standards
are
here,
but
how
do
we
do
it?
And
what
have
other
people
done?
And
this
is
an
annotation
that
shows
what
real-life
examples
from
around
the
United
States
from
urban,
suburban
rural
areas,
from
hospitals
from
clinics
from
federally
qualified
health
centers
to
private
practices,
about
what
can
be
done?
What
can
be
done,
and
it's
not
only
about
dealing
with
disparities,
but
it's
promoting
healthy
lifestyles
and
wellness.
E
It's
about
dealing
with
prevention,
it's
about
dealing
with
chronic
illness
and
it's
about
reducing
unnecessary
expenditures.
Next
slide.
Now
the
next
three
slides
are
probably
the
most
important
in
the
presentation.
The
Texas
Health
Institute
came
out
with
a
very
important
document
recently,
particularly
given
the
focus
on.
You
know.
The
ACA
and
federal
state
run
and
hybridized
health
insurance
exchanges,
and
there
are
many
ask
x2
the
report,
but
I
want
to
call
out
two
recommendations.
E
One
is
that
exchanges
should
consider
recommending
that
health
plans
qualified
to
be
sold
in
the
exchange
use
research
resources
such
as
the
class
standards
to
guide
their
work,
and,
secondly,
navigators,
in-person
assisters
call
center
personnel
and
others
who
deal
with
consumers
should
receive
adequate
training
and
cultural,
linguistic
competency
standards
and
translators.
Interpreters
be
trained
and
follow
these
standards.
So
they
looked
at
a
number
of
different
states
that
and
seeing
what
they're
currently
doing-
and
everybody
is
pretty
early
on
in
the
process.
E
But
I
would
think
that
this
is
an
incredibly
important
area,
because
if
our
communities
are
going
to
understand
how
to
sign
up
for
the
exchanges,
will
it
be
put
into
languages
that
they
can
understand
whether
it's
an
English
or
another
language,
whether
people
who
are
visually
impaired
or
have
cognitive
limitations
or
developmentally
disabled?
How
will
this
information
get
out
to
serve
communities
and
particularly
people
with
chronic
health
conditions?
If
people
have
AIDS,
if
they
have
diabetes,
if
they
have
asthma,
how
do
they
make
their
ways
through
the
systems?
What
subsidies
might
they
need?
E
So
I'd
like
to
offer
my
thoughts
as
a
clinician
as
to
and
some
recommendations
as
to
what
state
legislators
can
do
well,
they
can
serve
as
community
leaders
and
champions
and
developing
initiatives
to
raise
awareness
about
disparities
in
health
and
health
care
and
power
change
that
meets
the
Triple
Aim
of
better
health.
That's
population,
health,
better
care,
better
experience
of
care
and
lower
cost
per
capita
cost.
Second,
we
can
craft
legislation
and
policies
that
are
culturally
and
linguistically
competent
and
consider
the
impact
on
diverse
communities
and
constituencies
just
a
quick
example
in
New
Jersey.
E
We
recently
had
signed
into
law
by
Governor
Christie
the
post
legislation,
the
practitioner
orders
for
life-sustaining
treatment,
so
not
advanced
directives
and
living
wills.
But
here
these
are
medical
orders
where
people
can
express
their
desires
for
artificial
rehydration
nutrition,
cardiopulmonary
resuscitation
for
ventilation,
it's
in
English.
What
languages
will
this
be?
Translated
into
these
complex
concepts
be
made
understandable
to
people
with
limited
health
literacy.
Maybe
a
few
states
have
begun
to
deal
with
this,
but
there's
an
example
that
passing
a
bill.
E
If
we
can
sort
of
look
at
the
socio-cultural
impact
and
see
how
we
can
make
it
work,
it's
much
more
likely
to
be
successful
third
bullet.
We
can
facilitate
efforts
to
eliminate
disparities
and
access
service,
utilization,
quality
and
outcomes
that
exist
in
different
populations.
Certainly
with
Medicaid
expansion
taking
place
now
I.
E
Imagine
most
states
are
very
involved
with
figuring
out
how
this
is
going
to
happen,
and
so
that's
clearly
one
area,
but
I
would
say
that
it
relates
to
everybody,
not
just
Medicaid
patients,
but
all
payers
all
people
in
a
state
are
going
to
be
impacted.
Similarly,
how
do
we
ensure
that
the
state
employee
workforce
receives
the
highest
quality
culturally
linguistically
appropriate
care
again,
something
that
state
legislators
are
concerned
about
as
they
should
be,
but
also
this
affects
everybody
in
one
state,
all
one's
constituents
next
slide.
E
Last
four
recommendations
again:
support
efforts
to
integrate
cultural,
linguistic
competence
into
patient
centered
medical
homes,
integrated
primary
care,
behavioral
health
homes,
accountable
care
organizations
and
other
emerging
service
delivery
models.
This
is
a
big
piece
again
of
the
the
ACA,
but
there
are
many
initiatives
around
the
country
talking
about
patient-centered
medical
homes
as
ways
to
improve
outcomes
of
care,
to
improve
uptake
of
preventive
services,
to
promote
wellness,
to
really
give
people
opportunities
to
improve
their
own
health.
E
As
well
as
dealing
with
many
of
the
system's
challenges,
we
legislators
can
convene
study
groups,
blue
ribbon
panels,
task
forces
and
other
advisory
groups
and
hold
town
hall
meetings
and
hearings
to
solicit
input
and
participation
from
community
members.
One
of
the
key
points
here
is
that
communities
are
often
the
experts.
They
often
know
what
the
issues
are,
and
so
how
do
we
bring
them
to
the
table
and
not
impose
what
we
think
may
be
culturally
and
linguistically
competent
solutions
without
getting
their
input?
Third
floors?
E
Actually:
seventh
bullet
incentivize,
the
integration
of
lifelong
cultural,
linguistic
competency,
education
into
K
through
12,
undergraduate,
postgraduate
professional
and
look
at
its
effectiveness
and
outcomes.
A
key
issue
here
is
that
if
we
wait
for
CME
programs
for
already
trained
physicians
and
nurses,
or
even
medical
students,
its
kind
of
late
in
the
game,
this
is
really
lifelong
learning
and
then,
finally,
maybe
this
is
a
little
bit
bold,
but
I
would
say
avail
yourselves
are
the
opportunities
to
participate
in
ongoing
cultural
competency,
training,
I,
think
the
more
of
these
sorts
of
dialogues
we
have
together.
E
We
found
that
when
we
brought
together
the
physicians,
the
nurses,
the
administrators,
even
policy,
people,
people
got
to
see
things
through
multiple
eyes
and
it
was
out
of
that
special
dialogue
that
things
happen
next
slide,
so
key
take-home
messages,
disparities
in
health
and
healthcare
are
common
and
disproportionately
impact
minority,
ethnic
and
socioeconomic
ly.
Disadvantaged
communities,
recent
health
care
policy,
legislative
accreditation
and
professional
initiatives
emphasize
the
importance
of
addressing
these
disparities
in
providing
class
to
our
diverse
population.
Next.
E
Next
slide,
please
educating
leaders
go
back
sorry,
educating
leadership
in
the
health
care
workforce
about
the
provision
of
high-quality,
patient-centered,
culturally,
responsive
and
effective
care
is
critical
to
reduce
disparities
and
foster
health
equity
and,
as
I
mentioned
before,
cultural
consecrating
is
necessary,
but
not
sufficient
to
eliminate
disparities.
Next
slide.
A
personal
perspective
I'd
like
to
offer
is
that
I
personally
think
that
cultural
competence
for
me
is
not
a
partisan
bipartisan
or
even
a
nonpartisan
issue.
I
recently
learned
a
new
word
called
transportus.
In'
is
apparently
a
website
which
brings
together
people
from
the
right.
E
The
left
the
center.
In
all
points
and
says,
can
we
have
an
authentic
dialogue
which
respects
the
different
points
of
view?
Can
cultural
competency
become
a
trans,
partisan
issue,
I
believe
that
Ken
and
why
I
believe
that
is
that?
Maybe
it's
not
just
about
cultural
competency
at
all
by
itself,
my
colleagues,
dr.
melanie
carolina
and
jan
marie
garcia,
coined
the
term
cultural
humility,
the
idea
of
seeing
the
humanity
in
us
all
the
theologian
Martin
Buber
many
years
ago
wrote
a
book
called
I
thou.
How
do
have
subject?
Subject
relationships
to
each
other?
E
It's
really
a
lifelong
commitment
to
self-evaluation
and
self-critique,
it's
about
dealing
with
issues
of
power
and
privilege
in
our
relationships
with
each
other,
and
it's
really
about
partnering
with
our
communities
to
learn
from
them
to
work
with
them
on
behalf
of
them,
so
that
we
improve
everyone's
health.
We're
just
about
done
next
slide.
I,
often
at
the
end
of
training
programs
will
provide
a
meditation
that
there
are
many
different
images
of
diversity
and
there's
no
right
or
wrong
answer
here.
But
if
I
were
to
poll
people,
if
we
could
do
that,
I'd
be
interested.
E
How
many
of
you
think
we're
a
melting
pot
or
a
mosaic
or
a
salad
or
a
rainbow
or
a
kaleidoscope
or
a
bubbling
boiling
cauldron
or
some
mix
of
above
I
would
offer
that
we've
been
wrestling
with
this,
since
at
least
Genesis
with
the
Tower
of
Babel,
with
Noah
the
flood
and
the
rainbows
I.
Think
the
real
challenge
for
us
and
the
greatness
of
America
is
hopefully
the
mutual
respect,
the
civility
the
tolerance,
the
justice
and,
fundamentally,
the
love
that
we
can
have
for
each
other
in
at
times
a
very
difficult
and
challenging
world.
E
Final
quotation
last
slide,
mathematician
Stephanie
pace,
Marshall
once
wrote,
adding
links
to
caterpillars
doesn't
create
butterflies,
it
creates
awkward
and
dysfunctional
caterpillars.
Butterflies
are
created
through
transformation.
Let
us
not
fool
ourselves
that
if
we
do
this
sort
of
training
that
that's
going
to
magically
bring
about
change,
there's
resistance,
there's
inertia,
but
I
will
tell
you,
there's
a
lots
of
possibility
and
we
have
seen
some
amazing
things
happen
in
some
of
these
training
programs
when
everybody
comes
together.
So
thank
you
very
much
and
my
apologies
for
some
of
the
technical
difficulties
with
the
slides.
E
B
You
very
much
dr.
liked
and
I
and
tell
apologises
about
the
blank
side
slides.
We
seem
to
have
been
experiencing
some
technical
difficulties
today.
Please
do
know
that
a
full
deck
of
slides
will
be
available
on
NC
s
l's
web
page
early
next
week.
At
this
point,
I'd
like
to
thank
our
three
wonderful
speakers,
representative
Alyssa,
Kenney,
Geyer,
Tricia
Tillman
and
dr.
Robert,
like
at
this
point,
we'd
like
to
open
up
the
floor
for
participant
questions
and
answers.
As
a
quick
reminder,
ask
a
question:
please
click
on
the
Q&A
button
and
type
in
your
question.
B
B
E
An
excellent
question
and
it's
a
very
important
one,
because
in
the
earlier
class
standards
that
came
out,
the
disabilities
piece
was
not
really
emphasized
adequately,
and
that
was
some
of
the
critique
that
came
back
in
the
the
town
halls
and
hearings
that
the
OMH
held
around
the
community,
so
disability,
culture
and
the
many
types
of
disability
culture
is
very
much
a
part.
We
believe
of
this
discussion
of
cultural
competency
and
there
are
people
actively
working
in
that
area
and
by
disability.
Here
it
may
be
physical
disabilities.
E
B
You
and
this
question
we're
going
to
direct
Tricia
to
begin
with,
and
then
dr.,
like,
if
you'd
like,
to
respond
as
well.
One
of
our
participant
participants
asked:
do
you
have
health
disparity
measures
that
have
been
validated
and
have
you
been
able
to
show
decreased
disparities
and
increased
equity
with
these
measures?
What
are
the
ones
that
you
are
using?
Are
there
national
ones
that
you're,
using
or
supporting.
D
So
this
is
Tricia
and
in
the
Oregon
Health
Authority
right
now
we
are
working
on
identifying
these
I
believe.
There's
a
report.
I
don't
know,
maybe
dr.
Mike
will
be
able
to
address
it
better
than
I.
Will
that
have
looked
at
what
are
the
best
measures
that
are
most
sensitive
to
identifying
health
inequities?
D
E
They
have
developed
tools,
metrics
for
doing
things,
I
know
that
they
have
health,
equity,
dashboards
disparities,
dashboards
where
they
monitor
things.
Similarly,
groups
like
Kaiser
Permanente
have
had
Institute's,
which
have
looked
at
congestive:
heart
failure,
sickle
cell
disease
diabetes
and
begun
to
look
at
what
the
impact
is
of
cultural
competence
and
other
initiatives
to
deal
with
that.
Now
that's
different
than
health
disparities,
measures
which
are
outside
well
I,
shouldn't,
say
they're
outside,
but
it's
not
looking
at
the
actual
service,
but
it's
looking
at
the
actual
effect
on
outcomes
of
diseases.
E
Now,
sometimes
those
are
public
health
measures
other
times
they
are
clinical
measures
as
well,
so
health
disparities
are
broader
than
health
care
disparities.
There
are
measures
for
both
of
them
that
exist.
That
may
be
worth
another
webinar
for
NCSL
to
get
people
to
get
into
that
in
much
more
detail.
Thank.
B
You
we
definitely
will
consider
that
I
think
we
have
time
for
one
more
question
and-
and
this
I
think
we'll
start
with
dr..
Like
our
participant
says,
we
have
a
diverse
population
of
resident
physicians
as
well
as
attending
physicians.
In
addition
to
improving
the
cultural
competence
of
clinicians,
how
do
we
reduce
the
biases
observed
which
patients
may
hold
towards
clinicians
of
diverse
backgrounds
and
let's
interfere
with
the
formation
of
partnerships
in
their
care?
An.
E
Absolutely
critical
question
and
I.
Thank
you
for
that,
because
that
came
up
frequently
in
our
training
programs
that
yeah
we
can
spend
a
lot
of
time
training
the
workforce
in
that.
But
what
do
we
do
when
there's
bias
and
prejudice
and
discrimination
that
sometimes
our
patients
and
community
members
may
bring
to
clinicians
or
in
fact
to
each
other,
and
that's
why
I
said
that
this
sort
of
education
needs
to
go
beyond
the
workforce
to
really
become
part
of
our
societal
fabric
so
that
we
can
understand
each
other?
E
B
Thank
you,
I
think,
that's
all
the
time
that
we
have
for
Q&A
again
I'd
like
to
thank
our
speakers
and
all
of
the
attendees
for
your
time
and
participation
in
today's
webinar,
and
thank
you
for
your
patience
with
our
technical
difficulties.
As
a
reminder,
an
archive
of
the
webinar
will
be
available
on
NC
s
l's
website
next
week
there
you
can
also
find
additional
resources
provided
by
dr.
like
and
again
I'd
like
to
thank
the
region,
2
health
equity
Council
for
co-sponsoring
this
webinar.