SESSION ONE:

Resources for you and/or your practice/organization:

Betancourt, Joseph R. “The Path to Equity in Healthcare Leads to High Performance, Value, and Organizational Excellence.” Journal of healthcare management / American College of Healthcare Executives vol. 65,1 (2020): 7-10. http//doi.org/10.1097/JHM-D-19-00257

Braveman, Paula. “What are health disparities and health equity? We need to be clear.” Public health reports (Washington, D.C.: 1974) vol. 129 Suppl 2, Suppl 2 (2014): 5-8. https://doi.org/10.1177/00333549141291S203 

Institute of Medicine. 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press. https://doi.org/10.17226/10260. https://www.nap.edu/download/10260 

Khan A, Yin HS, Brach C, et al. Association Between Parent Comfort with English and Adverse Events Among Hospitalized Children. JAMA Pediatr. 2020;174(12):e203215. https://doi.org/10.1001/jamapediatrics.2020.3215

Walker PF. Practicing medicine in the global village: use of guidelines and virtual networks. CMAJ. 2011 Sep 6;183(12):E926-7. https//doi.org/10.1503/cmaj.100625. Epub 2010 Jun 7. PMID: 20530162; PMCID: PMC3168667.

National Healthcare Quality and Disparities Report. Content last reviewed April 2020. Rockville, MD: Agency for Healthcare Research and Quality; September 2019. AHRQ Publication No. 19-0070-EF.

Rural Ethnic/Racial Disparities: Social and Systemic Inequities (November 2020) https://www.ruralhealthresearch.org/recaps/12

Rural Ethnic/Racial Disparities: Adverse Health Outcomes (November 2020) https://www.ruralhealthresearch.org/recaps/11 

Institute for Healthcare Improvement, Why It’s Not Possible to Have Equity in Health Care. Video link at: https://www.youtube.com/watch?v=xFx5tCVX1lM  

SESSION ONE:

Next Learnings

(proposed questions for future reflection, discussion, and professional collaboration)

1. What first or next steps should your organization take to enhance health equity within your practice?

2. Does your organization currently address the social determinants of health (economic resources, food insecurity, etc.) in delivering care to your patients? If so, how?

3. What are your organization’s current strengths and/or challenges in providing care to underserved populations in your area? How do you know? (Reflection question from the webinar)

4. Do you and/or your organization face challenging issues of racism and/or patterns of exclusion in your workforce, practice, or broader community? If so, how have you addressed them?

5. Does your agency/practice collect patient race, ethnicity, and language (REaL) data? If so, how is it used? In particular, do you tie patient REaL data to patient outcomes or other measures such as patient satisfaction, complaints, or adverse or critical incidents? (Reflection question from the webinar)

Session One Resources and Next Learnings PDF

SESSION TWO:  

Making the Case for Health Equity in VT: From Evidence to Action

In the second of a 5-part virtual series, we explore the business, medical (quality and safety), and legal “cases” for health equity in medical care. With a special focus on racial and ethnic disparities, language access, and the emerging issue of global medicine, this session will address:

 Implications of demographic megatrends for patient care and the health care workforce;

• Introduction to the national CLAS Standards and the law of language access.
• National best practices, tips, tactics, and recommendations for improving health equity to racial and ethnic minorities, LEP and Deaf and Hard of Hearing, immigrants and refugees, the LGBTQ population, and other non-traditional patient populations.

TARGET AUDIENCE: Health care practitioners & managers, public health staff, QI directors, social workers, community health workers, mental health & addictions counselors, and qualified medical interpreters.

ABOUT OUR PRESENTER: David B. Hunt, J.D., is the Senior Director of Health Equity at BCT Partners, a national management consulting and training firm specializing in diversity, equity and inclusion issues. A former employment law and civil rights attorney, Mr. Hunt is nationally known for his expertise in racial and ethnic disparities in health care, the law of language access, global medicine, and the new science of unconscious bias. Mr. Hunt was selected by the American Hospital Association, the national BC/BS Association, and America’s Essential Hospitals as a consultant/trainer on health equity and cultural competence issues. With leading physicians from Harvard and the University of Minnesota Medical Schools, Mr. Hunt developed the nation’s first CME accredited e-learning programs on cultural competence and global medicine for doctors and nurses, with over 180,000 providers trained. More recently, he collaborated with leading physicians to create a Provider Cross-Cultural Medical Assessment
tool which benchmarks hospital systems and physician performance in treating minority patient populations.

SESSION TWO:

Resources for you and/or your practice/organization:

Betancourt, Joseph R, and Alexander R Green. “Commentary: linking cultural competence training to improved health outcomes: perspectives from the field.” Academic Medicine: Journal of the Association of American Medical Colleges vol. 85,4 (2010): 583-5. doi:10.1097/ACM.0b013e3181d2b2f3

Flores, Glenn et al. “Errors of medical interpretation and their potential clinical consequences: a comparison of professional versus ad hoc versus no interpreters.” Annals of emergency medicine vol. 60,5 (2012): 545-53. doi:10.1016/j.annemergmed.2012.01.025

Limited English Proficiency and Patient Safety, The Disparities Solutions Center, https://www.mghdisparitiessolutions.org/limited-english-proficiency

Office of Minority Health, U.S. Department of Health and Human Services. April 2013.  National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care: A Blueprint for Advancing and Sustaining CLAS Policy and Practice.  

Stephen JM. Pediatric Nurses’ Experiences in Caring for Non–English Speaking Patients and Families. Journal of Transcultural Nursing. January 2021. https://doi:10.1177/1043659620986607

Robert Wood Johnson Foundation. Achieving Health Equity: Why Equity Matters. Health Equity in Action. www.rwjf.org/en/library/features/achieving-health-equity.html

“Unnatural Causes: Is Inequality Making Us Sick?” (film) (California Newsreel with Vital Pictures, Inc. 2008) at http://www.unnaturalcauses.org

“Worlds Apart: A Four-Part Series on Cross-Cultural Health Care” (film) Produced by Maren Grainger-Monsen, M.D. and Julia Haslett. Available from Fanlight Productions at 1-800-937-4113, www.fanlight.com or by email at orders@fanlight.com (2003)] https://med.stanford.edu/medethicsfilms/films/worldsapart.html

SESSION TWO:

Next Learnings

(proposed questions for future reflection, discussion, and professional collaboration)

1.Has your organization adopted a language access plan to provide limited English proficient (LEP) persons with meaningful access to health care and related services?  If so, do employees receive training to understand and implement the policies/procedures in this plan?

2.Which minority patient populations and special populations are providers in your practice MOST prepared to treat?  LEAST prepared to treat?

Session Two Resources and Next Learnings PDF

SESSION THREE:

Reducing Implicit Bias in Health Care: Moving Toward Equal Treatment

This interactive session will address recognizing implicit bias held by providers/practitioners during the clinical encounter, health care institutions and even patients. With a focus on the harmful impacts of implicit bias on patient health, care quality and equal treatment, the expert presenter will also offer evidence-based tools to reduce bias and ultimately racial and other health disparities.

TARGET AUDIENCE: Health care practitioners & managers, public health staff, QI directors, social workers, mental health & addictions counselors, community health workers*, and qualified medical interpreters*.

ABOUT OUR PRESENTER: Stacie L. Walton, MD, MPH, is a clinical and academic pediatrician who has served as a medical consultant for health care providers and institutions for over 25 years. Recently retired from Kaiser Permanente in the roles of Diversity Champion and Communication Consultant, she has provided trainings on cultural competence for health care providers in multiple venues across the United States and Puerto Rico. Recently, her nationally renowned cultural competency work addresses the impacts of implicit bias and privilege in patient interactions and health outcomes, while offering strategies for decreasing hidden biases in both personal and professional settings. Her long-standing commitment to advancing racial healing and equity in communities across the United States is evidenced by her work in national racial healing transformation and relationship building initiatives. This interactive session will address recognizing implicit bias held by providers/practitioners during the clinical encounter, health care institutions and even patients. With a focus on the harmful impacts of implicit bias on patient health, care quality and equal treatment, the expert presenter will also offer evidence-based tools to reduce bias and ultimately racial and other health disparities.

SESSION THREE:

Resources for you and/or your practice/organization:

Bowen Matthew, D. (2015). Just Medicine. New York: New York University Press.

Bowen Matthew, D. (2018). “The race problem” in American health care: The work that remains. https://youtu.be/crFc9zfu1Q8

Lopez, B. L. (2019). Unconscious bias in action. In M. L. Martin, S. Heron, L. Moreno-Walton, & M.

Strickland (Eds.), Diversity and Inclusion in Quality Patient Care: Your Story/Our Story – A Case-Based Compendium (pp. 69–74). New York: Springer International Publishing.

Edgoose, J., Quiogue, M., and Sidhar, K. (2019). How to identify, understand, and unlearn implicit bias in patient care. Family practice management, 26(4), 29-33. https://www.aafp.org/fpm/2019/0700/p29.html

FitzGerald, C., and Hurst, S. (2017). Implicit bias in healthcare professionals: A systematic review. BMC Medical Ethics, 18(1), 19. https://doi.org/10.1186/s12910-017-0179-8

Project Implicit. Implicit Association Test (IAT).
https://implicit.harvard.edu/implicit/takeatest.html How microaggressions are like mosquito bites • Same Difference https://www.youtube.com/watch?v=hDd3bzA7450

Irving, Debby. Waking up White: And Finding Myself in the Story of Race. Cambridge, MA: Elephant Room Press, 2014.

How to Be an Antiracist. New York: One World. Kendi, Ibram X., How to Be an Antiracist. New York: One World, 2019.

Kahneman, D. (2011). Thinking, fast and slow. Farrar, Straus and Giroux.

Casey, Mary E. & Shannon Murphy Robinson (2017). Neuroscience of Inclusion: New Skills for New Times, Outskirts Press, Inc.

Menakem, R. (2017). My grandmother’s hands: racialized trauma and the pathway to mending our hearts and bodies. [United States]: Central Recovery Press, LLC.

Eberhardt, J. L. (2019). Biased: uncovering the hidden prejudice that shapes what we see, think, and do. New York: Viking.

Wilkerson, I. (2020). Caste: The Origins of Our Discontents.

SESSION THREE:

Next Learnings

(proposed questions for future reflection, discussion and professional collaboration)

1. Do you feel empowered to address racial bias or national origin bias in your organization or
practice? Why or why not?

2. Have you observed or otherwise become aware of how patients may have been affected by
implicit bias in your practice/organization?

3. Which strategy or strategies to reduce implicit bias do you plan to use personally?

4. Which strategies to reduce implicit bias do you believe your organization would support?

5. How would you assess outcome(s) of implicit bias reduction in your practice or
organization?

Session Three Resources and Next Learnings PDF

SESSION FOUR:

Best Practices for Equitable Health Care 

This Session will introduce two essential clinical competencies, often overlooked by clinicians and other practitioners, to ensure a culturally responsive clinical encounter that can help shape assessment, treatment and outcomes, including:

• Strategies to work effectively with qualified medical interpreters (face-to-face and by phone)
• Tools for the practitioner to explore the patient’s culturally determined beliefs around health and illness, through applying explanatory models of care

Participants will gain knowledge and skills to incorporate practical tools to improve care quality and performance.

TARGET AUDIENCE: : Health care practitioners & managers, public health staff, QI directors, social workers,
mental health & addictions counselors, community health workers*, and qualified medical interpreters

OUR PRESENTERS:

Heather Link, MD, General Pediatrician, the University of Vermont
Health Network 

Linda Li, LICSW, Community Health Centers of Burlington, VT 

SESSION FOUR:

Resources for you and/or your practice/organization:

Beard, Kenya & Gwanmesia, Eunice & Miranda Diaz, Gina. (2015). Culturally Competent Care: Using the ESFT Model in Nursing. American Journal of Nursing, 115, 58-62. 10.1097/01.NAJ.0000466326.99804.c4.

Dinos, S., Ascoli, M., Owiti, J. A., & Bhui, K. (2017). Assessing explanatory models and health beliefs: An essential but overlooked competency for clinicians. BJPsych Advances, 23(2), 106–114. Cambridge University Press.

HealthPartners Center for International Health. (2008). Crossing Cultures: Using the L.E.A.R.N. Model. St. Paul, MN: HealthPartners.

Juckett, G. & Unger, K. (2014). Appropriate use of medical interpreters. American Family Physician 90(7), 476-80. https://pubmed.ncbi.nlm.nih.gov/25369625/

Kleinman, A. & Benson, P. (2006). Anthropology in the clinic: The problem of cultural competency and how to fix it. PLoS Med, 3(10), 1673-1676. https://doi.org/10.1371/journal.pmed.0030294

Ladha, T., Zubairi, T., Hunter, A., Audcent,T., & Johnstone, J. (2018) Cross-cultural communication: Tools for working with families and children. Paediatrics & Child Health, 23(1), 66–69. https://doi.org/10.1093/pch/pxx126

Marks, C. (April 29, 2021). The lonely, vital work of medical interpretation: During the pandemic, a job that is often hidden has become indispensable. The New Yorker. https://www.newyorker.com/science/medical-dispatch/interpreting-during-a-pandemic

The National Council on Interpreting in Health Care (NCIHC). (March 2021). Interpreter Advocacy in Healthcare Encounters: A Closer Look. https://www.ncihc.org/ethics-and-standards-ofpractice

The National Council on Interpreting in Health Care (NCIHC). (September 2005). National Standards of Practice for Interpreters in Healthcare. https://www.ncihc.org/assets/z2021Images/NCIHC%20National%20Standards%20of%20Practice.pdf

Refugee Health Technical Assistance Center. Best Practices for Communicating through an Interpreter. https://refugeehealthta.org/access-to-care/language-access/best-practicescommunicating-through-an-interpreter

Shepard, S. (September 30, 2020). Reducing risks with multilingual patients. Medical Economics.https://www.medicaleconomics.com/view/reducing-risks-with-multilingual-patients

SESSION FOUR:

Next Learnings

(proposed questions for future reflection, discussion and professional collaboration)

1. Has your organization developed and implemented initiatives to address racial and/or
ethnic health disparities? If so, do you have a strategy to partner with community leaders
of affected patients to work on these health issues?

2. Does your organization provide effective language access services to Limited English
Proficient (LEP) individuals?

3. Based on the racial and ethnic diversity of the patients you serve, as well as those in your
service area, do you receive education (at orientation and on a continuing basis) about
cultural issues important to your patients?

Session Four Resources and Next Learnings PDF

SESSION FIVE:
Building and Cultivating Culturally-Effective Organizations

This session will introduce participants to the Culturally Effective Organizations {CEOrgs) Framework, a national roadmap to guide health care organizations to improve capacity and effectiveness in providing equitable care and services. Participants will:
⇒ Learn how to distinguish individual, collective and organizational level cultural competence.
⇒ Learn how to distinguish individual, collective and organizational level cultural competence.
⇒ Identify organizational, structural, and clinical strategies to implement culturally appropriate policies and

PRESENTERS:

Paula Smith, MBA, EdD
Director, Southern New Hampshire Area Health Education Center (AHEC)

Trinidad Tellez, MD
Equity Consultant, Southern New Hampshire Area Health Education Center (AHEC)

TARGET AUDIENCE: Health care organization managers, executives, clinical and QI directors, and diversity, language access and HR directors. Health care and behavioral health practitioners, other front-line staff, and cultural leaders are also welcome to attend.

SESSION FIVE:

Resources for you and/or your practice/organization:

Institute on Assets and Social Policy (IASP) Heller School for Social Policy and Management, Brandeis University. (April 2015).Culturally Effective Healthcare Organizations: A Framework for Success, https://heller.brandeis.edu/iere/pdfs/jobs/culturally-effective.pdf.

Boguslaw, J., Venner, S., Santos, J., & Nsiah-Jefferson, L. (2013). Perspectives and practices of New Hampshire health care employers: Improving quality, reducing costs, and planning for the future by building culturally effective health care organizations. Waltham, MA: Brandeis University Institute on Assets and Social Policy. Retrieved from Brandeis University website http://iasp.brandeis.edu/pdfs/2013/Perspectives_Practices.pdf.

Institute of Medicine. (2010). Future directions for the National Healthcare Quality and Disparities Reports. Washington, D.C.: The National Academies Press. Retrieved from
http://www.ahrq.gov/research/findings/final-reports/iomqrdrreport/iomqrdrreport.pdf.

The Joint Commission. (2014). A crosswalk of the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in health and health care to The Joint Commission
Hospital Accreditation Standards. Oak Terrace, IL: Author. Retrieved from The Joint Commission website http://www.jointcommission.org/assets/1/6/Crosswalk-_CLAS_-20140718.pdf.

Health Research & Educational Trust. (2013). Becoming a culturally competent health care organization . Chicago, IL: Author. Retrieved from https://www.aha.org/ahahret-guides/2013-06-18-becoming-culturally-competent-health-careorganization#:~:text=It%20offers%20seven%20recommendations%20for%20improving%20cultural%20competency,community.%207%20Make%20cultural%20competency%20an%20institutional%20priority.

Handtke, O., Schilgen, B., & Mösko, M. (2019). Culturally competent healthcare–A scoping review of strategies implemented in healthcare organizations and a model of culturally competent healthcare provision. PloS one, 14(7), e0219971.

CEOrgs Toolkit: https://www.amoskeaghealth.org/center-of-excellence-for-culturallyeffective-care/

SESSION FIVE:

Next Learnings

See linked “CE Orgs Resources Addendum”, prepared by the session’s presenters.

Session Five Resources and Next Learnings PDF