Reducing Health Disparities; Improving Patient Outcomes;

1. Reducing Health Disparities;Improving Patient Outcomes; THROUGH PRACTICAL INITIATIVES

2. Introduction • Goal One: Build a team of health care professionals who understand their contribution to effective care giving • Goal Two:Empower all clinical-based staff to help improve care through practical actions

3. Patient Outcomes • This is a way of measuring the how well a patient responded to the treatment provided • It is usually compared to averages compiled by organizations • Meeting or exceeding those averages is considered a way of gauging proper care • Why improve patient outcomes?

4. Why improve patient outcomes? • Governments, health departments or insurance companies may • Measure your abilities on outcomes achieved • Base their reimbursements on outcomes • Decide on accreditation for facilities • But more importantly, improving patient outcomes means improving people’s lives

5. Health Disparities • Are differences in the quality of health and health care • Usually noticed among groups of people: • Minorities, • Rural populations • Non-citizens

6. Health Disparities • Reducing health disparities means finding out • who in a patient population is receiving substandard care • And why they are receiving substandard care

7. Health Disparities • Substandard care may be caused by: • Communication Problems • Discrimination • Lack of insurance coverage • Poor transportation • Shortage of care givers • Health literacy (patients have problems understanding health information)

8. Team Building • A health care team includes: • Doctors • Nurses • Schedulers • Billers • Receptionists • Security guards • Anyone who works in the clinical facility

9. Team Building • Each member of the team can affect patient care through their actions, • So they must understand how they can maximize positive contributions to patient care • When all of the team members are attuned to the mission of improving care, • Positive health outcomes will follow

10. Empowering Staff • Staff can be oriented about how their work affects patient care, • Through clarity of their job description • to understanding the mission of the organization • to practical skill building

11. Empowering Staff • Staff members can understand how their contributions matter when it comes to providing excellent care

12. Successful Teams • Understand that everyone has a role to play in helping patients get quality care • Know that quality care improves the lives of those people they serve

13. Successful Teams • Understand that unnecessary visits are reduced because care is more effective • Know that the experience better for everyone involved • Recognize quality care is what we would expect for ourselves, so providing it to others is the Golden Rule

14. What are common challenges • Medication non-adherence • Lost to follow-up • Patients with low health literacy

15. What are common challenges • Patients saying “yes” when they mean “no” • Difficult patients, e.g.

16. Common challenges, cont. • Difficult patients: • Substance users: alcohol, drugs • Angry patients • Drug seeking patients • Violent patients • Mentally challenged • Adolescents • Et cetera

17. Forging Solutions • Solving these and other problems is not a one person job: • Everyone in a health care setting contributes to the solution; • From the receptionist, • To the schedulers, • To the accountants, • To the nurses, • To the doctors…

18. Forging Solutions • At its heart, health care is based on service • It is also a professional environment where: • Everyone understands their role within a team • Knows what they contribute to the team,

19. Forging Solutions • And how it can affect care giving, • For the better, • And for the worse…(African sickness mask)

20. Forging Solutions • Each person can affect patient outcomes: • The unfriendly intake person can drive up lost to follow-ups, • The unhappy scheduler candiscourage patients, • The resentful clinician can too

21. Forging Solutions • Patients need to feel comfortable at each step of their visit, encountering professionals committed to their care:

22. Forging Solutions • Employees will not intuitively know their specific responsibility to help patients understand their path through care,

23. Forging Solutions • They must learn the importance • And responsibilities of their role, • And how much it is valued by the management and those they serve

24. Forging Solutions • The Hippocratic Oath can apply to all in the health care setting:

25. Hippocratic Oath • …Our responsibility includes not only the presenting illness, but also how the illness affects the person's family and economic stability.

26. Forging Solutions: Professionalism • Staff orientation upon hire and annually thereafter can ensure that people understand their professional responsibilities

27. Forging Solutions: Professionalism • Understanding the organization’s mission • and how a staff member’s work contributes to the mission • helps diffuse frustration among patients and staff alike

28. Forging Solutions: Professionalism • To understand how one’s work contributes to the overall attainment of the organization’s mission

29. Forging Solutions: Professionalism • Ground’s a person in the importance of their work • Clarifies a person’s understanding of how they contribute to improving people’s lives

31. Forging Solutions: Professionalism • Job descriptions can be a tool to clarify staff members’ role in care-giving • They reduce ambiguity by clarifying expectations

32. Forging Solutions: Professionalism • Annual performance reviews based on job descriptions can provide valuable guidance about successes and opportunities for improvement

33. Forging Solutions: Professionalism • Performance reviews • Can actually reassure employees • If done with the intent of helping someone find solutions to challenges they face • And providing skill building methods to help • And praising the successes they have demonstrated since the last review

34. Forging Solutions: Professionalism • In short, every employee needs to understand that each patien--regardless of who they are--deserves respect and professional care • At the core, we must remember…

35. Forging Solutions • The Golden Rule: • "Do unto others as you would have them do unto you."

36. Forging Solutions • The Golden Rule is the cornerstone of human rights. Essentially, regardless of: • Their circumstances • Their station in life • Their appearance • The choices they have made • The time of day, the day of the week…

37. Forging Solutions • Each patient deserves equal and just treatment. • As caregivers, our role is • Not to judge people, • Not to impose our resentments on patients, • Not let our political views color our care

38. Forging Solutions • It is to set aside any ill will we may have before we encounter a patient • And treating all patients with the consideration and respect that your faith and/or professional code expects of you

39. Forging Solutions • Active incorporation of the Golden Rule into our professional lives can: • Reduce culturally-based differences • Reduce health disparities • Resolve underlying issues chronically and adversely affecting health outcomes

40. Approximately how many different cultures are there in the Asia/Pacific region? • Nine • 23 • Unknown

41. What does culture include: • Language • Traditions • Behavior • Beliefs • All of the above • None of the above

42. What is your culture? • I’m a health professional • I’m a Christian • I’m masculine • I’m feminine • I’m heterosexual • I’m gay • I’m wealthy • I’m educated

43. Cultural Competency is the ability to: • Interact effectively with people of different cultures • Appreciate differences and adapt for effectiveness • Implement system-wide practices to optimize care • All of the Above

44. Which of the following ways can improve your cultural fluency? • Ask and really listen • Minimize your assumptions • Empathize with your clients • All of the above • None of the above

45. Which of the following is True: I am a Deaf/Mute • Don’t worry, I can’t hear a thing • Ignore me because I can’t speak • I want to be treated with respect and dignity

46. A family member is an effective interpreter for patients seeking medical care • True • False • Other

47. Which of the following is NOT true of a culturally competent organization:  • Provides professional interpreters • Information is in the languages of its patients • Staff reflects the cultural mix of its of its clients. • Staff does not need to be reminded to treat all patients with respect.

48. Case One Ramone • 45 Filipino male who works on a fishing boat. • Married to a local woman with 3 young children • He is very religious. • Has sex with other men but does not consider himself homosexual. • Very upset with positive HIV test and accuses you of malpractice How would you address his concerns?

49. Case Two Rich • 35-year old local male seeing you off and on for 5-years. • HIV+ and doesn’t work. • He is an alcoholic, angry, and wants pain medications immediately • Non-adherent to HAART because of the diarrhea and nausea How should the receptionist be taught to deal with this patient? How can the physician help this patient?

50. Forging Solutions • While this is all well and good, the question ultimately becomes how do we handle situations that challenge our attempts to live by the Golden Rule?