1. Understanding and Implementing the CLAS Standards
Standard 9: Organizational Self-assessment (guideline and recommendation)
“Health care organizations should conduct initial and ongoing organizational self-assessments of CLAS-related activities and are encouraged to integrate cultural
Under ideal circumstances, organizational self-assessments should address all the activities called for in the 14 CLAS standards. To begin the process, an initial self-assessment—reviewing organizational policies, practices, and procedures—will be necessary before proceeding to develop and implement the strategic plan outlined in Standard 8. Then, continuous self-assessment should assess the progress being made in implementing all the standards. This continuous organizational self-assessment aims to gather baseline and unfolding information needed:
This self-assessment process is, in effect, a classic SWOT (strengths, weaknesses, opportunities, threats) analysis of the organization’s capacities, strengths, shortcomings, and challenges in developing an institutional focus on CLAS.
The Role of Organizational Self-Assessment
Conducting a cultural audit to review policies, procedures, and practices should be the first step. Existing cultural competence assessment tools can provide general guidance to determine whether the core infrastructure for providing CLAS—management, governance, delivery systems, customer relations—is currently in place. The cultural audit can identify:
Such a self-assessment can empower the organizations to develop strategic plans for providing CLAS (see Standard 8). Ongoing self-assessment can track progress in implementing the standards and refine strategic plans as needed.
Tools for Organizational Self-Assessment
CLAS-Related Measures in Performance Improvement and Outcomes Assessments
Similarly, performance improvement programs could include evaluation questions focusing on whether there are differences among ethnic or language groups in service utilization (eg, failure to appear for appointments, termination of enrollments). Such data can be used to refine programs by identifying problems that can be easily addressed. For example, by determining why certain times are less convenient for patients from a particular group, an organization could adjust appointment times and improve access to services among the group.
Adding a question about self-identified ethnicity to existing patient surveys can provide a way to integrate cultural competence-related measures into performance improvement activities. These data can be used to compare patient satisfaction among ethnic groups and to identify specific service-related differences. Collecting these data, however, must be done in a culturally and linguistically appropriate way, with translated questionnaires or bilingual interviewers for telephone surveys.
Although patient satisfaction surveys are a common method to evaluate services, they may not produce an accurate view of the quality of services. Designing patient satisfaction surveys that capture a patient’s complete attitude toward quality and satisfaction can be quite challenging. For example, neither patients nor clinicians may be able to appropriately assess the quality of language assistance services because neither has the linguistic skills to verify the competency of the interpreter or the accuracy of the translation. Another factor is the wide cultural variations in how clients respond to satisfaction-related questions, especially if their feedback may be negative.
Assessing the efficacy of CLAS on health outcomes requires aggregate data on patient race and ethnicity, but such data should not be aggregated only on the basis of last names—a common practice in efforts to compile ethnicity statistics. The last-name approach does not capture:
Nevertheless, collecting race, ethnicity, and language data is necessary to ensure appropriate monitoring of patient-service needs and utilization, quality of care, and outcome patterns. A more complete discussion of this need can be found in Standard 10.