1. Understanding and Implementing the CLAS Standards
Standard 12: Community Partnerships for CLAS (guideline)
“Health care organizations should develop participatory, collaborative partnerships with communities and utilize a variety of formal and informal mechanisms to facilitate community and patient/consumer involvement in designing and implementing CLAS-related activities.”
Overview
For the culturally competent organization, responsive delivery of services to a community results from a collaborative process that is informed and influenced by community interests, expertise, and needs. Patients are more likely to use services that are developed with attention to community needs and wishes, thereby leading to more effective care and healthier communities.
Although healthcare organizations today typically include language about community responsiveness in their mission statements, many continue to struggle to achieve true partnerships with patients and community representatives. By dealing with the challenges of appreciating the complexities of the cultural beliefs and practices of ethnic and other communities, healthcare organizations stand to derive substantial benefit from establishing dynamic partnerships with representatives from the communities they serve.
Healthcare organizations should regard community partnerships as opportunities to plan services that are in line with the everyday realities of life in their communities. In working with community representatives, organizations’ executives and managers can enjoy valuable opportunities to become familiar with situations that may be quite different from their own. For example, patients will not be able to adhere to healthcare recommendations that are outside their means, such as taking a daily walk if they live in a high-crime neighborhood. Situations such as that emphasize why community involvement is crucial—if people receive recommendations that in reality they cannot follow, they will stop listening.
Challenges of Authentic Community Involvement
The concept of community involvement has both practical and philosophical aspects—that is, a healthcare organization should consider whether it is developing community partnership only to comply with regulations or whether it is open to accepting honest, constructive input that may at times be highly critical. Even authentic commitment can be frustrating when the implementation of culturally appropriate services becomes difficult, especially for organizations that might not have been involved previously with culturally diverse communities.
Discovering the most productive ways to involve communities in the process of developing and overseeing cultural competence activities can become a highly challenging process. A program that a healthcare organization perceives as a success story may receive less favorable reviews by members of the community. Medicaid population groups, for example, can pose challenges to becoming and staying involved in ongoing community partnership or planning processes. Several factors may account for this:
- Medicaid participants often are not familiar with the financial and managerial aspects of healthcare institutions.
- They may not remain on Medicaid for a long period of time (resulting in frequent turnover on advisory committees).
- They may lack sufficient time or resources to participate fully.
Nevertheless, several federal programs have developed successful histories of involving consumers in their governance structures and planning processes. One example is Head Start, whose consumer profile has many similarities to that of Medicaid.
Incentives to participate. To optimize community participation in CLAS planning activities, healthcare organizations may find that providing incentives can be productive. Many low-income working individuals feel that their time and other resources limit their ability to participate in community meetings. To encourage people who cannot afford to lose a day of work if they participate in formal processes for commenting on proposed services, organizations may want to consider providing:
- Monetary stipends
- Transportation reimbursement
- Childcare
- Meals before or after meetings
Another potential barrier is concern about power imbalances between healthcare organizations and their community or between organizations and individual patients. One concern is that community-based organizations could be exploited by community input processes sponsored by healthcare organizations—eg, that providers may benefit from community expertise without providing reciprocal benefits to the community organization. In addition, some members of certain ethnic, age, or gender groups do not feel comfortable sharing their opinions and ideas. Unfortunately, some individuals may believe that they do not have a right to participate with their physicians or other healthcare providers in treatment planning.
Solutions to issues like these will need to involve broad cooperation:
- Asking community leaders to develop long-term advisory relationships
- Inviting community members to join discussions in which they can feel safe from negative consequences
- Joint educational efforts by community and healthcare organizations to teach patients how to interact with the healthcare system
Establishing a senior-level community liaison position who would meet regularly with executives and senior managers can offer one route to help ensure that community members are effectively represented in the planning of CLAS activities.
