Collection of Race, Ethnicity, and Primary Language Data: Awareness and Perspectives of Hospital CEOs, Leaders and Staff
Romana Hasnain‐Wynia, PhD
Director, Center for Healthcare Equity/Institute for Healthcare Studies
Director, Center for Healthcare Equity/Institute for Healthcare Studies
Northwestern University, Feinberg School of Medicine
June 28, 2010
Academy Health Boston MA
Boston, MA AUTHORS
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•
•
•
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Romana Hasnain‐Wynia
R
H
i W i
Sunita Mutha
Sarah Rittner
Sarah Rittner
Elizabeth Jacobs
Amy Wilson Stronks
Amy Wilson‐Stronks
Funding for this work was provided by Funding
for this work was provided by
The California Endowment
Background/Context
• Disparities in quality of care remain a challenge in the U.S.
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• Hospitals and other HCOs need to address disparities
• Addressing disparities within organizations requires leadership and staff awareness
• To document the existence or absence of To document the existence or absence of
disparities requires demographic data, quality d t
data and the capacity to stratify them.
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it t t tif th
A Framework for Reducing Disparities in ea t Ca e Syste s
Health Care Systems
Views of hospital leaders about disparities in their hospitals
Disparities exist, but not inside my hospital. They Disparities
exist, but not inside my hospital. They
happen before patients come here and after they leave
they leave.
(Though I can’t prove this…)
Siegel, B et al. Assumed equity: early observations from the first hospital disparities collaborative. J Healthcare Qual. 2007
Exploring Cultural and Linguistic Services in the Nation’s Hospitals
t e at o s osp ta s
• Released in March 2007
• Download a free copy of the report on HLC website
• Provides an overview of the HLC studyy
– Detailed methodology
– Site visit protocol
– Recommendations for hospitals, policymakers, and researchers
Download this report free at: http://www.jointcommission.org/
patientsafety/hlc
HLC Study Methodology
y
gy
 Cross‐sectional qualitative study of 60 hospitals
– 2 samples of 30 hospitals
 In
In‐person
person administrative interviews
administrative interviews
– CEO (one‐on‐one)
– Leadership, Human Resources, Cultural and Language Services p,
,
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(3 groups of 3 representatives)
 In‐person clinical interviews
In‐person clinical interviews
– Patient‐centered assessment interviews focused on a clinical (
)
case scenario (one‐on‐one)
Hospitals, Language, and Culture Study, A.Wilson‐Stronks et.al June 2007
Methods
• Used grounded theory approach to identify themes (no a priori codes were assigned)
(
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)
• Each of the 59 transcripts was independently coded by 3 of the authors and compared for
coded by 3 of the authors and compared for agreements. Disagreements were resolved by consensus
• Data were managed using NVIVO qualitative Data were managed using NVIVO qualitative
software HLC Sample Hospitals (n=60)
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p
(
)
Region (representing 32 states)
West
21
Midwest
12
Northeast
10
South
17
100‐299 beds: 18
Rural: 15
25‐99 beds: 10
Non‐profit:32
Urban: 35
300+ beds: 32
Public: 15
Public: 15
Teaching/Academic: 22
Hospital Characteristics
Probability
Purposive
-based
N=30
N
30 (%) N
N=30
30 (%)
Region
West
South
Northeast
Locale
Rural
Semi-rural/urban
Urban
Size
Small (25-99 beds)
Medium (100-299 beds)
Large (300+ beds)
Teaching status
Teaching
Non-teaching
Ownership
Private
Public
Total
N=60
(%)
8 (27)
8 (27)
8 (27)
6 (19)
13 (44)
9 (30)
4 (13)
4 (13)
21 (36)
17 (30)
12 (18)
10 (16)
3 (10)
5 (17)
22 (73)
12 (40)
5 (17)
13 (43)
15 (25)
10 (17)
35 (58)
1 (3)
6 (20)
23 (77)
9 (30)
12 (40)
9 (30)
10 (17)
18 (30)
32 (53)
18 (60)
12 (40)
4 (13)
26 (87)
22 (37)
38 (63)
22 (73)
8 (27)
23 (77)
7 (23)
45 (75)
15 (25)
Findings
Pre site visit survey (n=60):
• 82% of hospitals reported collecting race/ethnicity
• 85% of hospitals reported collecting primary language
• 42% of hospitals reported collecting race/ethnicity p
y g g
and primary language
Findings
Key Informant Interviews:
• 7.5% of CEOs, 5.3% of senior leaders, and 23.3% of cultural and language services staff stated that race/ethnicity data were collected at their hospital.
• 15% of CEOs, 28% of senor leaders, and 68% of staff stated that primary language data were collected at their hospital.
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• 0% CEOs, 3% senior leaders, and 8% of staff stated that their l d
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hospital collects race/ethnicity and primary language data.
Findings:
Themes
• Discrepancy in findings on hospital data collection (who’s right?)
(
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• If data are being collected, hospital leaders/staff largely unaware (why?)
leaders/staff largely unaware (why?)
– Could be reflecting on concerns about sensitivities and politics of collection
• Leaders recognize that data can be used to g
improve care – Few said data collection unimportant
Few said data collection unimportant
– Few moving to collect and use
Data Collection and Use
Data Collection and Use
CEO QUOTES: Yes we collect data
• “Well
Well, intuitively I would say that we have some data , but we don
intuitively I would say that we have some data but we don'tt have have
really good data .” • “There are fields in the nursing assessment for language and race, but I know that these fields are sometimes left blank.” • “I am always saying that you have to break this information down by ethnicity and other areas. So we are always looking at this data and getting at ethnic differences. Then if we find something we will address it. I guess the other thing is that I made a commitment on the national level to this issue‐ social justice and equity and gathering the right data to make sure were not just talking about equity but translating it into action.”
Data Collection and Use
Data Collection and Use
Senior Leader Quotes: Yes, we collect data
i
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• “One of the things that we’ve done through our Office of Diversity is start to ask people on arrival at the hospital, “What is the language you prefer to receive your medical information in.” Now that we’re gathering that information I think we just started doing that a
that information, I think we just started doing that a year ago, we can start looking at clinical outcomes for different groups and also at patient satisfaction. We’re
different groups and also at patient satisfaction. We
re not there yet, but we’re starting to at least capture data in a way that we can go there.”
Data Collection and Use
Data Collection and Use
Cultural and Languages Services Quotes: Yes, we C
lt l d L
S i
Q t Y
collect data
• “Our data management system has allowed us to quantify our language needs and improve health outcomes. What are the differences when an interpreter is involved and when one is not?” differences when an interpreter is involved and when one is not?
• “We’re making the commitment as an organization to collect race and ethnicity‐related data and primary language. It's opened up a lot of opportunities for us to see how can we take that information and make sure that it continues with the patient throughout their stay here and also how can we use that information internally to t h
d l h
th t i f
ti i t
ll t
strengthen or enhance some of our patient‐centered care, our recruitment processes.” Data Collection and Use
CEO and Leadership‐No
• “We have made a decision that we're going to start upon admission collecting information about race and ethnicity Now we go into
collecting information about race and ethnicity. Now, we go into that a little bit cautiously because of the political sensitivities to that. If we're going to be able to effectively meet the needs of a changing demographics in population then we need better
changing demographics in population, then we need better understanding of who they are.”
• “We
“We really don't collect data related to race. We are kind of really don't collect data related to race We are kind of
reluctant about that, we are not sure if that's the right thing to do although it would be a good thing to do in terms of "is there a quality issue here?" We haven
quality issue here?
We haven'tt done it.
done it ”
• “Does our sensitivity to all diverse circumstances have an impact? Yes. I'm sure it does. Do we have any data to '
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d
support that? Probably not.”
Data Collection and Use
Data Collection and Use
Cultural and Languages Services: No
• “Most information is passed along verbally and not documented because there are so many forms to fill out and the medical issues are more h
f
f ll
d h
d l
important and the cultural or language things get left off… there are areas that we as medical people may not realize that there are certain things that are offensive to ask about. So we need to learn how to get that in a different manner. We might ID them by their clothing, a dialect they speak, whatever; it may not be taken at intake and on forms.”
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• “People say they don't have time to collect these data or to learn how to. Th i f
The information is supposed to be there but it is not evident and it is not i i
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b i i
id
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where it needs to be. It should be on the face sheet ‐ the first thing you see. And there is more than one computer program used within the hospital and they do not talk to each other.”
Data Use
(when collected) Key informant interviews:
• Determine the need for new or expanded Determine the need for new or expanded
services
• Evaluate the effectiveness of services or care
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• Learn more about specific populations
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• None are using demographic data to stratify q
quality measures.
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Conclusions
• CEO’s and senior leaders often unaware of demographic data collection activities.
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• Substantial differences in perceptions of staff and leaders
and leaders.
– Prior survey reports on race, ethnicity and language data collection by hospitals may be misleadingly high.
– Without USING these data, collection activities are less likely to be recognized or understood.
Recommendations: The Role of Leadership
• Establish a centralized program to coordinate culture and language services, including data collection activities • Make the commitment to culturally and linguistically appropriate care highly visible within g
y pp p
g y
the organization
• Have internal multidisciplinary dialogues
Source: Wilson‐Stronks A, Galvez E. Exploring cultural and linguistic services in the nation’s hospitals: A report of findings. Oakbrook Terrace, IL: The Joint Commission; 2007.
Implications for Policy and Practice
Implications for Policy and Practice
• Hospital leaders and staff should understand the importance of systematic collection of p
y
patient demographic information.
• When prompted, leaders and staff often When prompted leaders and staff often
recognize potential utility of these data.
– Even those not collecting data, often say they should be.
– Tools and resources/incentives to facilitate data collection and use are needed.
New Institute of Medicine Report
New Institute of Medicine Report