Project Option 1.4.4: Clinical Cultural Competence: Develop cross-cultural training program that is a
required, integrated component of the training and professional development of health care providers
at all levels; the curricula should increase awareness of racial and ethnic disparities in health and the
importance of socio-cultural factors on health beliefs and behaviors; address the impact of race,
ethnicity, culture, and class on clinical decision making; develop tools to assess the community
members’ health beliefs and behaviors; develop human resource skills for cross-cultural assessment,
communication, and negotiation: ENHANCE INTERPRETATION SERVICES AND CULTURALLY COMPETENT
CARE
Unique Project ID: 196829901.1.2
Performing Provider Name/TPI: Sierra Providence East Medical Center / TPI: 196829901
Project Description:
This project will improve effective communication by designing and developing a program to improve
the cultural competency of UMC staff as well as staff competency in assessment of health literacy.
This goal of this project will be to design and develop a program to improve the cultural competency of
the staff as well as competency in assessment of health literacy for the improvement of effective
communication. Tenet believes that effective health communication is as important to health care as
clinical skill. Tenet is committed to improving individual health and building healthy communities, and
Tenet wishes to support our health care providers as they recognize and address the unique culture and
health literacy of our diverse patient population. When this support is provided, patients will have
access to qualified health care in their primary language and will support the likelihood of safe and
effective care, open communication, adherence to treatment protocols, and better health outcomes.
This project will involve the implementation of organizational performance improvement and
transformational activities that spread learning and awareness, thereby building patient/provider
communications that are culturally competent and health-literacy aware.
Goals and Relationship to Regional Goals:
Project Goals: A major goal of the project will be the improvement of patient experience as evidenced
by improvement of Nurse/Physician communication scores and overall program scores on patient
assessment tools.
This project meets the following regional goals: There is consensus about the nature and importance of
cultural competence as an essential component of accessible, responsive, and high quality health care.
Health care services that are respectful of and responsive to the health beliefs, practices and cultural
and linguistic needs of diverse patients can help bring about positive health outcomes. This project will
align to the Regional goals of improvement of the management patients with chronic diseases, to help
prevent unnecessary readmission and providing patients the care they need to prevent disease and to
self-manage their disease process. The intent of the this project will support the Regional goals of
overcoming language barriers to accessing healthcare resources in the region and increase the patient
experience through delivery of high-quality, effective healthcare services.
Challenges:
Challenges facing the project include the current lack of knowledge regarding health literacy, and the
assumption of culturally competency of staff due to Hispanic staff caring for Hispanic population.
5-Year Expected Outcome for Provider and Patients:
Organizational cultural competence is an important component of patient-centered care and has the
potential to improve access to care, quality of care, and, ultimately, health outcomes. A patient’s own
limited health literacy level, affected in part by cultural and ethnic barriers in language and
understanding, can further impede communication. Sierra Providence East believes it can serve as a
catalyst for driving the development and maintenance of individual provider cultural competence by
providing the leadership, policies, and systems to support the awareness of culturally competent care
with our patients. SPEMC health professionals must provide clear, understandable, evidence based
health information to the SPEMC patient population. With clear communication, SPEMC will expect to
contribute to the patient’s understanding of their disease process, self-management concepts and what
resources are available to them throughout their transitions. Through this project, the expectation is to
improve the patient experience as well as to improve the patient’s understanding of their responsibility
to their healthcare, thus, reducing preventable readmissions and improvement of their overall wellbeing.
Starting Point/Baseline:
A demographic evaluation will be made of all employees, to include, race, languages spoken, and
education level. In addition, the facility will inventory all available training materials specific to cultural
competency.
Rationale:
The 2010 US Census reported the United States population has become more diverse than ever before,
and this trend is expected to continue over this century. In El Paso, the minority is the majority with 80.7
percent of the population being Hispanic, as compared to a 16.7 percent Hispanic population in the
United States and a 37.6 percent Hispanic population in Texas. As El Paso becomes a more ethnically
and racially diverse city, our health care systems and providers need recognize and address the unique
culture and health literacy of a diverse patient population. Failure to understand and manage
socio‐cultural differences may have significant health consequences for minority groups in particular.
Systems lacking culturally and linguistically appropriate health education materials lead to patient
dissatisfaction, poor comprehension and adherence, and lower‐quality care. Low health literacy creates
difficulties in communicating with clinicians, poses barriers in managing chronic illness, lessens the
likelihood of receiving preventive care, heightens the possibility of experiencing serious medication
errors, increased risk of hospitalization, and results in poorer quality of life. Effective health
communication is as important to health care as clinical skill.
Project Components:
This project will accomplish the following project components:
a) Develop cross-cultural training program that is a required, integrated component of the
training and professional development of health care providers at all levels.
o
Sierra East will develop such a program under this project.
b) Conduct quality improvement for the project using methods such as rapid-cycle
improvement. Activities may include, but are not limited to, identifying project impacts,
“lessons learned,” opportunities to scale all or part of the project to a broader patient
population, and key challenges associated with expansion of the project, including special
considerations for safety-net populations.
o
Sierra East will continue to improve the program developed under this project by
conducting quality improvement activities following the implementation of the
program.
Unique community need identification numbers the project addresses:



CN-1: Primary Care
CN-2: Secondary and Specialty Care
CN-6: Other Projects
How the project represents a new initiative or significantly enhances an existing delivery system
reform initiative:
Sierra Providence East project for driving the development and maintenance of individual provider
cultural competence by providing the leadership, policies, and systems to support the awareness of
culturally competent care with our patients. This will be a NEW initiative for SPEMC.
Related Category 3 Outcome Measures:
OD-6: Patient Satisfaction
IT-6.1: Percent improvement over baseline of patient satisfaction scores
196829901.3.2
Reasons/rationale for selecting the outcome measures:
As this project is implemented and culturally competent care is enhanced, Sierra East believes that
patients will receive more effective care, which will result in an improvement in patient satisfaction
scores for the target population of the project. Specifically, Sierra East expects that the successful
implementation of this project will be evidenced by an improvement in patients’ ratings of the
communication skills of their health care providers.
Relationship to Other Projects: This project is part of Tenet’s larger plans to expand and develop
primary care and specialty care services in the El Paso community, while improving access to care and
containing the costs of care. Specifically, this project will complement Tenet’s Expand Primary Care
Access project (196829901.1.1) and Enhance Interpretation Services and Culturally Competent Care
project (196829901.1.2); each of these projects is intended to improve the patient experience by
providing care in more effective and efficient ways.
Relationship to Other Performing Providers’ Projects and Plan for Learning Collaborative:
This project is congruent with an Enhance Interpretation Services and Culturally Competent Care project
to be performed in RHP Region 15 by Providence Memorial Hospital (130601104.1.2).
Performing Providers, IGT entities, and the Anchor for Region 15 have held consistent monthly meetings
throughout the development of the Waiver. As noted by HHSC and CMS, meeting and discussing Waiver
successes and challenges facilitates open communication and collaboration among the Region 15
participants. Meetings, calls, and webinars represent a way to share ideas, experiences, and work
together to solve regional healthcare delivery issues and continue to work to address Region 15’s
community needs. UMC, as the Region 15 Anchor anticipates continuing to facilitate a monthly
meeting, and potentially breaking into workgroup Learning Collaboratives that meet more frequently to
address specific DSRIP project areas that are common to Region 15, as determined to be necessary by
the Performing Providers and IGT entities. UMC will continue to maintain the Region 15 website, which
has updated information from HHSC, regional projects listed by Performing Provider, contact
information for each participant, and minutes, notes and slides from each meeting for those parties that
were unable to attend in-person.
Region 15 participants look forward to the opportunity to gather annually with Performing Providers
and IGT entities state-wide to share experiences and challenges in implementing DSRIP projects, but also
recognize the importance of continuing ongoing regional interactions to effectuate change locally.
Through the use of both state-wide and regional Learning Collaborative components, Region 15 is
confident that it will be successful in improving the local healthcare delivery system for the low-income
and indigent population.
Project Valuation
$2,592,762. In determining the value of this project, Tenet considered the extent to which providing
more culturally competent care will address the community’s needs, the population which this project
will serve, the resources and cost necessary to implement the project, and the project’s ability to meet
the goals of the Waiver (including supporting the development of a coordinated care delivery system,
improving outcomes while containing costs, and improving the healthcare infrastructure). Specifically,
Tenet considered the needs of the large Hispanic population in the El Paso community, as well as the
effort that will be required to develop a culturally competent care training program specific to the needs
of this population and to implement it by training health care providers at Sierra East.
Tenet plans to implement a similar Category 1 project at its Providence Memorial Hospital location,
serving a different geographic area of the city. The disparity in valuation between this Providence
project and the similar Sierra East project is due to the fact that Providence is a much larger facility than
Sierra East (with 508 beds, compared to 110 at Sierra East) and accounts for 270% more Medicaid and
uninsured days than Sierra East.
196829901.1.2
1.4.4
1.4.4.X
Sierra Providence East Medical Center
196829901.3.2
IT-6.1
Related Category 3
Outcome Measure(s):
Year 2
(10/1/2012 – 9/30/2013)
Milestone 1: Establish baseline for
metrics P-1.1, P-2.1, P-8.1, I-18.1, and I18.2.
Metric 1: Establish baseline for future
years.
Milestone 1 Estimated Incentive
Payment: $634,098.
Year 3
(10/1/2013 – 9/30/2014)
Milestone 2 [P-1]: Conduct an
analysis to determine gaps in
language access and culturally
competent care.
Metric 1 [P-1.1]: Gap analysis.
Baseline/Goal: Completion of
analysis.
Data Source: Gap analysis.
Milestone 2 Estimated Incentive
Payment: $345,883
Milestone 3 [P-2]: Develop a program
to enhance organizational, systemic,
or clinical cultural competence as
described in the project options.
Metric 1 [P-2.1]: Develop and
implement program to improve
cultural competence.
Baseline/Goal: Development and
implementation of program.
Data Source: Program materials.
Milestone 3 Estimated Incentive
Payment: $345,883
ENHANCE INTERPRETATION SERVICES AND CULTURALLY COMPETENT CARE
196829901
Percent improvement over baseline of patient satisfaction scores
Year 4
(10/1/2014 – 9/30/2015)
Year 5
(10/1/2015 – 9/30/2016)
Milestone 4 [P-8]: Develop program to
improve staff cultural competency and
awareness.
Milestone 5 [I-18]: Implement intervention to
increase access to language services and
culturally competent care.
Metric 1 [P-8.1]: Increase number of
champions/staff that are designated
and trained in a population’s culture
and unique needs.
Baseline/Goal: 50 employees
Data Source: HR workforce training
data; program materials.
Metric 1 [I-18.1]: Increase percentage of
target population reached.
Baseline/Goal: 20% increase.
Data Source: Documentation of target
population reached, as designated in the
project plan.
Milestone 4 Estimated Incentive
Payment: $346,889
Milestone 4 [I-18]: Implement
intervention to increase access to
language services and culturally
competent care.
Metric 1 [I-18.1]: Increase percentage
of target population reached.
Baseline/Goal: 10% increase.
Data Source: Documentation of
target population reached, as
designated in the project plan.
Metric 2 [I-18.2]: Increased scores on
standardized and evidence-based
cultural competence assessment tool.
Baseline/Goal: 15% increase.
Data Source: Assessment reports.
Milestone 4 Estimated Incentive
Payment: $346,888
Metric 2 [I-18.2]: Increased scores on
standardized and evidence-based cultural
competence assessment tool.
Baseline/Goal: 25% increase.
Data Source: Assessment reports.
Milestone 5 Estimated Incentive Payment:
$573,120
196829901.1.2
1.4.4
1.4.4.X
Sierra Providence East Medical Center
196829901.3.2
IT-6.1
Related Category 3
Outcome Measure(s):
Year 2
(10/1/2012 – 9/30/2013)
Year 2 Estimated Milestone Bundle
Amount: $634,098
Year 3
(10/1/2013 – 9/30/2014)
Year 3 Estimated Milestone Bundle
Amount: $691,766
Percent improvement over baseline of patient satisfaction scores
Year 4
(10/1/2014 – 9/30/2015)
Year 4 Estimated Milestone Bundle
Amount: $693,777
TOTAL ESTIMATED INCENTIVE PAYMENTS FOR 4-YEAR PERIOD: $2,592,762
93807.6
ENHANCE INTERPRETATION SERVICES AND CULTURALLY COMPETENT CARE
196829901
Year 5
(10/1/2015 – 9/30/2016)
Year 5 Estimated Milestone Bundle Amount:
$573,120