Proposal: Adapting a Cultural Competence Assessment Protocol for Nursing
Facilities Serving Racially and Ethnically Diverse Residents
Project Goal
The overall goal of this project is to determine the feasibility of adapting an existing
cultural competence organizational assessment protocol for application in nursing
facilities, in particular, skilled nursing settings, so that they can assess their
organizational cultural competence as well as use results to develop strategies for
improvement.
Project Objective
The project objective is to convene a meeting of experts to review and assess the
feasibility of adapting the existing protocol for nursing facility settings.
Background
The Cultural Competence Self-Assessment Protocol was developed to serve as a tool by
which health care systems could conduct audits of their activities to address the needs of
racially and ethnically diverse patients. This detailed instrument, which includes a guide
for its administration, was created around four core elements: the organization’s
relationship with its community; administration/management relationship with staff,
inter-staff relationships, and patient-provider interactions. It asks specific, detailed
questions on these dimensions and offers a scoring guide by which health care systems
can be rated along a five-point spectrum of cultural competence.
Over 500 organizations have requested the protocol. Responses from hospitals that have
applied it have indicated its value in identifying both successes and challenges in meeting
cultural competence patient needs, and assisting in setting future directions for
improvement. A synopsis of the protocol, its objectives, process and benefits, was also
published in the book, Immigrant Women’s Health (E. Kramer, S. Ivey, Y. Ying, Jossey
Bass, San Francisco, 1999).
Indicative of its potential for adaptation to other health care venues, CMRI, a medical
review organization based in California, has contracted for the application of the protocol
in health plan settings. Currently, at least four health plans have agreed to administer the
protocol as a way of meeting the 2003 QAPI cultural competence requirements.
Target population
The increasing population of older US residents includes increasing numbers of racially
and ethnically diverse populations needing care in nursing facilities. To date, however,
skilled nursing facilities and related settings have no tools available to them to assist in
addressing and assessing current and future cultural competence needs. The proposed
project would build on existing efforts to provide the first forum for designing such a
tool. The target population is racially/ethnically diverse Medicare and Medicaid
beneficiaries in nursing facilities.
Project Design and Deliverables
The proposed project will use the experiences and the review process developed for the
CMRI initiative. In particular, after reviewing several instruments, CMRI staff concluded
that the Cultural Competence Protocol offered the most comprehensive review of
relevant actions and was potentially compatible with health plans. The CMRI project has
used a formal process to convert the existing protocol. This process includes creating a
team to review the protocol and to identify action steps. It incorporates use of expertise in
health plans’ organizational structure, member needs, developing a strategy for
conducting a pilot assessment, and reviewing results. Meeting agendas have reflected
these elements and have allowed for successful, detailed discussion on each protocol
question. The project team anticipates using a similar design to conduct this project.
Deliverables
The project has four deliverables
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Meeting agenda and relevant background materials. Project staff will create
an agenda for a one-day meeting. It will work with CMS staff in its development
as well as in preparation of background information. Such information is expected
to include the existing protocol as well as a summary of the conversion process
and issues that are part of the health plan project. (due 4 months from EDOC)
Identifying meeting attendees. The project team will develop a list of
prospective attendees for the meeting. In addition to CMS staff, the external
expert list will include four professionals knowledgeable in: conducting research
and related work in skilled nursing settings; cultural competence and long-term
care; and organizational assessment. (due 4 months from EDOC)
Conducting the meeting. The project team will organize and conduct a one day
meeting. (6 months from EDOC)
Report development. A draft report on the results of the meeting will be
forwarded to CMS staff for review. After reviewing and incorporating comments,
the project team will submit a final report. (Preliminary report by ninth month;
final due at one year from EDOC)
Measurable objectives
The project includes the following measurable objectives:
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Evaluation of the efficacy of converting the existing cultural competence
protocol for nursing facilities. That is, can the protocol be effectively adapted to
these settings?
Identifying the design for piloting and assessing the practical application of
the protocol. What are the steps needed to test the instrument?
Preliminary determination of the information needed by nursing facilities to
apply the protocol. What do nursing facilities need to know about using the
protocol?
Outcomes—measures of project success
The project will provide an effective review of the protocol as a tool to meet the needs of
nursing facilities with diverse populations, preliminary determination of its value to these
settings, and conversion steps and guidance for developing a full pilot project.
Product Schedule
This project will be conducted and completed over 12 months.
Staffing
Dennis P. Andrulis, Research Professor, State University of New York/Downstate
Medical Center, Brooklyn, will serve as Principal Investigator. Candice Mathew Healy
will serve as senior analyst and meeting coordinator.
Budget
A detailed budget is attached.
Please address all correspondence to:
Dennis P. Andrulis
Research Professor
Department of Preventive Medicine
SUNY/Downstate Medical Center
450 Clarkson Ave
Box 1240
Brooklyn, NY 11203
Tel: 718-270-7726
Email: dennis.andrulis@downstate.edu