CPXP Flash Cards
Cultural Competence BAP
A set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals that enables effective work in cross-cultural situations
Culture
Integrated patterns of behavior that include the language, thoughts, communications, actions, customs, beliefs, values and institutions of racial, ethnic, religious or social groups
Competence
Capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors, and needs of the community
How does cultural competency impact healthcare
- Enables positive and constructive dynamics between patient and provider.
- Improves communication
- Promotes trust
Characteristics of a culturally competent provider
Views patient as a unique individual
Realizes their experiences, beliefs, values and language affect their perceptions of clinical care
Cultural Sensitivity
- Recognition that there are differences between cultures
- Reflected in the ways that different groups communicate, relate to one another and interact with healthcare professionals.
Areas of cultural sensitivity
Communication, personal space, touching, eye contact, social orientation, time, family organization, language, relation to nature, ethnicity, values, beliefs, customs, spirituality, religion
Diversity includes (REGARDS)
Race, Ethnicity, gender, age, religion, disability, sexual orientation
What is PFCC (Patient & Family Centered Care) for?
Promote the health & well-being of individuals and families
Patient Family Care Model (RIPC)
Respect, Information Sharing, Participation, Collaboration
Equipping Caregiver for a Patient & Family Centered Care Model DDCC
- Definition of Patient Experience
- Definition PFCC
- Cultural Competence
- Communication and Empathy
PFCC Strategies for an Exceptional Experience
- Bedside shift reporting
- Calming and healing techniques
- Communication tools: Pearls, AIDET, Heart-Head-Heart
- Communication frameworks: scripting, storytelling, huddles, patient rounding
- Conversation strategies
- Experience Mapping
- Room Service Food on Demand
- Rounding
- Relationship Building
Health Literacy
The degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate health decisions
Impact of health literacy limitations
- Preventative services
- Medical condition and treatment
- Rate of hospitalization
- Health status
- Healthcare costs
- Stigma & Shame
Promoting health literacy
- Clear & Simple
- Cultural respect
- offer and confirm understanding through teach back
What are patients rights?
- Receive accurate, easily understood information
- A choice of health care providers
- Access emergency health care services
- Fully participate in all decisions related to their health (if able)
- Considerate, respectful care
- Communicate with health ar eproviders in confidence
Strengths/limitations of CAHPS Survery
Strength - Standard actionable questions; scientifically sound
Limitations - timeliness, rater fatique
This is not a patient satisfaction survey
Strengths/limitations of rounding
Strength - most reliable - real time, engages leaders
Limitations - time intensive
Strengths/limitations focus groups
Strength - deeper dive into topics
Limitations - small samples of issues
Strengths/limitations of social media
Strength - instant feedback
Limitations - may be hard to aggregate data
Strengths /limitations of compliments & complaints
Strength - can count, sort and trend
Limitations - dependent on rater actions
Strengths/limitations of PFACs
Strength - builds relationships
Limitations - often infrequent meetings
Strengths/ limitations discharge phone calls
Strength - quick feedback
Limitations - requires consistent resource
Strengths/limitations of employee satisfaction or engagement survey
Strength - informs regarding culture
Limitations - it is a point in time survey (every two years)
What is the “mean”
The mathematical average 7,6,3,3,1 (4) 4,4,4,4,4 (4) 5,5,5,0,5 (4) Smooths data by removing peaks and valleys
What is the “median”
The number that divides the sample - middle value
- If middle has two numbers - add two numbers and divide by 2
- Sort numbers lowest to highest
What is the “mode”
The most common (frequently occurring) value
50, 55 ,58 ,70 ,70, 90, 93, 99 (70)
What is the “range”
The highest minus the lowest 50, 55, 58, 70, 70, 90, 93, 99 (99-50= 49)
Spread of the data set
What is “variability”
Reflects how scores differ from one another
What is “variance”
The average squared difference from the mean
Measure the amount of variability in a set of scores
What is “inclusive range”
The highest score minus the lowest score plus 1
What is “histogram”
A graph
What is “standard deviation”
The average deviation from the mean. The lower the number, the less the variation, the closer to the mean
What is “correlation”
The degree that two factors are related
What is “positive correlation” - direct correlation
the values change in the same direction (graph heading upward)
What is “indirect correlation”
a negative. The values change in opposite directions. (when one goes up and the other goes down)
99.7% of data in normal distribution is within how many deviations of the mean?
3
95% of data in normal distribution is within how many deviations of the mean?
2
68% of the data in normal distribution is within how many deviations of the mean
1
Another name for normal distribution
bell curve
What is qualitative data?
Information that is not in numeric form.
Example : patient comments
What is quantitative data?
Information that is numeric in form.
Example: number of days in hospital
What is valid data?
data is valid when it measures what it is supposed to measure
What is reliable data?
data is reliable when it produces similar results under consistent conditions.
Example: scale - if it weighs you different each time it is not valid but still reliable (consistent)
What is evidenced based data?
hard data to support effectiveness of a process or improvement
What is a flow chart?
A diagram that represents a workflow or process. Connects with arrows, Analyzing, designing, documenting or managing a process or program
Example: Org Chart
What is a pie chart?
Circle chart divided in slices - visual display of data. Displays nominal or ordinal categories
What is nominal data
data categorized according to descriptive information
What is ordinal data
data categorized according to ranking
What is a run chart?
trends improvement over time. Graphically display cycles overtime. It is simple to produce but does not allow for full range of analytic techniques that a control chart would. Effective way to show process improvements
What is a control chart?
a graph that is used to study how a process changes over time. Central line in middle for an average. Limited upper and lower points
Affinity Diagram
LEAN - brainstorming - organized data - random thoughts
Use when issues are too large and complex to grasp
Brainstorming
Alayzing verbal data such as survey results
Dashboards
Used to share data with specific audiences. (board of directors, managers, front line staff) Identified trend
What is Value Based Purchasing?
- CMS driven
* Reimbursement based on quality, rather than quantity
Percentage of patient experience tied to care coordination
25% - 2017 to increase by 2%
How to effectively communicate with stakeholders
- Communicate
- Use key drivers
- vendor resources
- The “why” - why it is important
- They understand their important role
When computing the standard deviation, what do you need to do FIRST as a measure of central tendency
Compute the mean
What data collecting tool would be most useful in reviewing written comments in a patients survey?
Affinity Diagram
What is Experience Based Design
EBD - FOCUSED ON understanding the experiences and EMOTION of those who are involved in receiving and delivering healthcare services.
Best for “what really matters to our customers”
Understanding our patients emotional experience.
What is LEAN
Improve Value Stream by eliminating WASTE
Focus on effectively delivering value
Respect people
What is PFAC - Patient Family Advisory Council
Council that partners with patients, family and healthcare team to improve the patient and family experience
Effective uses of PFAC
Help with Patient & Family Experiences
Assist in how care is delivered to patients
Decide on materials given to patients and families
Help with facility design
Benefits of PFAC for an organization
- Insight to what is done well and ares of change needed
- Helps to prioritize improvement needs
- Offers new ideas and solutions
- Promotes partnership with patients and families
- Strengthens community relationship
Benefits of PFAC to patients and families
- Understand the healthcare system
- Community advocate
- Feels listened to and valued
- Skill development
- Relationship building
PFAC Design & Implementation
- Sponsor - leader
- Liaison - assists Sponsor
- Steering Committee
- Planning Committee - staff & patient/family
- Members - patient, family, staff, senior leadership, service area directors, physician representative
What is Shared Decision Making?
A collaborative process that allows patients and their providers to make health care decisions together
Benefits/Limitations of Technology Solutions - such as patient portal
Benefits: Meets customer expectations Parallel best practices in other industries Easy to use Opportunity for engagement and partnership in care Improved adherence to care Limitations: Cultural resistance to change Infrastructure costs Concerns in privacy Training required Needs access to technology
Key elements for successful and sustained change in healthcare?
- Sense of urgency
- Guiding coalition
- Vision and strategy
- Communicate the change vision
- Empower broad-based action (empower staff to do the right thing)
- Generate short-term wins
- Consolidate gains producing more chnage
- Anchor new approaches in culture (sometimes the only way to change is to change people)
Transactional Leadership
Focuses on tasks and status quo Accepts existing culture Responsive Extrinsic Motivation Management by exception Corrective action to improve performance
Transformational Leadership
Achieving inspirational vision Shapes a new culture Proactive Intrinsic Motivation Intellectual stimulation Promotes innovative ideas to solve problems
Six Stigma
process that can be definited, measured, analyzed, improved and controlled
Rigorous approach to identifying and implement solutions
MEASURE
TQM Total Quality Management
Long term quality improvement
Customer satisfaction
IHI - Institute for Healthcare Improvement - AMI
Plan, Do, Study, Act PDSA - action oriented
What are we doing (Aim)
How will we know it is an improvement (Measure)
What change can we make that will improve (Idea)
What is Outcome Measure? (how the parts and steps impact patients)
How the system impacts the values of patients, their health and wellbeing
How the system impacts other stakeholders such as payers, employees, or the community
Driven by national standards and financial incentives.
EXAMPLE: Pt experience - number of complaints
Access - number of days to 3rd next avail appt.
Critical care - ICU pct unadjusted mortality
What is Process Measure? (what are the parts and steps in the system)
Are the parts in the system performing as planned?
Are we on track to improve our system?
EXAMPLE: Pt experience - Decrease time between lab and test results
Access - Daily hours available for appts
Critical care - pct of patients with intentional rounding completed
What is Experience Based Co-Design (EBCD)
INVOLVES GATHERING experiences from patients and staff through in-depth interviewing
Identifying key EMOTIONALLY significant touch points
Assigns positive or negative feelings
EBD; EBCD Framework CUIM
- Capture the Experience (observations, interview, questionaires
- Understand the Experience (affinity diagram, reports, sharing experience, emotional mapping, identifying priorities
- Improve the Experience (Co-design / Forming Team)
- Measure the Experience (Subjective and Objective Measure
Descriptive Statistics
Values that describe the characteristics of an ample or population
What is ethnography
A form of qualitative research that allows a trained observer to observe and document the experience. Studying the patient experience
What is frequency distribution
A method for illustrating the distribution of scores within class intervals
What is a histogram - bar graph
A graphical representation of a frequency distribution
PDCA The Plan Do Study Act PTOA
testing a change in the real work setting
planning it, trying it, observing it and acting on what is learned
Process Flow Chart
Picture of th eseparate steps of a process in sequential order
USES:
develop understanding of how a process is done
study a process for improvement
communicate to others how a process is done
when communication is needed between people involved
document a process
planning a project
Total Quality Management (TQM)
Management approach to long-term success through customer satisfaction. All members participating in improving processes.
Evidence Based
Hard data to support the effectiveness of a process or an improvement
Persuasive
Nominal measure
Answer fits into category
Example: Gender, Race, Yes/No
Ordinal measure
Categorical but sequential
Example: Date range, Pain scale
Goes up in equal amounts as the scale goes up
Interval data
Scale data or temperature gauge
Numerical and logical
Example: 1 is great than 0
Likert scale
Any scale with multiple points
Example: Many survey questions (Fair, good, very good)
Any measure from lowest to highest
*After data collected you can turn into interval data so more statistics can be run such as mean
Ratio data
Comparison or relation between two numbers
Example: 1 to 4 ratio of female nurses
Number of sample size reliable results for an actionable result?
30
Standard Deviation
Measure variability and how much is considered normal. Measure the average amount of variability
in a set of scores
Most commonly used
In a perfect normal distribution or bell curve the mode, median and mean are all….
Equal
Top Box Data - Strength and limitations
Strength - Simple
Limitation - loses information on variability and precision
Triple AIM
patient experience, population health, reducing cost
Outcome Measure
