Diversity in Health Care: A Call to Action

November 2, 2017

Among our core values at Northwest Permanente, P.C., is diversity, both within our workforce and in the care we provide to our members. Recently on LinkedIn, NWP CEO Imelda Dacones posted the following account of a recent meeting where she discussed Kaiser Permanente’s approach to cultural competence.

How does cultural competence translate to excellence in health care? And what does it mean to the bottom line?

Yesterday, in an intimate classroom setting, I was privileged to share the panelists’ table with Diversity officers and leaders from OHSU, Moda, and Providence at the Inaugural Portland Healthcare Diversity Summit.

Asked another way, the question above really is “what happens when we do not provide culturally competent care?” i.e., when we do not effectively deliver health-care services that meet social, cultural or linguistic needs of patients?

In the “linguistics” arena, here are findings I shared from some studies:

  • <48% of patients who needed an interpreter report having one or “usually” having one
  • patients with limited English proficiency suffer from more medical errors that lead to harm, poorer quality of care and poorer outcomes
  • those with low literacy (think health education materials, instructions on prescription bottles or hospital discharge instructions, etc.) use more medical services to the tune of $32-58 billion (3-6% more) in additional health care expenditures

The bright spot is that when we do meet the linguistic needs of patients, there is greater patient satisfaction, greater patient engagement and adherence, and even increased use of preventive services.

At Kaiser Permanente Northwest, we have eliminated disparity in colorectal cancer screening for our Hispanic/Latino patients with help from Spanish-speaking, culturally aware care teams, as well as with more robust interpreter services and varied approaches to outreach.

As for meeting social and cultural needs, one study estimates even just a 10% reduction in disparity in effective asthma treatment and prevention of asthma attacks among African-American patients can save $1,900 per person per year in medical costs and missed work productivity.

On the West Coast, KP has eliminated disparity in blood pressure control among our African-American, Hispanic/Latino and Asian patients. This is lives saved, premature deaths and disability due to strokes and heart attacks reduced, and, yes, $$$ saved.

Health-care disparities drive additional health-care expenditures as above. Another $10 billion can be attributed to illness-related lost productivity and $200 billion to premature deaths from heart disease, stroke, diabetes, cancer, etc.

And, in KP, and certainly in the country, we have more work to do. Culturally competent care is a journey and a process. The work is never done. Enablers are coverage and access to high quality health care, as are a diverse workforce and partnerships with communities, community health workers and organizations.

For physicians, culturally competent care, translated into health-care excellence, is a moral, ethical, and professional imperative. As a woman, as a woman of color, as an immigrant, to me it’s mission-critical, as it is with Kaiser Permanente. Permanente medicine is practiced by nearly 22,000 physicians who are empowered to provide the right care, at the right place, for the right reasons. For close to 12 million KP members and patients, Permanente medicine is a tremendous advantage.

We can pound on our chests, demand action now for justice, morality and ethics. For the few Diversity, Equity, and Inclusion leaders I met at the summit, for the few who are “fighting this fight” to improve patient satisfaction, health-care outcomes and quality of care, and to eliminate health and health-care disparities, we must, too, use data to drive the change we want and need to see. And, yes, still policymakers, leaders, payers, governments and employers will listen more and hear better when the data we show about all this, too, beyond justice and equity, is about the bottom line.

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