Beyond Compliance: The Need for A Systems Approach to Address Joint Commission Cultural Competence Standards

The Joint Commission, with implementation to occur in 2011, recently released proposed cultural competence standards. The National Center for Healthcare Leadership (www.nchl.org) reviewed the proposed standards and developed an evidence-based systems approach for health care organizations to proactively assess and improve their performance against the standards. The systems approach is grounded in evidence from the leadership and organizational change literature and results in an organization-specific action plan to improve performance. First, the proposed standards are reviewed and the evidence base for the systems approach to diversity, inclusion, and cultural competence is presented to participating organizations. Then, participating organizations assess their baseline performance by completing two assessments: one focused on the leadership and diversity management infrastructure in the organization and the other on policies and practices to deliver culturally and linguistically appropriate care. Results are mapped to the standards and to existing models for diversity and cultural competence including the CLAS Standards and the National Quality Forum's (NQF) seven domains to report and assess cultural competence: Leadership; Integration into Management Systems and Operations; Patient-Provider Communication; Care Delivery and Supporting Mechanisms; Workforce Diversity and Training; Community Engagement; Data Collection, Public Accountability, and Quality Improvement. The systems approach and the evidence base for it are reviewed in the context of the proposed Joint Commission cultural competence standards and case examples of the approach are presented.