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Improving Service Delivery

The theme of organizational supports under the Office of Minority Health national standards on Culturally and Linguistically Appropriate Services (CLAS) is comprised of initiatives and activities to be undertaken by health care organization leaders:

  • Conducting organizational self-assessments
  • Collecting patient level data on race, ethnicity, and spoken language
  • Reviewing demographic cultural and epidemiological profiles of the community
  • Developing collaborative partnerships within the community
  • Providing opportunities for ongoing training and education

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Leadership involvement linked to success of organizational cultural competence efforts

As with any organizational initiative, structural supports for the provision of culturally and linguistically appropriate services need to begin with health care leadership. According to a study funded by The Joint Commission, “leaders provide the framework for planning, directing, coordinating, providing and improving care, treatment, and services to respond to community and patient needs and improve health care outcomes.”

This sentiment was echoed in additional research which cites the commitment of leadership as being the most significant element in an organization’s ability to integrate cultural competency, and that the most successful cultural competence efforts had commitment from organizational leaders (California Endowment, 2006).

In Minnesota

Minnesota's non-white population is projected to grow from 19 percent in 2015 to 25 percent in 2035. The Hispanic/Latino population alone is expected to grow 58 percent during this time. As Minnesota’s population becomes more diverse, so does need for organizations to undertake initiatives and activities to assure the provision of culturally and linguistically appropriate services.

Multiple Minnesota-based studies point to wide gaps between racial and ethnic groups on measures of access and health outcomes. According to a 2000 University of Minnesota study, many Hispanics/Latinos seek care only when a condition has reached a crisis point. Even when Hispanics/Latinos were able to see a health care provider, many did not feel they received adequate care because of language and cultural barriers.

More recently, a 2003 Minnesota Department of Human Services study found that populations of color enrolled in Minnesota’s Health Care Programs (MHCP) experienced more barriers to access and utilization of health care services than do their European American counterparts. Among racial and ethnic populations included in the study, the groups most likely to be immigrants (Hispanic/Latino, Hmong, and Somali) reported the greatest number of barriers. About 45 percent of adults felt that their ability to pay or being enrolled in MHCP caused their doctor or other health care providers to treat them unfairly.

Conducting Organizational Self-assessments

A multitude of options are available for developing or improving programs and services aimed at meeting the needs of diverse populations. More important, organizations should understand the strengths and opportunities for improvement that lie within their current efforts before investing resources for improvement. For these reasons, it is beneficial for health care organizations to conduct a self-assessment of their cultural and linguistic service offerings, also known as a CLAS Assessment.

The benefits of this exercise include (Center for Nonprofit Management, 2009):

  • Bringing focus to improvement efforts
  • Optimizing use of resources
  • Emphasizing opportunities for improvement over “placing blame”
  • A holistic view of the organization

Assessments need not be formal, heavily structured, or require a lot of resources to complete. There is no standardized assessment tool in place for evaluating CLAS activities. Organizations can use the Culture Care Connection CLAS Assessment to obtain recommended actions for addressing gaps.

Patient- and community-level data

Health care organizations should collect and review patient and community level data to gain a better understanding of diverse populations and their cultural and linguistic needs. This information in turn may be used to inform strategic planning that incorporates the provision of culturally and linguistically appropriate services.

The collection of patient-level data including race, ethnicity and spoken language preferences as well as the stratification of conflict/grievance and satisfaction survey data can allow for the effectiveness and utilization of cultural and linguistic services to be measured and evaluated.

Review of community level data provides another opportunity for organizations to assess and accommodate the needs of patients from diverse populations. Community level data such as demographics, information about vulnerable populations and health status data may provide insights about populations that currently utilize an organization’s services as well as those who don’t, thereby creating opportunities for outreach and service area expansion.

Developing collaborative partnerships within the community

Another way for health care organizations to stay in tune with the needs of diverse populations is by developing collaborative partnerships. Minnesota is home to nearly 1,000 organizations whose mission is aligned with meeting the needs of diverse populations.

Health care organizations can collaborate with these organizations by:

  • Establishing opportunities for members from diverse populations to provide feed back on their health care experiences in general, or with regard to a specific organization (focus groups)
  • Inviting community or religious leaders to serve on advisory panels
  • Advertising or sponsoring public service announcements using ethnic media outlets
  • Inviting the community to attend health fairs at your organization
  • Attending community events as a means for distributing health materials or providing health screenings
  • Working with traditional healers to gain a better understanding of health-related practices as well as identifying opportunities to serve as a partner in providing care to the community
  • Posting job vacancy notices with organizations that provide job skill training, or advertising the openings with ethnic media outlets

Provide opportunities for ongoing training and education

Leaders can impact their organization’s ability to provide culturally competent care to diverse populations by providing opportunities for staff at all levels and within all functional areas to receive ongoing training and education. Just as continuing education is required to be aware of the technical development in health care professions, additional training is also necessary to foster positive working relationships with the populations served (University of Minnesota, 2000).

Further, a 2006 report from the Commonwealth Fund noted that ongoing staff training was an “essential component of successful cultural competence programs.” Through training and education, staff become more familiar with patients’ cultures, which can promote an environment of understanding and appreciation for diversity. Training and education efforts could also be used as a forum to gain staff buy-in and understanding of your organization’s cultural competence efforts.

Of the various training resources available, few were developed with the needs of Minnesota's providers and the predominant cultures of Minnesota in mind. Minnesota specific training resources >