A Diversity and Cultural Proficiency Assessment Tool for

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					                 GTA DIVERSITY AND ONTARIO’S

  A Diversity Self-Assessment Tool for
   Local Health Integration Networks

Ontario is one of the most diverse and cosmopolitan areas of the world. The
province’s constantly changing demography, the socio-economic reality of
diverse and marginalized communities, and the poorer health outcomes that
they experience means that local health integrated networks (LHINs) will need to
build diversity and cultural competency into the fabric of health care planning
and delivery.

This Diversity Self-Assessment Tool was created as a planning tool to help
LHINs identify their current capacity and progress, as well as needed
improvements to realize diversity and cultural competency within their service

The Tool is divided into two parts. The first part is an organizational self
assessment. It can guide LHINs in examining their internal policies, procedures
and structures. The philosophy behind this section is that the most effective
leaders are those who lead by example. By modeling the principles of diversity,
equity and inclusion LHINs will credibly direct health service providers (HSPs)
to become culturally competent themselves, and better reflect their diverse
communities in all aspects of planning and delivery.

The second part of the Tool is designed to help the LHINs advance diversity and
cultural competency in the health care system in its role as a funder. LHINs can
support diversity and improve inclusion by setting comprehensive standards for
health service providers; developing resources that enable health service
providers to become culturally competent; and monitoring and enforcing
diversity benchmarks.

Self-assessment is only as useful as organizations are willing and able to use the
results as a springboard for further action. This Tool is one component in a
larger organizational change process of asking questions, revising assumptions,

engaging communities, building capacity, and delivering equitable care. It
provides a critical lens, which allows a LHIN to reflect on its current position and
plan an effective response so that all clients within its service area can enjoy good
health and equitable access to health care.


Cultural competency refers to the ability of organizations and systems to
function and perform effectively in cross-cultural situations (Cross 1989;
Kunisawa 1988; Sue et al., 1992). In this context, culture is defined as the unique
characteristics that all of us possess that distinguish us as individuals and
identify us as belonging to a group or groups (Hastings Institute). The diversity
of identifying characteristics includes one’s race, culture, language, faith/religion,
gender, sexual identity, gender identity, family status, ability, socio-economic
status, immigrant status, age, and other relevant life experiences such as
homelessness, mental health issues and addictions.


This Diversity Self-Assessment Tool is presented by the GTA Diversity and
LHINs Working Group. We are an ad hoc coalition of health-care providers and
community-based organizations from across the GTA who strongly support
equity, inclusion and accountability at all levels of LHINs planning, funding and
delivery. Please contact the following individuals for more information:

Angela Robertson, Sistering
(416) 926-9762

Kwasi Kafele, Centre for Addiction and Mental Health
(416) 535-8501 ext. 6539

                                           PART 1

A local health integration network (LHIN) that is culturally competent
establishes diversity as a corporate strategic priority; reflects the principles of
diversity, equity and inclusion in its organizational culture; mirrors the
community’s diversity in its governance and staffing; and cultivates inclusive
relationships with communities.

Indicators of success for a diverse and culturally competent LHIN include
commitment from the top, clarity on what needs to be changed; process
internally managed, knowledge-based, and supported by training; commitment
reflected in policies and procedures; goals action-oriented and measurable;
resources targeted; and built-in accountability in action plan.

Diversity as a Corporate Strategic Priority

   Has your Board developed a                     Have social determinants of
    Vision Statement on Diversity                   health, cultural competence, and
    that provides overall direction for             anti-oppression frameworks been
    the organization?                               adopted by your LHIN and
                                                    integrated into all aspects of your
   Are diversity, cultural                         work?
    competence, and the
    reduction/elimination of health                Are principles of diversity, equity
    disparities strategic priorities for            and inclusion embedded in all
    your LHIN? Are these priorities                 organizational policies and
    reflected in your mission and                   practices?
    value statements, and in your
    strategic plan?                                Do all statements/documents
                                                    reflect that all services, whether
   Have you designated a high-                     delivered directly or indirectly,
    ranking member of your staff to                 should be culturally competent
    be responsible for the                          and inclusive?
    coordination and implementation
    of your diversity strategy?

   Have you developed and                   Do your organization’s internal
    promoted a diversity plan that            and external communications
    outlines clear goals, policies,           stress your commitment to
    operational plans, and                    diversity and give concrete
    management accountability                 examples of what you are doing?
    mechanisms related to diversity?
                                             Has your Board of Trustees and
   Have sufficient resources been            staff received anti-
    explicitly allocated to the               oppression/equity training, and
    effective implementation of your          training in diversity leadership,
    diversity goals?                          planning and decision-making?

   Are anti-discrimination and
    workplace harassment policies in
    place, and do staff understand

An Inclusive Organizational Culture

   Does your LHIN recognize that            Do you have equitable
    an individual’s culture is an             partnership standards developed
    integral part of his/her wellbeing,       in order to ensure inclusion,
    and support diversity as an               respect, effective engagement,
    integral aspect of client-centred         accountability and improvement
    care?                                     in community relationships
    (Cultural diversity includes one’s        which is integrated in the
    race, culture, language,                  following areas:
    faith/religion, gender, sexual                o Diverse representation
    identity, gender identity, family             o Shared power and
    status, ability, socio-economic                  decision making
    status, immigrant status, age, and            o Input from diverse
    other relevant life experiences                  communities
    such as homelessness, mental                  o Access to resources
    health issues and addictions.)                   (including facilities and
                                                     expertise) and information

   Does your LHIN acknowledge              Does your LHIN accommodate
    and seek out the experience and          diverse religions and cultures?
    expertise of community
    resources?                              Do your policies about time off
                                             for holidays and religious
   Is your organization’s                   observances take into account the
    environment supportive,                  diversity of your workforce?
    accessible, welcoming, safe and
    free of stigma, harassment, and
    discrimination for all

Reflecting Diversity in Governance

   Is the diversity of your service        Has the Board developed a plan
    area reflected in the membership         to monitor and evaluate your
    of the Board of Trustees and its         organization’s progress on
    committees?                              diversity goals?

   Is there ongoing diversity              Have you made diversity issues
    training for Board members?              part of your management and
                                             board retreat agendas?
   Has the Board clearly outlined its
    expectations for management on          Are indicators of diversity and
    the implementation of diversity,         inclusion included in the
    equity and inclusion policies?           performance appraisal of the
                                             board of directors’ functioning?

Reflecting Diversity in Staffing

   Do you have a comprehensive
    bias-free hiring and human
    resources plan that includes:

    o Addressing possible barriers           o Ensuring that your staff
      in the recruitment, hiring,              composition is reflective of
      promotion and retention of               the diversity of your service
      diverse staff                            area at all levels of the

    o Advertising employment
      opportunities broadly in the           o Ensuring that search firms are
      no-mainstream and                        required to present a mix of
      alternative media of equity-             candidates reflecting your
      seeking groups                           community’s diversity

    o Including indicators of                o Ensuring that diversity
      diversity competence and                 management skills and
      outcomes in staff performance            knowledge are requisite
      appraisals                               requirements of the executive
                                               director and senior staff
    o Developing a diversity,
      cultural competency and anti-
      oppression training program
      for all staff

Engaging the Community

   Has a representative cross section      Have you identified community
    of your service area been                groups & organizations, schools,
    consulted to identify key health-        places of worship, businesses and
    related diversity issues? Have           publications that deal directly
    reasonable outreach efforts been         with the diverse communities
    made to remove any barriers to           within your service area?
    their participation?
                                            Have you developed effective
   Have diverse communities,                and inclusive formal and
    particularly those facing barriers       informal working relationships
    and other forms of                       with diverse groups and
    discrimination, been directly            organizations?
    involved in the development and
    oversight of your corporate             Have you developed a
    strategic goals and diversity            communications strategy to
    goals?                                   inform diverse communities of
                                             your activities and to invite them
   Do you have a strategy to partner        to participate? Does it address
    with diverse communities to              issues of language access and
    work on issues of concern to             various formats?
    them in an ongoing manner?

                                       PART 2

As funders, local health integration networks (LHINs) can provide strong,
consistent and proactive leadership in ensuring that there is equity, inclusion and
accountability at all levels of health service planning, funding and delivery.
LHINs can achieve this by setting comprehensive standards for the agencies they
fund; coordinating information and developing resources that enable health care
providers to become culturally competent; and monitoring and enforcing
benchmarks in respect to diversity performance.

Setting Standards and Expectations

   Do all service accountability               Has criteria been developed that
    agreements with health service               binds funding for HSPs to
    providers (HSPs) reflect the                 improved access and service
    strong expectation that they be              delivery for diverse and
    accountable for the health needs             marginalized communities in
    of diverse communities?                      clear and identifiable ways?

   Have you set diversity-related
    expectations and standards for
    HSPs, in areas like:

    Client Care:

    o Culturally competent clinical              o Diversity/service equity plan
      practice that includes a range               that sets out strategies to
      of culturally appropriate                    identify, engage, and meet the
      service delivery models that                 needs of diverse communities,
      take into account and                        with targets and benchmarks
      accommodate the values,
      norms and needs of diverse                 o Programs
      communities                                  developed/reviewed through
                                                   community consultation

    o Creation of an environment in        o Diversity considerations
      which clients from diverse             incorporated into all aspects
      cultural backgrounds feel              of service delivery, including
      comfortable and able to access         assessment, planning,
      health care services (includes         intervention, discharge, and
      signage, food service,                 evaluation
      chaplaincy services, client
      information, etc.)                   o Concrete steps to overcome
                                             cultural, language and
                                             communications barriers
                                             including support services
                                             such as interpretation and

    o Anti-discrimination policy           o Strong diversity plans that
      and complaints process that            address governance, staffing,
      applies to staff, clients and          client care, and community
      volunteers which adheres to            relations
      the Ontario Human Rights
      Code                                 o Reasonable steps taken to
                                             ensure that the composition of
                                             the Board and staff is
                                             reflective of the community
                                             they serve

Enabling Cultural Competency

   Have sufficient funds been            Has guidance been offered
    allocated to support HSPs in           relating to the integration of
    becoming cultural competent.           complementary and alternative
    Are they allowed to use grant          models of care?
    funds for cultural competency
    training, interpretation,             Has research on health status and
    translation, and outreach?             outcomes for marginalized
                                           populations been conducted and
                                           disseminated in collaboration
                                           with marginalized communities?

   Has information on best practices         Has guidance been offered to
    for implementing cultural                  help HSPs integrate race,
    competency been collected and              ethnicity, language, sexual
    disseminated?                              orientation and other identity
                                               data components into their data
   Has a model implementation                 collection processes?
    plan and toolkit been developed
    for HSPs that includes strategies,        Have common reporting
    policies, and a phase-in timetable         requirements for HSPs been
    with checklists and measurable             developed to enhance the
    short- and long-term process               comparability of reported
    goals related to diversity?                information?

Establishing Mechanisms for Accountability

   Have you developed an                     Are HSPs assessed on their
    evaluation plan to monitor the             ability to close health disparities
    accessibility, appropriateness and         and otherwise meet the needs of
    effectiveness of LHIN-funded               diverse communities?
    programs and services?
                                              Are HSPs required to conduct an
   Are HSPs required to collect               annual client satisfaction survey
    baseline data on community                 that has clear and specific
    demographics, needs and service            diversity-related questions?
    inequities, against which to track
    and evaluate progress?                    Will your LHIN publish an
                                               annual diversity report card
   Have diversity-related measures            based on identified indicators,
    been incorporated into                     which is available to the public?
    performance evaluation systems
    set out for HSPs, including
    internal audits, client satisfaction
    assessments, quality-assurance
    data, and outcomes-based


Lingjuan Ma Lingjuan Ma MS
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