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From the article accepted for publication in the Journal of Healthcare Management
Assessment of Organizational Cultural Competency
Organizational cultural competency will be assessed using a newly validated tool developed by Dr. Thomas LaVeist of the Hopkins Center for Health Disparities Solutions. The Cultural Competency Organizational Assessment-360 (COA360°) is designed to assess the "cultural competency" of a healthcare organization, NOT individuals. The tool is also adaptable to the unique configuration of diversity within the organization’s service area, race, ethnicity, language, or religion. It is a multi-dimensional tool which provides a "360-degree view" of the organization from the perspective of each of the its constituencies including, administrators, healthcare providers, non-provider staff, clients, and people living in the service area who are not clients of the healthcare organization (see Appendix A for a report on the validation).
This tool is designed to assess healthcare organizations regarding the management of issues related to cross-cultural interactions and the provision of health services to clients/patients with limited English proficiency. For the purposes of the COA360°, a healthcare organization can be a hospital, health system, medical group practice, long-term care facility, clinic, or a department of a hospital or larger entity - any unit that raters would recognize as an independent organizational entity.
The assessment tool uses a combination of subjective and statistical data to produce scores for the healthcare organization based on 14-item CLAS standards (Culturally and Linguistically Appropriate Standards) established by the United States Department of Health and Human Services, Office of Minority Health. A set of questionnaire items were developed which are designed to measure each of the 14 CLAS Standards.
The initial validation study of the COA360° was conducted by a team of researchers from the Hopkins Center for Health Disparities Solutions (HCHDS) at the Johns Hopkins Bloomberg School of Public Health, led by Dr. Thomas LaVeist (director of the HCHDS). The team conducted a search of PubMed which identified 212 authors or co-authors of articles with "cultural competence" as a keyword published between January 2002 and September 2005. Of the 212 potential evaluations, 20 were excluded for one of the following reasons: invalid address (6), self-reported non-qualified (3), inability to complete due to time constraint (9), declined (6), or incompleteness (2). Six authors were deemed ineligible for the study because of their affiliation with the research institution conducting the COA360° validation study. Each remaining author was sent 4 of the 14 CLAS standards and the COA360° questions designed to measure that standard. They were asked to read the CLAS standard and to rate how well each item contributed to the measurement of the CLAS Standard using a five-point Likert-type scale (1 = Not at All; 2 = Very Little; 3 = Somewhat; 4 = Well; 5 = Very Well). They were also asked to rate how well the items as a whole measured the CLAS Standard. The evaluation packets were sent via email or U.S. Postal Service. Follow-up mailings were sent 3 weeks after the initial mailing. A second follow-up questionnaire was sent 3 week later to remaining non-responders. We obtained at least 10 evaluators per CLAS standard section.
The mean score for each item and the overall score for each CLAS Standard was calculated as the mean of the items’ scores within that section. As shown in Table 1, mean scores for each item was rated > 4.00 on a 5-point scale, with the exception of item 7 of standard 1. However, the difference from 4.00 for this item was less a tenth of a point (0.07). Of the remaining 78 items on the COA360°, 43.0% of the items had a mean rating between 4.00-4.49 and 57.7% had a mean rating between 4.50-5.00 indicating that each item contributed to the measurement of its related CLAS Standard well or very well.
Additionally, the mean scores for the CLAS Standard sections overall were all rated > 4.13 on a 5-point scale. Of the 14 CLAS Standard sections, 6 (42.9%) had a mean score between 4.0-4.49, and 8 (57.1%) received average scores between 4.5-5.0. We conclude that the COA360° is a valid measure of cultural competency of health care organizations as determined by a national panel of researchers who have published articles on cultural competence in peer-reviewed journals.
| CLAS Standard | COA360 Item 1 | COA360 Item 2 | COA360 Item 3 | COA360 Item 4 | COA360 Item 5 | COA360 Item 6 | COA360 Item 7 | COA360 Item 8 | COA360 Item 9 | Overall |
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 4.07 | 4.21 | 4.21 | 4.29 | 4.21 | 4.07 | 3.93 | 4.21 | 4.00 | 4.13 |
| 2 | 4.36 | 4.36 | 4.14 | 4.43 | 4.36 | 4.50 | 4.36 | |||
| 3 | 4.67 | 4.56 | 4.78 | 4.33 | 4.44 | 4.78 | 4.78 | 4.62 | ||
| 4 | 4.40 | 4.40 | 4.50 | 4.40 | 4.30 | 4.30 | 4.30 | 4.30 | 4.30 | 4.36 |
| 5 | 4.64 | 4.64 | 4.71 | 4.67 | ||||||
| 6 | 4.67 | 4.75 | 4.67 | 4.83 | 4.67 | 4.67 | 4.67 | 4.67 | 4.70 | |
| 7 | 4.88 | 4.75 | 4.75 | 4.75 | 4.78 | |||||
| 8 | 4.44 | 4.78 | 4.78 | 4.67 | ||||||
| 9 | 4.73 | 4.73 | 4.82 | 4.64 | 4.73 | |||||
| 10 | 4.78 | 5.00 | 4.89 | 4.78 | 4.78 | 4.84 | ||||
| 11 | 4.62 | 4.54 | 4.08 | 4.41 | ||||||
| 12 | 4.38 | 4.25 | 4.38 | 4.50 | 4.13 | 4.50 | 4.35 | |||
| 13 | 4.50 | 4.38 | 4.38 | 4.38 | 4.50 | 4.50 | 4.50 | 4.38 | 4.50 | 4.44 |
| 14 | 4.73 | 4.91 | 4.73 | 4.79 |