Table 2 Background information on the six approaches
From: How should health service organizations respond to diversity? A content analysis of six approaches
Background information on model | CLAS Standards (CLAS) | Joint Commission Roadmap (JCR) | Cultural Responsiveness Framework (CRF) | Council of Europe Recommendations (COER) | Equality Delivery System (EDS) | Equity Standards (EQS) |
|---|---|---|---|---|---|---|
origin | US dept of Health and Human Services; Office of Minority health (U.S.) | The Joint Commission (U.S.) | Victorian Government; Dept. of Health (Australia) | Council of Europe; The committee of ministers (Europe) | The National Health Services (NHS); The Equality and Diversity Council (U.K.) | Health Promoting Hospitals; Task Force on Migrant-Friendly and Culturally Competent Health care (Europe) |
year | 2001 | 2010 | 2009 | 2011 | 2011 | 2013 |
aim | *ensure equitable and effective treatment in a culturally and linguistically appropriate manner *correct inequities *more responsive services *elimination of racial and ethnic health disparities *inform, guide and facilitate culturally and linguistically appropriate care | *improve overall safety and quality of care *integrate concepts from communication, cultural competence and patient-centered care fields into hospitals | *better links between access, equity, quality and safety *better health outcomes for culturally and linguistically diverse (CALD) populations *enhance cost effectiveness of service provision *track organizations' improvement; align cultural responsiveness (CR) with existing standards; develop benchmarks | *Equitable access to health care of appropriate quality | *better outcomes for patients and communities, better working environments for staff *improve equality performance *review equality performance *a tool to comply to the ‘public sector Equality Duty’. | *ensure equitable and accessible health care *reduce disparity in health care*an Equity self-assessment by health care organizations |
vision | *cultural and linguistic competence *culturally and linguistically appropriate services (CLAS) | *effective communication (EC) *cultural competence (CC) *patient- and family-centered care (PFCC) | *cultural responsiveness (CR) | *improving the adaptation of health service provision to the needs, culture and social situation of migrants | *equality for patients and staff *personal, fair and diverse services and workplaces | *promoting equity |
target population | *inclusive of all patients *especially racial, ethnic, and linguistic populations that experience unequal access | *no target group, recommendations address 'issues' in health care (e.g. language, culture etc.) | *Culturally and linguistically diverse populations (CALD) | *migrants | *protected groups | *migrants and all other vulnerable groups |
target organization-type | *health care organizations *policymakers, accreditation agencies, purchasers, patients, advocates, educators, health care community in general | *hospitals | *all Victorian health services | *governments of CoE member states | *NHS commissioners and providers | *health care organizations |
structure | *14 standards in three types: mandates (4), guidelines (9), and recommendations (1) *three themes: culturally competent care, language access services, and organizational supports for cultural competence | *54 recommendations structured around main points along the care continuum *aspects of the care continuum: admission; assessment; treatment; end of life care; discharge and transfer; organization readiness | *six standards across four domains, divided in measures and sub-measures (both quantitative and qualitative) *Standards: a whole organization approach; leadership; interpreters; inclusive practice; consumer/community involvement; staff. *Four domains: organizational effectiveness; risk management; consumer participation; effective workforce | *14 recommendations, specified in 31 sub-recommendations. | *18 outcomes grouped into four goals; nine steps for implementation *EDS goals: better health outcomes for all; improved patient access and experience; empowered, engaged, and well-supported staff; inclusive leadership at all levels | *five main standards, divided in substandards and measurable elements *main standards: equity in policy; equitable access and utilization; equitable quality of care; equity in participation; promoting equity |