Second National Conference on
Quality Health Care for Culturally Diverse Populations:
Strategy and Action for Communities, Providers, and a Changing Health System

3-5. Participatory Quality Improvement (PQI)©: A New Methodology For Integrating Cultural Diversity Into Improvement Processes

This workshop describes a methodology that recognizes health care disparities as a significant health services delivery issue. Participatory Quality Improvement (PQI)©integrates principles of Clinical Quality Improvement (CQI) with tools and techniques for providing culturally competent care to diverse populations. Cultural and linguistic competence is defined as "congruent behaviors, attitudes, and policies that enable systems, agencies, and professionals to work effectively and efficiently in cross-cultural and diverse linguistic situations on a continuous basis.” (New York State Cultural and Linguistic Competency Standards, 1997).

PQI©involves patients and communities in redesigning clinical and structural processes that are culturally and linguistically appropriate. A video demonstrating a simulated encounter between health care professionals, researchers, and community members will illustrate examples of issues that need to be negotiated in a technical assistance contract with a community-based health care organization serving multilingual, underserved minority groups.

With the nation's rapidly changing demographics, health care systems are increasingly challenged to respond to the needs of underserved and culturally diverse populations. Healthy People 2010 calls for eliminating racial and ethnic disparities in morbidity and mortality in six areas of health status: cancer, cardiovascular disease, infant mortality, diabetes, HIV/AIDS, and child and adult immunizations. PQI©offers the potential to help eliminate gaps in health outcomes by addressing culture-based beliefs, customs, and norms that impede and/or facilitate access to care, clinician/patient communication, adherence to treatment regimens, and primary prevention. The methodology involves patients, communities, health care providers, organizations, and stakeholders as partners in decision-making throughout improvement efforts. Additionally, it builds upon the "Clinical Value Compass” tool for systematically improving health outcomes.¹ This combination of methods permits ongoing attention to cultural and linguistic competence through Plan-Do-Check-Act cycles. The graphic below displays the interface between these approaches. It delineates examples of cultural competence measures as dimensions of continuous improvement of health outcomes.

PARTICIPATORY QUALITY IMPROVEMENT (PQI)©
A Model for Linking Cultural Competence and Clinical Quality Improvement

Jo Ann Kairys, MPH and Christine Stroebel, MPH; ©2000, Center for Healthy Families and Cultural Diversity.

Group discussion of issues and concepts will be part of the workshop. Take home concepts include: techniques for linking cultural competence with quality improvement, examples of application of participatory quality improvement to diverse communities, and a list of resources in quality improvement and cultural competence.

^1. Clinical Improvement Action Guide, Nelson EC, Batalden PB, Ryer JC. Joint Commission on Accreditation of Healthcare Organizations, 1998.
^2. Published in Patient Care, "Appendix: Useful clinical interviewing mnemonics,” May 15, 2000, pp.188-189.

Jo Ann Kairys, MPH is the Executive Director of the Center for Healthy Families and Cultural Diversity and the Program Coordinator for the Agency for Healthcare Research and Quality (AHRQ)'s Innovation Award for the NRSA Primary Care/Health Services Research Postdoctoral Fellowship. She has extensive experience in strategic planning and marketing in health care, including moderating and analyzing focus groups with diverse populations. Ms. Kairys joined the faculty of the Department of Family Medicine after working at Dartmouth Medical School as Coordinator for Executive Education for the Center for the Evaluative Clinical Services. She brings expertise in clinical quality improvement program implementation and analysis and has been involved in numerous qualitative research survey projects. She has traveled widely in Russia and Central and Eastern Europe on USAID-funded healthcare partnership programs.

Christine K. Stroebel, MPH is the Program Development Analyst for the Center for Healthy Families and Cultural Diversity. She brings expertise in coalition building, training health organizations in continuous quality improvement practices, designing and conducting workshops, facilitating teams, and teaching English to non-English speaking adults. Ms. Stroebel has over 17 years of experience working with diverse populations in a wide range of settings, including public health departments, a health maintenance organization, international development organization, health care research company, and an educational foundation sponsoring students from abroad to study in the US. Ms. Stroebel has led multi-sector, community-based coalitions through teambuilding, assessment, planning, decision-making, implementation, and evaluation processes.

Jo Ann Kairys, MPH, Executive Director;
Christine Stroebel, MPH, Health Educator
Center for Healthy Families and Cultural Diversity
Department of Family Medicine
University of Medicine and Dentistry of New Jersey - Robert Wood Johnson Medical School
One Robert Wood Johnson Place
New Brunswick, NJ 08903
Phone: (732) 235-7665
Fax: (732) 246-8084
Email: kairysjo@umdnj.edu
Email: stroebck@umdnj.edu

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