With a patient population that is among the most diverse in the nation, it’s no surprise that UCLA Health is at the forefront of taking concrete measures to provide equitable care. Thanks largely to the efforts of the Unity in Diversity Council (UID), equity, diversity and inclusion concepts are woven into the fabric of nursing at every level across campuses.
The Press Ganey Patient Experience Survey is one example.
Assessing EDI performance
The survey has been a standardized set of 29 questions that assess a patient’s experience during their hospital stay. Patients receive a digital survey (in English or Spanish) after discharge, providing them with an opportunity to articulate the quality of the care they received at UCLA Health, measured across nine service lines.
However, until recently, few of the survey questions touched on equity issues, says Kemi Reeves, DNP, MBA, GNP-BC, a gerontological nurse practitioner in the UCLA Health Alzheimer’s and Dementia Care Program and Unity in Diversity Council chair. “There were questions that asked if the nurse explained things in a way the patient could understand, or if the patient was treated with courtesy or respect. But we found the survey did not get to some of the equity and diversity details we were looking for,” Reeves says.
In late 2021, the council reached out to Press Ganey to ask if they had a bank of EDI-related questions from which they could draw. They did not, Reeves says. “So, the council expressed that they had plenty of talent and decided, ‘We can create our own.’”
That set the ball rolling.
A team effort
The first task, Reeves says, was to identify stakeholders across the health system who would provide input into crafting the questions. They included service line directors, the Office of Health Equity, Diversity and Inclusion, Nursing Analytics, the Unity in Diversity Council and the Nursing Executive Council, among others.
With their input, questions were developed that would best capture an assessment of performance for a diverse patient population.
During phase two, language was optimized to ensure literacy level and readability of each question. That process involved the Center for Nursing Excellence, Office of Patient Experience and the director of Language and Hospitality Services.
“It went through a lot of hands to ensure we’d get a good assessment,” Reeves notes.
At the end of the process, the UID Council settled on three questions:
- During your stay, how well did the staff respect your cultural, racial, ethnic, religious needs and preferences?
- If you do not speak English at your home, how well did we communicate with you?
- During your stay, how well did the staff respect your gender identity and sexual orientation?
Work still to do
After nearly a year of fine-tuning, the questions went live in 2022. Feedback has shown that UCLA Health does a good job of treating patients with respect but can improve communication and service delivery for those whose primary language is not English, Reeves says.
“There’s a lot of work being done to meet that need, including having bilingual staff undergo language-proficiency assessments and ensuring the availability of certified medical interpreters at the bedside,” Reeves says. In addition, work is ongoing to provide more services for hearing-and sight-impaired patients, she adds.
Youlanda Coleman, whose mother is in the Alzheimer’s and Dementia Care Program, says culturally sensitive care became important to her after her mother was diagnosed. It was then that she noticed a lack of diversity in reference materials.
“I read a lot of books about dementia, and they were all based upon predominantly white families living in the Midwest who had the resources and options to take care of their loved ones that aren’t available to everyone,” Coleman says.
She adds that people can feel excluded when the recommendations do not come from a diverse set of voices.
“I was glad to meet Kemi and learn that she was interested in this subject, because a lot of what I read is not going to work with my parents,” Coleman says.
Leading the effort
While being able to identify how UCLA Health is performing internally is crucial to improving the delivery of care, Reeves says the greater goal is to be able to benchmark the health care system’s performance with other institutions around the country.
“We’re not there yet,” Reeves notes. “The hope is that other institutions will adopt those questions. But the exciting part is we are leading this effort.”
