Moffitt Cancer Center provides a summary of its efforts to promote diversity and inclusion. It discusses health disparities among racial and ethnic groups for various cancers. It also outlines its cultural and linguistic competence initiatives, including community outreach programs, language services, and workforce diversity efforts. The goal is to improve access to care, quality of care, and patient satisfaction for its diverse patient populations. Challenges include overcoming resistance to change, competing priorities, and limited resources.

1. Moffitt Diversity
ACCESS to Care:
Building a Culture of Diversity & Inclusion
Cathy Grant, Director
Friday, August 5, 2011
Florida Diversity Council

2. Objective
• About Moffitt
• Health Disparities
• Cultural and Linguistic Competence
• Diversity & Inclusion at Moffitt

3. About Moffitt Cancer Center
• Single Mission – The Prevention and cure of cancer
• Celebrating 25th Anniversary
• Only NCI designate cancer center in FL
• Staff –4,287 Total Employees
• Moffitt is licensed for 206 beds
• From 2009 to 2010
• Admissions grew from 7,742 to 8,616
• Outpatient grew from 289,502 to 320,558
• As of October 2010, grant funding at Moffitt increased to
$83.8 million

4. Cancer Programs
• Blood & Marrow Transplantation
• Don & Erika Wallace Comprehensive Breast Program
• Cutaneous Oncology
• Gastrointestinal Malignancies
• Genitourinary Oncology
• Gynecologic Oncology
• Head & Neck Oncology
• Internal and Hospital Medicine
• Malignant Hematology
• Neuro-Oncology
• Psychosocial & Palliative Care
• Radiation Oncology
• Sarcoma
• Senior Adult Oncology
• Thoracic Oncology

5. Video: Justine’s Story

6. Demographics
White Latino Black Asian Multicultural
(Not Hispanic)
United States 63.7% 16.3% 12.6% 4.8% 2.9%
Florida 57.9% 22.5% 16.0% 2.4% 2.5%
Hillsborough 53.7% 24.9% 16.7% 3.4% 3.1%
County
Source: US Census: http://quickfacts.census.gov/qfd/states/12/12057.html

7. Language
24% speak a language other than English at home
77% speak Spanish
23% other language
40% reported not speaking English “very well”
Source: U.S. Census Bureau, 2005-2009 American Community Survey

8. Health Disparities
Differences or gaps in care experienced by one population
compared with another population which can result in less
access to care, a poorer quality of care, and higher death
rates from certain diseases.

9. Prostate Cancer
Age-Adjusted Death Rates per 100,000 Persons
By Race & Hispanic Origin: U.S. (2005)
A ge-A djusted D eath R ate per 100,000 Persons
60
53.3
55
50
45
40
35
30
24.5
25 22.6
17.6 18.5
20
15 10.4
10
5
0
All Races White African American Asian/Pacific Hispanic
American Indian/Alaska Islander
Native
Center for Disease Control and Prevention, Office of Minority Health and Health
Disparities. An Overview. http://www.pitt.edu/~super4/39011-
40001/39961.ppt#259,1,Office of Minority Health and Health Disparities (OMHD)

10. Breast Cancer
Age-Adjusted Death Rates per 100,000 Persons
by Race & Hispanic Origin: U.S. (2005)
A g e -A d ju s te d D e a th R a te p e r 1 0 0 ,0 0 0 P e rs o n s
35 32.8
30
24.1 23.4
25
20
15.2 15.0
15 12.2
10
5
0
All Races White African American Asian/Pacific Hispanic
American Indian/Alaska Islander
Native
Center for Disease Control and Prevention, Office of Minority Health and Health Disparities.
An Overview. http://www.pitt.edu/~super4/39011-40001/39961.ppt#259,1,Office of Minority
Health and Health Disparities (OMHD)

11. Colon, Rectum & Anus Cancer
Age-Adjusted Death Rates per 100,000 Persons
by Race & Hispanic Origin: U.S. (2005)
24.8
Age-Adjusted Death Rate per 100,000 Persons
25
20
17.5 16.9
15
12.0 12.4
11.2
10
5
0
All Races White African American Asian/Pacific Hispanic
American Indian/Alaska Islander
Native
Center for Disease Control and Prevention, Office of Minority Health and Health
Disparities. An Overview. http://www.pitt.edu/~super4/39011-
40001/39961.ppt#259,1,Office of Minority Health and Health Disparities (OMHD)

12. Trachea, Bronchus & Lung Cancer
Age-Adjusted Death Rates per 100,000 Persons
by Race & Hispanic Origin: U.S. (2005)
58.4
A g e -A d ju s te d D e a th R a te p e r 1 0 0 ,0 0 0 P e rs o n s
60
55 52.6 53.1
50
45
40
34.1
35
30 25.7
25 22.4
20
15
10
5
0
All Races White African American Asian/Pacific Hispanic
American Indian/Alaska Islander
Native
Center for Disease Control and Prevention, Office of Minority Health and Health
Disparities. An Overview. http://www.pitt.edu/~super4/39011-
40001/39961.ppt#259,1,Office of Minority Health and Health Disparities (OMHD)

13. Racial/Ethnic Disparities in
Health Care
Differential utilization based on race for within Medicare:
Mammography (Gornick et al.)
Amputations (Gornick et al.)
Influenza vaccination (Gornick et al.)
Lung Ca Surgery (Bach et al.)
Renal Transplantation (Ayanian et al.)
Cardiac catherization & angioplasty (Harris et al, Ayanian et al.)
Coronary artery bypass graft (Peterson et al.)
Treatment of chest pain (Johnson et al.)
Referral to cardiology specialist care (Schulman et al.)
Pain management (Todd et al.)

14. Potential Reasons for Disparities in Care
Patient Level Health Care Organization /
• Patient preferences Systems Level
• Treatment resistance / • Lack of access to care
compliance • Lack of interpretation and
• Health perceptions translation services
• Care seeking behaviors and • Time pressures on
attitudes physicians and other
• Clinical appropriateness of clinical staff
care
• Geographic availability of
health care institutions
Provider Level
• Bias • Changes in the financing
• Stereotyping and delivery of health care
• Clinical uncertainty services
• Poorer quality of care
• Lack of patient-centered care
• Unconscious and automatic
Source: Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare,
March 2002.

15. Minorities Less Involved in Their Health Care
Decisions Than They Would Like to Be
Percent of adults involved in health care decision as much as they wanted
75% 78%
80% 73%
65%
56%
40%
0%
Total White African Hispanic Asian
American American
Source: The Commonwealth Fund 2001 Health Care Quality Survey.

16. Hispanics and African Americans
More Likely to Feel Treated with Disrespect
Percent of adults who felt they were treated with disrespect
20% 18%
16%
13%
11%
10% 9%
0%
Total White African Hispanic Asian
American American
Source: The Commonwealth Fund 2001 Health Care Quality Survey.

17. Focus of Efforts
A.C.C.E.S.S. to Care
• Enhance Moffitt Cancer Center’s image among at-risk and
underserved communities through delivery of culturally and
linguistically competent care, prevention education and mutually
beneficial partnerships;
Culture of Diversity & Inclusion
• Serve as a resource, as well as, identify opportunities to increase
Moffitt’s preparedness when serving diverse communities.

18. A.C.C.E.S.S.
• Awareness and Education
• Community Outreach
• Cultural and Linguistic Competence
• Equity and Inclusion
• Support Other initiatives (Technical Assistance)
• Strong Partnerships

20. Definition of Culture
Integrated patterns of human behavior that include the
language, thoughts, communications, actions, customs,
beliefs, values, roles, relationships, and institutions of
racial, ethnic, religious, or social groups

21. Cultural Competence
Cultural Competence is defined as “a set of behaviors, skills,
attitudes, knowledge, practices, policies, and strategies that
together enables the Moffitt workforce to work effectively
in cross-cultural situations to improve:
(1) Patient safety;
(2) Patient satisfaction;
(3) Access to and utilization of care; and
(4) Quality of care
(5) Workforce diversity; and
(6) Participation in clinical trials and research

22. Why CLC?
• Beyond the “right thing to do”………..
• Changing demographics
• Health care services that are respectful of and responsive to
the health beliefs, practices and cultural and linguistic needs
of diverse patients can help bring about positive health
outcomes.
•
• Growing evidence as an important strategy for reducing
health disparities
• Legal and regulatory mandates

23. Improving Quality of Care
• Diverse and Limited English Proficiency (LEP) patients are
less likely than others to receive the most effective,
evidence-based treatments for certain conditions
• Diverse populations report more communication difficulties
with their physicians, less involvement in clinical decisions,
more difficulty understanding instructions on prescriptions,
and instructions from physician’s staff

24. Improving Patient Safety
• Diverse and Limited English Proficiency (LEP) patients
suffer more medical errors with greater clinical
consequences
• Communication problems may lead to misdiagnosis,
inappropriate treatment, and limit authentic informed
consent

25. Improving Patient Satisfaction
Good patient/provider communication is linked to better
patient satisfaction, adherence to treatment
recommendations, and improved health outcomes

26. Reducing Liability
Communication issues are a key component of claims
filed by patients whose culture, ethnicity, religion
and/or English language ability differ from that of the
healthcare provider

27. Five Essential Elements of a
Culturally Competent System
• Value Diversity
• Have the capacity for cultural self-assessment
• Be conscious of the dynamics inherent when cultures
interact
• Have institutionalized cultural knowledge
• Have developed adaptations to diversity
27

28. Lost in Translation…

29. Linguistic Competence
Readily available and culturally appropriate
communication and language services and supports,
and vital documents and informing materials, for
patients and family members through such means as
bilingual/bicultural staff, and professional medical
interpreters and translators

30. Impact of Language Barriers
• When Lacking Language Assistance
• Less likely to have a Primary Care Physician (PCP)
• More likely to not go to follow up appointments
• More like to be in fair or poor health
• Medication instructions errors
• Less satisfied with the health care received
• With available Language Assistance
• Successful patient-provider relationship
• Standard medical interview techniques – complete exchange of
information
• Empathic connection

31. It’s the Law!
Title VI of the Civil Rights Act
of 1964
“No person in the United States shall, on ground of race, color, or
national origin, be excluded from participation in, or be denied the
benefits of, or be subjected to discrimination under any program or
activity receiving Federal financial assistance.”
• Who is covered?
• Extent of obligation: Four-factor analysis
• State requirements
www.os.dhhs.gov/ocr/civilrights/resources/specialtopics/lep/

32. Awareness and Education
Focused on each person’s role in reaching the center’s
Diversity-related mission and goals
• Diversity Unplugged
• Employee Networks – GLAAM
• New Hire Orientation
• Diverse Voices – E-Newsletter
• National Minority Cancer Awareness Week

33. Community Outreach/Relations
Increase visibility and knowledge by providing information about the
importance of cancer prevention, healthy lifestyles, and early
detection of cancer to our most at-risk, under-served and under-
insured communities.
• Capacity – Building Programs
• Lay Health Advisors
• Cancer Education Toolkits
• Health Education Workshops
• Culturally relevant; low literacy
• Prostate; Breast; Cervical; Colon; Healthy Lifestyles
• Haitian Initiative / Witness Project (Komen)
• EmpowerMENt Project
• Moffitt Healthy KIDZ
• ¡Salud!
• Access to Mammography Screening

34. Community Outreach/Relations
(cont.)
• Annual Men’s Health Forum
(English / Spanish)
• Community Benefit
• National Minority Cancer Awareness
Week (NMCAW) - 3rd Week of April
• Micro Award for Cancer Community
Health Initiatives (MACCHI)

35. Language Services
• Staff
• Two Translators
• Five Spanish Interpreters
• One Spanish/American Sign Language interpreter
• Pacific Interpreters - 180 languages and dialects
• Video Remote Interpreting (VRI)

36. Other Inclusion Efforts
• Supplier Diversity
• Recruitment & Retention
Diversity Scholarship
School at Work
Candidate pool

37. Ongoing Challenges
• History
• Resistance to change: internal and external
• Competing priorities
• Culture: internal and external
• Trust
• Resources / Money: Internal and external

38. THANK YOU!
Dialogue
Questions
Comments