The Cultural Competency Organizational Assessment-360 (COA3660)[1] is a multi-dimensional, web-based tool used to assess the cultural competency of health care organizations. The COA360[2] is unique in that it has been designed for use in hospital organizational “sub-units”, such as clinical departments, hospital impatient service units or outpatients units, rather than focusing on an individual, such as physicians and other medical personnel. This tool provides a “360-degree view” of health care organizations by including the perspectives of the organizational unit and each of the health care unit’s constituencies including administrators, healthcare providers, non-provider staff, and clients/patients.
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The COA360 was developed by Dr. Thomas LaVeist[3], director of the Hopkins Center for Health Disparities Solutions[4]. Dr. LaVeist is a professor of Health Policy and Management and the William C. and Nancy F. Richardson Professor in Health Policy at the Johns Hopkins Bloomberg School of Public Health[5]. The U.S. Census Bureau[6] projects that by 2050, non-Hispanic whites in the United States will be in the numerical minority and the U.S. will be a nation of “minority-majority,” a term for a place where in the ethnic population outnumbers the racial majority (usually, non-Hispanic whites). The COA360 was created to help address the effect of the "minority-majority" shift on the healthcare industry.
The validation 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. The COA360 tool uses a combination of subjective and statistical data to produce scores for the healthcare organization based on the 14-item Culturally and Linguistically Appropriate Standards (CLAS)[7], which were established by the United States Department of Health and Human Services, Office of Minority Health (2001). This score denotes the level of cultural competency in which the organization is operating on and can give an indication of how the unit fares with regard to similarly structured organizational units. The report provides feedback for each of the 14 CLAS Standards based on a set of questions developed to measure each standard, as well as the relevant Joint Commission standards[8]. The Joint Commission produced an extensive guide linking the CLAS Standards to relevant existing Joint Commission accreditation standards. The COA360 can also be linked to the cultural competency domains identified by the Joint Commission.
The COA360 is administered via the world-wide-web, which enables the tool to be easily accessed and conveniently used. The tool consists of several questionnaires which obtain multiple perspectives of a healthcare unit’s ability to create a culturally competent environment. Ratings from all the questionnaires are complied and then summarized, allowing for a comparison of the scores of each constituency group for each of the tool’s domains. This comparison demonstrates the areas of strength and weakness as perceived by the various groups. A report is generated to include these ratings, as well as a score that indicates where the unit stands in comparison to similarly structured units. It also provides feedback for each of the 14 CLAS standards. The overall result yields an assessment that can be used to improve and evaluate leadership/management and organizational operations.
This tool evaluates the readiness of health care organizations to meet the needs of the rapidly diversifying U.S. population, and will help ensure that services are linguistically and culturally appropriate for all segments of the patient population. This can lead to improvements in patient-staff interaction, an increase in overall satisfaction for all parties, facilitate loyalty among patients and staff, as well as attract, retain, and motivate high-quality professionals from diverse backgrounds. Also, this instrument is able to adapt to the unique configuration of diversity within the organization’s service area (i.e. nationality, ethnicity, language, tribal affiliation or religion).