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Results based accountability

Towards an Integrated Approach to Multicultural Performance Improvement Measurement

Maurice Eisenbruch, Patrick Harris, Michael Kakakios, Carmine Di Campli

This research explores quality and performance improvement initiatives, with implications for health systems and better outcomes for increasing numbers of patients/clients from culturally and linguistically diverse backgrounds. The first section discusses local and international approaches to performance and quality improvement with relevance the NSW Health Service System, with the aim of developing an approach to multicultural health that is synchronised with quality improvement developments both in NSW and internationally. Developments both in quality improvement, specifically Results Based Accountability (RBA), and policy frameworks, specifically Ethnic Affairs Priority Statement (EAPS) Standards Framework in NSW and Culturally and Linguistically Appropriate Standards (CLAS) in the U.S., can be integrated to form a strong standardised approach to multicultural health performance improvement and measurement across health systems, programs, services, and organisations.

RBA Framework: (From Friedman, 2001)

Performance measures were developed for multicultural health programs using the RBA framework. The focus is on the Health Care Interpreter Service (HCIS) in one Area Health Service in New South Wales as a case study of a culturally competent health system intervention. By drawing a fence around one major service within the multicultural health program, HCIS in South East Sydney and Illawarra Area Health Service, performance measures using the RBA framework were systematically and empirically developed. Focus groups with stakeholders were used to initially develop the measures, while testing the acceptance of RBA as a standard quality improvement framework for multicultural health programs. These measures were then linked to both EAPS and CLAS. The robustness of each measure was then tested via a survey with the focus group participants.

Results indicated that outcomes focussed tools such as RBA are successful mechanisms with which to develop performance measures in multicultural health programs. In addition, such mechanisms are strengthened by directly linking with broader multicultural initiatives such as EAPS and CLAS, which can provide useful variables underlying the processes in such frameworks are RBA which in turn are linked to improved outcomes.

The project provides the first steps in standardising performance improvement through measure development in multicultural health programs. The project contributes to the advancement of cultural competence in health care by providing an initial basis from which to link performance measures and outcomes, using the RBA framework as standard to operationalise culturally appropriate system frameworks such as CLAS and EAPS.