Cultural Responsiveness + Quality Improvements

"The systemic neglect of culture is the single biggest barrier to advancing the highest attainable standard of health worldwide."

~ Professor David Napier, University College London, The Lancet Journal

Cultural Responsiveness + Quality Improvement

Culturally & Linguistically Appropriate Services (CLAS) Standards

CLAS Standards are a set of 15 action steps intended to advance health equity, improve quality, and help eliminate health care disparities. CLAS are respectful of and responsive to each person’s culture and communication needs.

Network for the Improvement of Addiction Treatment (NIATx) Model

The NIATx model uses powerful evidence-based change management tools, principles, and products to help organizations transform their processes and systems of care.

Provide effective equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, perferred languages, health literacy, and other communication needs.



NIATx Cultural Action Model

It can be difficult to identify how an organization is doing in meeting the objectives of the CLAS Standards and, subsequently, in making the necessary changes across the organization to ensure services reflect cultural and linguistic needs. The NIATx Cultural Action Model assesses, implements, and sustains CLAS action through a combination of tools that can be used to create quality improvements and cultural responsiveness. Our consultants provide what is required to move from CLAS conversation to CLAS action, implementation, and integration.

NIATx Foundation CLAS Product Suite

NIATx offers a suite of CLAS products intended to promote sustainable changes to leadership policies (CLAS Standards 2-4); structure, staffing, and resources (CLAS Standards 5-8); and processes and practices (CLAS Standards 9-15). These products leverage the five NIATx Improvement Principles and ten actionable steps to change following the Plan-Do-Study-Adjust (PDSA) cycle of continuous improvement.

NIATx CLAS Assessment Tool (NCAT)

NCAT is used to develop an environmental and operational baseline for your organization or community system. View sample report.

NIATx CLAS Implementation Process (NCIP)

NCIP is a two-part process to support the planning and implementation of your NIATx CLAS change projects.

NIATx CLAS Improvement Sustainability (NCIS)

NCIS is about sustaining quality improvements and cultural responsiveness to ensure maximum return on investment.

NIATx CLAS Change Leader Academy (CLA)

CLA provides virtual training followed by coaching to help organizations assess needs, focus team plans for action, and implement changes that produce measurable improvements.


CLAS Activities in Action

What does implementation look like?

Governance, Leadership & Workforce

- Train staff in CLAS
- Recruit a workforce representative of community served
- Create and support a designated CLAS position

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Communication & Language Assistance

- Offer comprehensive language assistance services
- Require interpreters' skills to be certified and/or assessed
- Use advanced technology interpretation services

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Engagement, Continuous Improvement & Accountability

- Improve collection of race, ethnicity, and language data
- Conduct organizational assessments
- Incorporate CLAS into mission, vision, and strategic plans

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Case Profile: CLAS Implementation Process

Main Street Clinics recently conducted the NIATx CLAS Assessment to improve this aspect of their operations. In addition to the assessment findings, Main Street identified two organizational concerns—declining admissions and staff recruiting and retention—to address by improving their CLAS competencies.

Working with a newly formed CLAS Improvement Committee, NIATx provided an improvement framework and established two teams. The Admissions Team identified key cultural groups in the area (i.e., Spanish-speaking, African American, farmers) and conducted walk-throughs of the admissions process with these groups to identify and resikve issues. The Recruitment and Retention Team conducted focus groups with employees and community members. Outcomes included forming a team to streamline hiring, using professional associations representing different cultures, improving employee onboarding, and making employee benefit/compensation changes.

Admissions increased at the Main Street Clinics over the next six months by 12%. A significant part of that increase was attributed to the targeted cultural groups the Admissions Team worked with in designing these changes. Position posting-to-fill times went from 84 days to 38 days. Employee turnover slightly decreased by 3%, with most improvement occurring from reducing turnover in the first 30 days. The CLAS improvements have created better linkages with the community, vastly improved language services, and reduced the Board’s concerns with admissions.

The case profile is based on a conglomeration of different CLAS-related projects that the NIATx Foundation has participated in to illustrate how the NIATx CLAS Implementation Process can operate to create organization and community improvements. Download the full case study profile.