Quality Care for Changing Communities

Building cultural competence across the state

Health care organizations are heading in different directions with cultural competence depending on their strengths and assets, from health systems with centralized offices driving change initiatives, providing a central point of education for staff, and acting as diversity advocates; to nursing homes starting to build support for their increasingly diverse workforce.

Health care organizations across Minnesota are recognizing the shift in their patient, community, and workforce demographics, and are acting on research that shows disparities in care delivery. Change statewide is being driven community by community, as their demographics change.

In St. Cloud, the 2000 US census showed 7.3 percent residents ages five and older spoke a language other than English at home. In 2006, 21 percent of school children spoke a language other than English at home. Changing demographics prompted CentraCare to hire a cultural competency specialist to expand its diversity efforts.

“Every health care organization needs to be intentional about building a stronger foundation for tackling the health care needs of diverse populations,” said Rosemond Sarpong Owens, health literacy/cultural competency specialist for CentraCare Health System.

Hospitals and clinics feel they have had more of a burning platform than other settings, moving them sooner to take action toward cultural competence. Even so, hospitals are challenged to meet the cultural and language needs of their patient populations, according to a study by The Joint Commission. Their efforts to address language are more concrete than those to address culture.

Several hospitals and clinics described some of their cross cultural challenges: providers feel uncertain that they are treating the right problem when an ER patient doesn’t speak English, the Amish patient who has an advanced health condition because she didn’t seek preventive care, staff feeling fearful because they perceive the behavior of ER patients and their families as aggression.
Away from the burning platform, providers face language and culture barriers, patients are unsure how to utilize the health care system, and the workforce is becoming more diverse.

“As we think about who will be working in health care, we need to provide education and training for the growing population of immigrants in Minnesota,” said Donna Zimmerman, vice president of government and community affairs at HealthPartners. “They will be our health care workforce and health care leaders.”

According to American Community Survey 2005 data, 15 percent of US health care workers are foreign born—one in four doctors (physicians and surgeons) were born abroad, as were 26 percent of nursing and home-care aids.

Business case

For health systems, the analytics are available to support the business case for cultural competence. A tremendous amount of research is now available, from the Robert Wood Johnson Foundation and others, demonstrating the cost effectiveness of having a solid infrastructure in place to support cultural competence, noted Elizabeth Anderson, director of cross cultural services for HealthEast.

Changing demographics require changing approaches. “I believe that if you do not provide quality language services, you will have more medical errors, more adverse events, and lower patient satisfaction,” said Anderson.

“We are a nonprofit, but we are a business too. We want to be the first choice for patients, physicians, and employees,” Anderson said. “Paying attention to diverse communities is critical for our long term success.”

For Fairview Health Services, the business case for cultural competence has not been hard to make. Sue Plaster, director of diversity, could easily take their four corporate goals and build corresponding diversity goals:

• Exceptional patient care ties directly to cultural competence.
• Exceptional patient and family experience maps to creating a welcoming environment—through signage, accessible translations, and other work.
• Effective and efficient use of resources maps to supporting workforce diversity to optimize and make the best use of Fairview’s talent.
• Strategic growth requires examining the demographic trends in the community.
  

Scott Wordelman, president and CEO of Fairview Red Wing Health Services, an affiliate of Fairview Health Services, has a changing workforce and a changing community. He didn’t develop a formal business case for cultural competence. “We have a demand for a workforce in the future and we clearly need to meet the health care needs of the community today. But, for me, it’s a matter of the heart, not the head. ”

Seeing the community

From her rural clinic, Toni Tebben, site coordinator at CentraCare Long Prairie, suggests that health care leaders need to go into the smaller clinics, into the smaller communities, to see what’s happening. “There are patient safety concerns and provider concerns.”

Fairview Health Services did just that by encouraging presidents across its care system to participate in a Walk in My Shoes training. The core of the program was to have executives participate in three experiential learning activities with people from diverse backgrounds: a home experience, shadowing an employee within the system, and an experience in the community.

“They recognized that there was a gap between where we were as executives and the paradigm of the workforce and the communities we serve,” said Wordelman. As a result of participating in the program, Wordelman has a heightened sense as a leader about the need to bring his awareness and influence to the hospital and to community health. Among other actions, he’s worked to build relationships with the native Mdewakanton Dakota Prairie Island tribe. Fairview will start providing services to the tribe in January.

Supporting communities in change

Minnesota’s nonprofit structure­—churches, charities, and others—is very supportive and welcoming of immigrants and refugees. The support spills over to health and human services that need to care for these populations.

Sarpong Owens believes that health care organizations need to be catalysts for change. They need to help people coming from outside of the US understand and seek out preventive care, and help diverse populations navigate the care system and know how to use the resources available.

Wordelman is hearing increased concern from other health care leaders, and leaders in general, about how to support Red Wing as it moves away from being a sleepy river town. Red Wing is working as a community to create a more welcoming and healthy community.

Patient-centered care plus

At the core of both patient-centered care and cultural competence is the emphasis on seeing the patient as a unique person. Cultural competence expands patient-centered care to include the need to be attentive to the health beliefs, values, and perspectives of the patient—how the family and community impact the patient’s health.

“The key is to provide tools that enable the workforce to provide great care,” said Anderson. “We want quality to be in reach of every single patient.”