Critical Path Network: Attracting diverse patients is part of a strategic plan
Critical Path Network
Attracting diverse patients is part of a strategic plan
Program includes translators, diversity training
When the Greenville (SC) Hospital System realized it was serving a growing population that didn’t speak English, the four-hospital system launched a diversity initiative that not only helps staff understand the multicultural patients it treats but has the goal of making the hospitals the health care providers of choice among the city’s immigrant population.
"Including the non-English-speaking patients is within the scope of the hospital mission, and socially, it’s the right thing to do. But from a business imperative, it’s also the right thing to do because as the immigrant population becomes an increasingly larger part of this community, we want to make sure they are our customers," says Fred Hobby, the hospital system’s diversity officer.
Until the 1990s, Greenville’s population was largely white and African-American and overwhelmingly Baptist.
Since then, more than 300 international companies have located to Greenville and its surrounding area, including a Hitachi consumer electronics factor, a Michelin manufacturing facility, and BMW plant.
At the same time, the Latino population in Greenville grew, increasing by 362% in the city and 411% in the region between 1990 and 2000.
As diverse populations moved in, the hospital began to see a significant number of patients who were Catholic, Buddhist, and Muslim.
The hospital system began a twofold effort to provide care for its changing population: hiring interpreters to help with communication and training the staff to understand the diverse populations it was serving.
"As hospitals are impacted by non-English-speaking patients, their dual focus should be on finding interpreters as well as putting the infrastructure in place in terms of diversity training," Hobby says.
The diversity department conducted training sessions on all three shifts at all four facilities in an attempt to educate 5,600 employees that the community they serve is changing and the hospital was making plans to serve the diverse population. This was followed by "Cultural Barriers to Effective Practice of Medicine," a workshop for clinical staff.
"Our first educational effort was to get everyone from housekeeping and food service to the clinical staff in an accepting or inclusive frame of mind. The second initiative is to equip the direct caregiver with cultural knowledge of some of the patients they are beginning to see in large numbers," he says.
The module focuses on the unique characteristics of some populations.
"Different cultural beliefs mean different practices regarding grooming, grieving, and birthing. Although women give birth the same way regardless of their culture, the role of the husband and family varies widely from culture to culture, and we had to prepare the work force with this information," he says.
For instance, older Asians tend to be extremely modest, so the typical hospital gowns probably would not be acceptable to them.
Hot tea is the most popular drink with meals, even in the summer, with some populations.
"Just bringing in hot tea without having to be asked shows a bit of awareness and helps break down the barriers," he says.
Latino men are taught not to show pain, adds Hobby. "This means that if there is an injured Mexican male in the emergency department and he’s not bent over or moaning, this isn’t an indication that his treatment can wait," he notes.
Staff are aware that some women do not wash their hair during the menstrual cycle or after giving birth so they won’t suggest a shampoo to these women.
Members of some Arabic cultures do not want nonfamily members to touch the body after death and want to bring in a family member to prepare the body for burial in a ritual manner.
"We don’t expect all employees to remember every cultural nuance of every culture we serve. We want to create an awareness that the patient may have different beliefs and encourage the staff to do research on the patient’s culture or call the cultural office before they get too far into the regime," he explains.
A few years ago, a young girl was hospitalized with a string tied around her wrist and a nut attached to the string, a talisman to ward off evil. The nurse cut the string, upsetting the parents who felt it would make her condition worse.
"Today, we would have an interpreter inquire about the string and point out that the child is at risk of putting the nut in her mouth and choking. We expect our staff to recognize that this patient may have beliefs or practices that are different from their own and that they need to do some research," he says.
The hospital’s discharge planning staff have been supplied with pocket-sized books that contain information about food practices, symptom management, grooming, pain expression, depression, and other beliefs and practices for about 15 nationalities.
They have been trained to recognize cultural nuances and to ask questions when they aren’t sure about the patient’s beliefs.
"There are gradations of cultural practices among people who have moved here directly from another country with no time to become assimilated and immigrants who came here 20 years ago," Hobby says.
Discharge planners should find out, through interpreters, how long patients have been in the area and whether they moved from another state or directly from their native country, he points out.
The length of time someone has been in this country can make a big difference on how well he or she understands the health care system, Hobby adds.
"Through interpreters, the case managers talk with the patients about discharge instructions and then ask the patient to verify that they understand what they have been told," he says.
Many English-speaking patients who are being discharged with multiple medications are confused about the regimen, Hobby continues.
"Imagine what it is like when an English-speaking case manager explains the discharge instructions to a non-English speaking patient. In these cases, it’s very important to verify that patients understand the instructions. The interpreter should ask the patient to repeat the instructions so we know that they have a verbal understanding," he adds.
Bear in mind that people from Asian and Latino cultures may act as though they understand out of courtesy when they don’t understand at all, Hobby advises.
"Unfortunately, there is still a fairly significant level of mistrust among the immigrant population. The experience the patient would have with doctors in their home country is quite different from what we have learned to accept here," he says.
The hospital has identified bilingual employees and created a roster of people who could be called on to interpret. Bilingual staff, now called dual-role interpreters, receive a pay incentive if they agree to be trained and certified as hospital interpreters.
The hospital also has hired full-time and part-time certified interpreters.
Before embarking on its diversity program, the hospital system studied its Latino population and found that it included patients from 17 different countries.
The study showed that the average educational level was around the sixth grade, although there were a significant number of patients with degrees from Latin American colleges. The majority were ages 24 to 42 — the working and childbearing ages.
A similar study of Asian and European populations determined that Vietnamese made up the largest percentage of Asian patients, followed by Japanese and Korean. German was the biggest group among Europeans, followed by French and Russian.
There was some concern that pursuing the immigrant population might result in more bad debt for the hospital, a concern that has not been the case, Hobby says.
"We found early on that the immigrant population’s value system involving debt is quite different from that of some indigenous residents," he adds.
People who are uninsured or underinsured still make an effort to pay their bill, even though they may be paying just $50 a month on a $1,500 bill.
However, faced with a significant number of low birth-weight babies and millions of dollars in costs for neonatal intensive care (NICU), the hospital launched a prenatal training class in Spanish to educate women from Latin American countries about good health habits during pregnancy, such as breast-feeding, infant care, and not smoking or drinking. A registered nurse and an interpreter teach the classes.
The classes, targeted to non-English-speaking women who go to the hospitals’ OB/GYN clinics, started out small, with about eight women, and have grown to 26 women or more in each class.
"It’s made a difference in the lives of women. It’s demonstrated that the hospital cares and that we welcome them as patients. The upside for the hospital is that the more babies are healthy and go full term, the less the expense that will have to be borne by this hospital if they have to go into the NICU," he says.
When the Greenville (SC) Hospital System realized it was serving a growing population that didnt speak English, the four-hospital system launched a diversity initiative that not only helps staff understand the multicultural patients it treats but has the goal of making the hospitals the health care providers of choice among the citys immigrant population.Subscribe Now for Access
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