Health Care Organizations Break New Ground In The Quest To Improve Care For Immigrant And Minority Americans

New York City, October 2, 2002—Even as recent studies have documented serious racial and ethnic gaps in health care access and quality, a new report from The Commonwealth Fund spotlights a diverse group of health care organizations striving to improve access and quality of care for a growing minority and immigrant population. According to the report, these organizations are working to dismantle the cultural and communication barriers to good health care through innovative programs that develop minority leadership, promote community involvement, and increase awareness of the social and cultural factors that affect health beliefs and behaviors. In addition to highlighting these model programs, the report also provides the first comprehensive framework for health care organizations seeking to address cultural barriers in health care delivery. The report, Cultural Competence in Health Care: Emerging Frameworks and Practical Approaches, is written by Joseph R. Betancourt, M.D., of Massachusetts General Hospital-Harvard Medical School, and Alexander R. Green, M.D. and J. Emilio Carrillo, M.D., both of New York-Presbyterian Hospital-Weill Medical College of Cornell University. The Fund report follows from recommendations of the Institute of Medicine report, Unequal Treatment, highlighting cultural competence as part of a comprehensive effort to address racial and ethnic disparities in health care. Betancourt will present findings from the new report, which provides a blueprint for assessment and intervention in this emerging field, at the 3rd National Conference on Quality Health Care for Culturally Diverse Populations, being held in Chicago October 2-4, 2002. The conference is cosponsored by The Commonwealth Fund. "As the U.S. population grows increasingly diverse, cultural and communication barriers to good health care loom larger than ever," said Karen Davis, president of The Commonwealth Fund. "The good news is that there are health care organizations on the cutting edge of change who are innovating, adapting, and improving to meet the challenge." The authors conducted an extensive literature review, interviewed experts in the field of cultural competence, and conducted site visits in academic, government, managed care, and community health settings to explore programs in more depth. They also recommend steps health care organizations can take to implement programs that take into account the needs of their own patient population, available resources, and the business case for improving care. The authors also conducted site visits to analyze key components of cultural competence programs in a variety of health care settings:

• White Memorial Medical Center, Family Practice Residency Program, Los Angeles, CA
  A cross-cultural curriculum is part of the training for all family practice residents in this hospital, which serves the East Los Angeles community with a predominantly Mexican American population, half of whom speak mostly Spanish. In addition to 30 hours during orientation focusing specifically on cross-cultural issues such as the role of traditional healers, cultural competence is integrated into many areas of the standard longitudinal teaching curriculum.
• Language Interpreter Services and Translations (LIST), Washington State
  LIST runs a training and certification program for interpreters and translators in the health care setting. Washington state provides reimbursement for certified interpreters and translators for Medicaid beneficiaries. Eight languages are readily available.
• Kaiser Permanente Medical Center, San Francisco, CA
  This medical center has established several programs, including a department of multicultural services that provides on-site interpreters for patients in all languages and modules of culturally targeted health care delivery. Nationally, the managed health care organization has created a Department of Diversity that is implementing numerous programs in three areas: workforce diversity, culturally competent care delivery, and linguistic and cultural services. In addition, each geographic region of the organization is implementing its own programs-for example, the Center of Excellence in Latino Health, based in Denver, Colorado-and has responsibility for sharing its best practices.
• Sunset Park Family Health Center Network, Lutheran Medical Center, Brooklyn, NY
  The community health center began their Asian Initiative to expand access to care for the recent Chinese immigrants in the area with innovations such as flexible hours, language and interpretation services, links to community leadership, and training Chinese-educated nurses in upgraded clinical skills so they could pass state licensing exams. The initiative now includes regular staff training programs, and works to create an environment that prizes cultural diversity, such as celebrating various religious and cultural holidays. A new initiative, the Mexican Health Project, targets another rapidly growing immigrant community.

"Cultural competence is central to quality improvement, and should help health care systems and clinicians provide the best possible care to any patient they come in contact with, regardless of race, ethnicity, culture, class, or language proficiency," said Betancourt. "The models profiled in this report highlight the cutting edge of work in key areas of cultural competence, and provide a roadmap for those interested in improving care and eliminating disparities." Key findings also include promising practices on three levels--organization-wide, systemic or administrative, and clinical--used by health care organizations to increase cultural competence. Organization-wide practices:

• Hiring and promoting minorities in the health care workforce.
• Involving representatives from the community in planning and quality improvement efforts.

Systemic practices:

• Providing on-site interpreters in settings with large numbers of limited-English-proficient (LEP) patients, and making off-site services available in settings with smaller numbers of LEP patients or limited resources.
• Ensuring that health information is at an appropriate literacy level and targeted to the language and culture of patients.
• Collecting racial, ethnic, and language preference data for patients in order to monitor disparities in care.

Clinical care practices:

Integrating cross-cultural training into professional development and training activities for health care providers.

Incorporating cultural and language-appropriate survey methods into quality improvement efforts.

"Health care organizations can use this framework to assess the cultural competence of their own practices at all levels, from doctors providing care to administrators making budgetary decisions," said Dora L. Hughes, M.D., senior program officer at The Commonwealth Fund. "It provides concrete recommendations that can be used to improve the quality of care for all patient populations."