Talk directly to patients about beliefs, practices
Remember there is diversity among ethnic groups
When Sonja Boone, MD, director of diversity for Northwestern Memorial Hospital in Chicago, talks to case managers about how they can provide patient-centered care to people from other cultures, she encourages them to talk directly to the patients about their beliefs and practices and about how the hospital can meet their needs.
"It’s better to find out about a patient’s beliefs rather than assuming," she says.
Human beings all have biases that cause them to assume things about patients, Boone points out. For instance, she says, a case manager may assume that a punk rocker doesn’t have a good support system at home and may make similar assumptions about people from other cultures based on general ideas of what members of the culture believe.
"People tend to see cultural competency as pushing one button, but actually, people within a culture can be very diverse. Case managers and other hospital staff need to be aware that diversity is all encompassing," Boone says.
She encourages case managers to break down the stereotypes and communicate with each patient as an individual rather than as someone who is from a certain group.
Boone meets with case managers on a case-by-case basis to talk to them about the challenges they face and how they can make sure that all the populations they serve are receiving quality care.
"When people are really busy and they have a heavy caseload, the smaller nuances between patients can get lost. We want every contact a patient has, from housekeeping to the physician, to make them feel like they and their beliefs regarding respected," she says.
For instance, when they discuss post-discharge options with their patients, the case managers ask people of other cultures about their beliefs regarding skilled nursing facilities or rehab facilities, rather than going to them with a plan for a post-discharge facility, Boone says.
If the family wants the patient to go home, the case managers work with them on that alternative.
The most requested language by patients at Northwestern is Spanish, followed by Polish, then Russian and Cantonese.
"We look at people who are in contact with the patients, such as nursing staff and case managers, and make every attempt to reflect the communities we serve. We work with the staff to become culturally and linguistically competent," she says.
The hospital has translated several of its forms into Spanish and Polish and is considering a pilot project to translate some of the forms into other languages. As of September 2004, information on race, ethnicity, and language became required fields in the admission data. Admissions staff underwent training to learn how to ask the questions in a way that would be the most sensitive and respectful to the patients, Boone says.
"This helps us get to the issues of disparity up front and to make sure we deliver culturally competent care in the beginning of the stay," she says.
Boone anticipates that eventually when the admissions department enters information on the patient’s ethnicity and language, it automatically will alert an interpreter to go to the patient’s room. "Having this information prompts the nurses to ask the patient if they would like an interpreter or a different type of meal or if there is a tradition we can help with. It is a tool that can be used to improve communication with the patient, and that’s what cultural competency really is about," she says.
The hospital contracts with Press Ganey, a South Bend, IN, health care satisfaction measurement company, to administer a patient satisfaction survey that includes questions on whether the patient’s cultural needs were met.
A concurrent patient survey, done while the patient is in the hospital, asks if the patient’s cultural needs are being met and gives staff an opportunity to make adjustments if the answer is no.
The hospitals’ diversity training classes emphasize the importance of getting to know each individual patient and his or her differences instead of looking at them as a member of a particular group. "We are helping people break down the barriers of communication and get to know each other. It also helps us work better with our colleagues because we help them break down the barriers to communication, and that creates fewer conflicts and a better working environment," she says.
The hospital has incorporated managing diverse staff into its management training. The program doesn’t deal with specific cultures, but it is centered around communicating with the staff and helping the staff communicate better with patients, she says.
Hospitals walk a fine line between teaching staff about the cultural practices and beliefs of a particular culture and perpetuating stereotypes, Boone says. "When I review the literature, it is almost impossible to teach cultural ideas without coming across as stereotypical. We are looking at a curriculum that focuses on communication and approaching patients in a way that is caring and respectful."
The hospital has had a strong commitment to diversity for several years and includes diversity program goals in its strategic goals, she says.
"Our purpose is to have a focused initiative where we pay attention to the concerns in health care, how we address the concerns, and to create processes that help it happen. Diversity goals are embedded into the fabric of hospital processes and are a part of how we care for patients," Boone says.
At Northwestern, the case management department, as well as other departments, keeps three elements in mind in regard to diversity, she adds:
- Representation: How many minority staff are working with patients. This goes beyond affirmative action but includes people from all walks of life, Boone says.
- Inclusiveness: Creating an environment that welcomes people from all backgrounds and creates an environment where people feel comfortable and empowered.
- Cultural competency: Delivering care to patient in a way that is sensitive to and respectful of cultural backgrounds and health beliefs.
"The hospital staff should reflect the community it serves. The work force shortage in health care presents a huge choice. As we look at that challenge and the challenge of serving a more diverse population, recruiting minority clinicians and people on the management team should be a huge thrust in health care," Boone says.
Northwestern is part of a seven-hospital consortium working with the American Hospital Association on eliminating health care disparity.
When Sonja Boone, MD, director of diversity for Northwestern Memorial Hospital in Chicago, talks to case managers about how they can provide patient-centered care to people from other cultures, she encourages them to talk directly to the patients about their beliefs and practices and about how the hospital can meet their needs.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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