Transcript Slide 1

The following resource was submitted with the purpose of
distributing to AONE members as part of the AONE
Diversity in Health Care Organizations Toolkit
Submitted by:
Lutheran Medical Center
Contact person: Rosanne Raso, RN,
MS, CNAA
Senior Vice President, Nursing Services
Brooklyn, NY
Culturally Competent Care Across the Continuum:
Designing and Implementing Culturally Competent Care for the Chinese Population in Brooklyn, New York
Virginia Tong, Vice President for Cultural Competence, Lutheran HealthCare
PLANNING
Overview
Lutheran HealthCare, composed of its’ ambulatory
arm, The Lutheran Family Health Centers network,
and inpatient component, Lutheran Medical Center,
designed and implemented plans to provide
culturally and linguistically competent services to
the immigrant Chinese population that began to
grow in the community in the 1990s.
Data collection
• 1989 - The Sunset Park Health Council, the
community advisory board for the ambulatory care
center, notices more Chinese residents on the
subway.
Hospital Data
Staffing
• Collected primary language of patients.
• Created job descriptions with
language required (or
preferred).
• Y2K - new computer system installed and started
to capture interpreter preferred and language
data. Patient language data now available.
• Lutheran HealthCare had few Chinese-speaking
staff. Need to increase number of bilingual staff.
• 2005 - Conduct language survey of all staff.
Implement new employee language screening and
include in employee database. Include language
skills and competence.
• Track increases in bilingual staff utilizing employee
database.
• 1990 - Funding by the United Hospital Fund (UHF)
enables a partnership with the Brooklyn Chinese
American Association and Chinatown Health Clinic
to conduct a community health needs assessment.
• 5,000 surveys are conducted in the Chinese
community in Sunset Park.
• Survey Results: The majority of the Chinese
residents living in Sunset Park, Brooklyn travel to
Manhattan Chinatown, almost 1 hour away, to seek
medical care. They do not know about health
services available in the community nor have they
ever heard of any of the hospitals in Brooklyn.
They need care delivered in the Chinese language.
SunsetSunset
Park Demographics
Park
Demographics
Other Race
1%
African American
3%
2005
Language Survey
LHC Staff Languages 2006
White
19%
Sample ad
Training Provided
Spanish
33%
Asian
25%
English
41%
Hispanic
49%
• 2000 - 25% of the Sunset Park community is Asian.
• Internal and external
recruitment strategies which
utilized resources such as:
– Chinese Advisory Group,
Cultural Access Task Force
– Community Organizations:
Chinatown Manpower
Association, ChineseAmerican Planning Council
– Ethnic newspapers: Ming
Pao, Sing Tao, World
Journal
– Job Fairs - Asian Job Fairs
– Diversity Websites - AsianJobs.com
2 or More Races
3%
Chinese
9%
Census Data
• Union supported changes.
Others
9%
Yiddish
1%
Russian
6%
Arabic
1%
• Staff were trained in:
– Cultural Competence (full day - mandated)
– Chinese Culture, Values and Beliefs
– Area specific trainings - Adult/Internal Medicine,
Women and Maternal Care, Behavioral Health
– Death & Dying customs and practices
– Medical Interpreter Training
Culturally Competent Care Across the Continuum:
Designing and Implementing Culturally Competent Care for the Chinese Population in Brooklyn, New York
Virginia Tong, Vice President for Cultural Competence, Lutheran HealthCare
DEVELOPING PRIMARY CARE SERVICES
Site 1: Family Practice FHC
• 1990-1994 - In consultation with the Brooklyn
Chinese American Association and Chinatown
Health Clinic, make an existing site, the Family
Practice Family Health Center, appropriate for the
Chinese community:
–
–
–
–
–
– CHP (Child Health Plus) applications & assistance.
• The site makes referrals to Family Practice FHC and
the Hospital.
bilingual signage
bilingual reception and medical assistant staff
bilingual social worker
bilingual health education materials
bilingual staff to assist with information and
applications for health entitlements
• Model of Practice - Private practice model,
only physicians, no residents, follow patients
into the hospital including deliveries and
newborn/pediatric visits.
Site 3: Brooklyn-Chinese
Family Health Center
• 1995 Develop site to increase financial access for
patients, in the heart of the community, that is a
one stop shop for:
• WIC (Women, Infants, Children) applications
and services.
• PCAP (Prenatal Care Assistance Program)
applications and assistance.
– 99% Bilingual staff including all leadership
staff - Site, Medical & Nursing directors
– Chinese décor, artwork, signage - Chinese
interior designer, waterfall for good
fortune
– Feng Shui considered in design
– Staffing includes social worker and
financial counselors
• Hours of operation are Sunday through
Thursday (many Chinese people work in
occupations where they do no work on
Sunday) with evening hours one day a week.
• 1995 - Over 40% of Family Practice FHC are
Chinese, the site is over-crowded and additional
space is needed.
Site 2: Health Education and
Resource Center
• Construction and Development:
• 1995-2000 - Identify space in the heart of the
community that is affordable and large enough to
develop a primary care space for the Chinese
community.
• 1997 - Space on a side street, in a new building was
identified. However, no funds for construction or
rent are available.
• 2000 - Acquired funding from NYC Primary Care
Initiative, NYS Dept. of Health, & NYC Primary Care
Development Corporation for construction and
operations. Sign lease for 4,000 square feet of
space.
• June 2002 - Site opens.
• 2005 - Site is open 6 days and evenings per
week. Over 30,000 medical and dental visits
were provided in CY 2005.
Culturally Competent Care Across the Continuum:
Designing and Implementing Culturally Competent Care for the Chinese Population in Brooklyn, New York
Virginia Tong, Vice President for Cultural Competence, Lutheran HealthCare
DEVELOPING INPATIENT SERVICES – THE CHINESE UNIT
Changes at the hospital
• 1990-2000 To provide access to the patients:
– Developed multilingual signage
– Hired bilingual patient relations representatives
for both the outpatient and hospital departments
– Recruited bilingual volunteers (funded by the
United Hospital Fund)
– Develop multilingual telephone coverage
Developing the business
case for the Chinese unit
• The Chinese population represents 25% of
the Sunset Park community and 3% of
hospital patients. Potential market.
• Chinese-speaking attendings complained that
their patients have difficulty with language
access in the hospital particularly in the
evenings, nights and weekends.
• Competition - Two other local hospitals in the
community are marketing to the Chinese
community.
Chinese Unit Staffing
• Used existing positions. No new positions
created, no staff terminated. Bilingual
Chinese-speaking staff cover 24/7 including:
– Nurses, Nurse Aides
– Housekeeping and Food Service Workers
– Security Guards
– Social Worker
• With union support:
– Chinese chef to make Chinese meals and
congee
Developing the Chinese
Unit
– Transferred a few non-Chinese speaking
staff off the unit to have vacancies on
unit
• 2004 decision by the CEO/president to
develop the unit.
– Recruited Chinese-speaking home care
workers and created training program to
train them to be certified nursing
assistants
• 6 beds in the medical/surgical unit
converted.
• Physicians and community organizations
raise $10K to provide artwork and
decorations.
• Changed room numbers from 4400’s to
4800’s as 4’s are “bad luck”.
• Prepared to cook Chinese meals including
accommodations for gas heat and wok.
– Hired 7 of the 9 students (2 hired by our
nursing home) who completed the
training
Culturally Competent Care Across the Continuum:
Designing and Implementing Culturally Competent Care for the Chinese Population in Brooklyn, New York
Virginia Tong, Vice President for Cultural Competence, Lutheran HealthCare
CHALLENGES
Budget
Training Challenges
• No additional funds.
• Used grant funds:
• Dilemma as to whether training should be
Mandatory vs. Voluntary.
– United Hospital Fund
– NYC PCDC (Primary Care Development Corp)
– NYSDOH - Community Health Care Conversion
Demonstration Project
– NYSDOH - Primary Care Initiative
• Fund raising from physicians and community
organizations.
• Union (1199) supported programs - Certified
nurses aide project.
• Supervisors were
unhappy with the
length of time to fill
positions with bilingual
requirements.
LUTHERAN MEDICAL CENTER
HUMAN RESOURCES DEPARTMENT
NOTIFICATION OF OPEN POSITION
FOR CURRENT EMPLOYEES
DEADLINE FOR APPLYING IS:
4:00 PM
October 3, 2005
TIME:
REFERRALS FOR THIS POSITION WILL BE MADE ONLY BY THE HUMAN
RESOURCES DEPARTMENT IF YOU MEET THE REQUIREMENTS OF THE JOB
AND H.R. CRITERIA.
POSITION
WARD CLERK
NON-UNION
DEPARTMENT
OR
SHIFT
DAYS
1199
EVES
SSOBA
NIGHTS
FLEX
May include weekends
• Conflicts between job
requirements vs.
language requirements.
• Frustration with the
lack of available pool of
bilingual technicians
and professionals.
BI-WEEKLY /
AUTHORIZED
75.00 HOURS / FULL-TIME
DESCRIPTION
charts.
OF DUTIES:
Provides clerical support to unit. Records all information on patient
Miscellaneous duties as assigned.
REQUIREMENTS
EXPERIENCE:
 Previous data entry & customer service experience preferred.
 Knowledge of medical terminology preferred.
 Must have the ability to work under pressure.
EDUCATION: HIGH SCHOOL DIPLOMA -
PREFERRED
• Releasing workers for training.
• Certification of language competence skills.
• Increase of Chinese patients
from 3% to 10% and
increased patient satisfaction
• “Chinese unit” replicated by 2
hospitals in Manhattan, New
York
• Expansion of “unit” from 6 to
24 beds
Human Resource Challenges
• Supervisors were
resistant to change.
• Funds for training ended 9/30/06.
Results
• Increase in the number of
Chinese patients in Lutheran
HealthCare – In both Lutheran
Family Health Centers
netwrok, the ambulatory
component of Lutheran
HealthCare, and Lutheran
Medical Center, the inpatient
component.
REQUIRED
 Or GED required.
SPECIFIC SKILLS:
 Must type 20+ WPM.
 Computer literate.
LANGUAGE SKILLS:
BI-LINGUAL
REQUIRED
PREFERRED
ENGLISH
SPANISH
ARABIC
CHINESE
YIDDISH, HAITIAN-CREOLE AND KOREAN
RUSSIAN
OTHER
Comments & Questions:
Should you have any questions or comments, please contact:
Virginia S. Tong, Vice President, Cultural Competence, 718-630-7236, [email protected]