Heywood Hospital is a 134-bed facility located in an urban area about two hours west of Boston in Gardner, Mass. Although Heywood's patient population is not as diverse as that of other hospitals near Boston, Heywood was determined to improve its care and service to the population that does have language or related barriers to communication.
The hospital has actively collected and used racial, ethnic, language, and religious data and preferences of its patients to gain an understanding of the community served by the hospital and the characteristics of its patient population. Data collection, if done properly, can facilitate analyzing quality-of-care and health outcomes data using patient demographics to specifically identify-and implement actions to reduce-disparities.
In 1999, a multicultural task force with interdisciplinary representation discovered pockets of socioeconomic and minority groups that could benefit from specialized services. One such service, an in-house interpreter program, has helped Heywood increase patient access and hospital encounters-when an interpreter is asked to provide interpreter services-among its hard-of-hearing and minority patient population.
Since implementation in 2002, the hospital's in-house interpreter program-which offers video relay for deaf and hard-of-hearing patients, a phone interpreter, and in-house interpretation-has had a tremendous impact on the quality of care offered to minority patients.
Increased hospital encounters. Prior to establishing its in-house interpreter program, Heywood had 56 hospital encounters with the deaf or hard-of-hearing population. A year after establishing the program, the hospital had 252 encounters, followed by 556 and 800 encounters in subsequent years. Last year, the hospital serviced 1,422 encounters with limited English proficiency patients, including deaf patients.
Increased interpreter services. The primary language of Heywood patients, after English, is Spanish, followed by American Sign Language. Once Heywood began providing Spanish interpretation, it received more demand for the service. Through serving patients, the hospital's staff has become culturally sensitive to the array of dialects within the Spanish language. The hospital also provides interpreter services for Vietnamese-the third most frequently used language by its patients-and has just linked with the executive director of a Hmong community group to interact and determine the group's needs.
Increased education in specific patient populations. In 2008, the hospital found that all admissions for one of its smallest minority groups were for chemical exposure. Staff and clinicians were able to link the admissions to workplace conditions and collaborate with community leaders to promote healthy behaviors in the workplace.
Another reason the hospital has increased its minority patient base is its staff and volunteers have become more culturally competent, which helps them communicate better with minority patients to ensure the best possible clinical outcomes. This is achieved in three ways.
Training staff on cultural issues. Heywood mandates cultural competency training for all new hires and trains its staff on cultural competency issues on an annual basis. For example, April is diversity month at Heywood, and the hospital uses the opportunity to educate staff on specific topics impacting various patient populations. The hospital also provides interpreter training annually.
Diversifying staff base. Multicultural services worked with human resources staff, volunteer services, and medical staff to self-identify, just as with patients. This information is also used to determine potential staff to be trained as interpreters for the in-house interpreter program.
Collaborating with management. The work of the multicultural task force is tied to the quality improvement process, so the task force reports progress to senior management.
Heywood executives and staff learned the following three lessons while improving quality for its minority patient population.
Be willing to learn. Heywood Hospital has used available resources from the Joint Commission, American Hospital Association/Health Research & Educational Trust, Massachusetts Department of Public Health, and other state collaborators.
Combine the disparities data collection and use with existing reporting requirements. This process will ensure streamlining efforts across multiple departments and facilitate broad buy-in. State initiatives, regional programs, and payer policies have also served as facilitators to data collection and use at Heywood Hospital.
Continually engage executive leadership. The CEO of the hospital is a member of the multicultural task force and reports back to the hospital's board of trustees.
"Moving to the next step after identifying trends in patient race, ethnicity, and primary language data is required," says Barbara Nealon, director of social and multicultural services. "It will involve a combination of translating materials into patients' preferred languages, providing specific services for patients, and going out into the community to connect with community leaders and provide education."
This article is excerpted with permission from the following resource: Joshi, M., Improving Health Equity Through Data Collection AND Use: A Guide for Hospital Leaders, American Hospital Association/Health Research & Educational Trust, Chicago, March 2011.
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