Health care providers focus on 'culturally responsive care'

By Julie Carroll

Wednesday, 17 June 2009

Nyahrai Lah, 56, a recent immigrant from the Southeast Asian country of Burma, also known as Myanmar, didn’t know what to expect when she made an appointment at the HealthEast Roselawn Clinic in St. Paul.

It was her first experience of health care in America.

To her surprise, she said, the clinic provided an interpreter, and the doctor understood and respected her culture.

“Every time I go to Roselawn Clinic, I feel like all the staff there treat me very well,” Lah said through an interpreter. “I feel like the care is excellent and I wouldn’t go anywhere else.”

Patients at HealthEast Care Systems’ hospitals and clinics in the Twin Cities’ east metro area speak 157 languages and represent an even greater ethnic and cultural diversity, according to Pennie Viggiano, assistant director of government and special populations at the Christian-based health care provider.

As the Twin Cities become more racially and ethnically diverse, HealthEast and other health care providers in the region have begun to focus more attention on providing what Viggiano calls “culturally responsive care.”

For Catholic health care institutions in particular — such as St. Joseph’s Hospital in St. Paul, which is part of the HealthEast system, and Benedictine Health Center in Minneapolis — being culturally responsive is an integral part of their mission to serve, especially society’s most vulnerable.

Being culturally responsive can take many forms, such as providing interpreters so people can communicate with their doctor in the language of their choice, understanding traditional medicine and beliefs, and being aware of different communication styles.

Between 2000 and 2007, the seven-county region saw an estimated 28 percent growth in the number of people of color, many of them immigrants, while the region’s white population remained virtually unchanged, according to data compiled by Twin Cities Compass from U.S. Census Bureau statistics (see www.tcccompass.org).

All regions of the state will be more racially and ethnically diverse in the future, according to the Minnesota State Demographic Center. By 2035, 48 percent of Ramsey County residents and 44 percent of Hennepin County residents are projected to be nonwhite or Latino. In suburban counties, the proportion of residents who are minorities is expected to double during that same period.

Differences matter

While many businesses in recent years have worked hard to overlook cultural differences in the name of political correctness, when it comes to health care, providers are finding that treating everyone the same is not the best practice.

In the past, Viggiano said, “we always spoke to our patients with the assumption of our own norms, and thus, that creates some barriers in care. What we’re finding . . . is if we look at every individual as someone with unique beliefs, cultural backgrounds and cultural norms, and really negotiate the care based on understanding what those cultural norms are, we can come to better outcomes and care.”

Take, for example, a Hmong patient who refuses surgery based on a traditional belief that illness comes from the spiritual realm. A culturally responsive health care provider might encourage the patient to practice his spiritual beliefs while continuing to receive medical treatment.

“Now we’ve got a patient who feels that they’ve got a team that respects their culture, they’ve got their shaman there, and if they ultimately end up . . . needing surgery, the patient feels really comfortable about that and complies with the surgery,” Viggiano said.

Language barriers are another concern when providing culturally responsive care, Viggiano said. HealthEast recently replaced all of the signs in its four hospitals with universal symbols, such as a picture of an X-ray to lead people to the radiology department.

HealthEast also instituted a 24-hour language line, where people can request an interpreter, get assistance in scheduling appointments, and communicate with a provider in their language; and increased the number of interpreters on staff.
Health care providers need to be aware of more subtle communication barriers as well, Viggiano said.

“Some Asian cultures emphasize respect and not disagreeing,” she said. “So somebody may be saying yes to you, but they’re saying, ‘Yes, I understand you,’ not ‘Yes, I agree with you.’

“Or, a person from a different culture may be very vocal and very emotional and seem like they’re upset,” Viggiano said. “But, [in their culture], if you don’t show emotion, it means you don’t care.”

HealthEast requires all staff members, from surgeons to billing clerks, to receive ongoing cultural sensitivity training, including classes, e-learning courses and lunch-and-learns.

Viggiano and Elizabeth Anderson, the newly hired system director for cross-cultural services at HealthEast, said they have been working to foster community partnerships through health fairs and building relationships with leaders from various communities.

As the official health care adviser to the Hmong community, Viggiano meets with Hmong leaders at least once a year to discuss ways to improve services to the Hmong community.

Recently, a Hmong leader told Viggiano not enough information was available in the community regarding the H1N1 flu. Viggiano contacted Emergency and Community Health Outreach, the state department responsible for communicating in emergency situations, and worked with them to get information to the Hmong community in their language.

Celebrating diversity

Benedictine Health System, another Twin Cities health care provider, also is making strides to be culturally responsive to both patients and staff members.

Benedictine Health Center of Minneap­olis, a Catholic-sponsored long-term care facility under Benedictine Health System, received a grant last year from the Min­nesota Department of Human Services to conduct a series of cultural diversity celebrations.

One of the celebrations, which focused on Native American culture, included storytelling, singing and dancing.

“It was time for lunch and the residents had to tear themselves away,” said Kath­ryn Grafsgaard, foundation director. “One resident said she is interested in reading more about the American Indian peoples, and for someone who lives in an institutionalized setting who doesn’t have a lot of community involvement, this is phenomenal to me that they would say, ‘I want to learn more.’”

Other celebrations focused on Latino, African and African-American cultures, Grafsgaard said.

“Our residents come from many backgrounds, and we want to provide them with tons of great experiences here where they can remember their cultural background, learn about a new cultural background, and be honored in their own traditions,” she said.

The celebrations fit with Benedictine Health Center’s mission “to advocate policies for the poor and powerless, eliminate prejudice and strive to develop a global vision personally and organizationally,” according to Grafsgaard.

“Even though our grant funding ended, I do know that we will continue the projects way into the future because they have brought such meaning and so much richness to people,” she added.

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