Most hospitals and health care systems collect patient race, ethnicity and primary language data, but using the data to provide equitable patient-centered care is a challenge for many. Providing equitable care—one of the six Institute of Medicine's Six Aims—is a priority as racial and socioeconomic inequity persists in health care. Leading hospitals are moving beyond data collection to analyzing and using the data to develop targeted interventions for improving care for underserved populations.
According to the 2010 National Healthcare Disparities Report released by the Agency for Healthcare Research and Quality, racial and ethnic minorities continue to receive a lower quality of care, as measured by performance on core quality measures. The 2009 NHDR notes three major implementation strategies to accelerate reduction of health care disparities:
- Train health care personnel to deliver culturally and linguistically competent care for diverse populations
- Raise awareness of disparities using research and data
- Form partnerships to identify and test solutions
Heywood Hospital, a 134-bed, nonprofit facility in Gardner, Mass., is one example of a hospital that has focused on training staff to deliver culturally and linguistically competent care, using data to raise awareness of diversity and potential disparities in care, and using a multidisciplinary team to lead improvement.
Though its geographic area seems to lack diversity, Heywood actively collects and uses racial, ethnic, linquistic and religious data and preferences of its patients. This process has revealed pockets of socioeconomic and minority groups who can benefit from specialized services. In 1999, the hospital established a multicultural task force with representation from executive management, information services, telecommunications, nutrition, plumbing services, mental health, social work and food service. Before 1999, Heywood only provided interpreter services for American Sign Language. In 2002, the hospital developed a program that offers video relay for deaf and hard-of-hearing populations, a phone interpreter and in-house interpretation.
Providing multicultural services has had a tremendous impact, including increasing the number of minority patients and attracting diverse staff and volunteers. Before establishing its in-house interpreter program, Heywood had 56 hospital encounters with deaf or hard-of-hearing patients. Last year, the hospital serviced 1,422 encounters with patients having limited English proficiency, including deaf and hard-of-hearing patients. Once Heywood started providing Spanish interpretation, it received more demand for the service. The hospital now provides interpreter services for Vietnamese, the third most frequently used language by its patients.
Heywood mandates cultural competency training for new hires, and trains staff annually on cultural competency issues. April is diversity month at Heywood, and the hospital educates staff on specific topics impacting various patient populations. The local community respects the hospital and looks to Heywood as a resource for cultural competency issues.
Challenges and opportunities remain at Heywood, including the need for more resources to fund equity efforts and to train staff to provide optimal customer service to all patients. Moving to the next step after identifying trends in patient race, ethnicity and primary language data will involve 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.
For other case studies about hospitals working to provide equitable, patient-centered care, visit the Hospitals in Pursuit of Excellence website at www.hpoe.org and download the report Improving Health Equity Through Data Collection AND Use: A Guide for Hospital Leaders.
H. Awo Osei-Anto is a researcher and Cynthia Hedges Greising is a communications specialist, both at the Health Research & Educational Trust. Visit Hospitals in Pursuit of Excellence at www.hpoe.org to explore these and other topics.