Key Takeaways

• One of the challenges faced by mental health providers when dealing with Hispanics or Latinx patients revolves around understanding their patient's culture and needs to enable them to make the correct diagnoses.
• The lack of diversity in their nursing workforce is another problem that U.S. healthcare providers are facing as they attempt to cater to Hispanics of Spanish speakers.
• Hispanics make up around 18% of the U.S. population but Hispanic nurses account for only a tiny percentage of the total healthcare labor force.

Introduction

Language and Cultural Barriers

• One of the challenges faced by mental health providers when dealing with Hispanics or Latinx patients revolves around understanding their patient's culture and needs to enable them to make the correct diagnoses.
• As an example, a patient might convey what's ailing them with a statement such as "Me diele el corazon." Literally, this translates to "my heart hurts." However, this particular Hispanic phrase actually meant that the patient is experiencing some emotional problems and not chest pain.
• Health providers would need to probe further and take into account the cultural context of what their patients are saying instead of being satisfied with the literal translation.
• Based on a report derived from most U.S. studies, large healthcare institutions typically encounter problems with regard to language barriers when providing their services to their patients.
• Due to this challenge, the services that they provide are being impacted in terms of healthcare quality, safety, and the satisfaction of healthcare professionals.

Lack of Diversity in the Nursing Workforce

• The lack of diversity in their nursing workforce is another problem that U.S. healthcare providers are facing as they attempt to cater to Hispanics of Spanish speakers.
• Hispanics make up around 18% of the U.S. population. However, Hispanic nurses account for only a tiny percentage of the total healthcare labor force.
• A manager from the Mount Sinai Health System emphasized the value of diversity in the nursing labor force and the need to have more Hispanic registered nurses.

Lack of Healthcare Workforce Training in Diversity Matters

• Meanwhile, a primary doctor from the "Center of Diversity and Inclusion" at the Massachusetts General Hospital mentioned that they are facing a challenge on how to best address inequities in their services for minority groups such as Latinos. The doctor mentioned that they were not given any training to truly practice racial equity in their work.
• The healthcare industry also needs to ensure that diversity training can be provided to its workforce to prevent racial bias among minorities.

Research Strategy

Key Takeaways

• Brigham and Women's Hospital added more interpreters and bought more iPads so that remote interpreters could see Spanish-speaking patients.
• Brigham and Women's Hospital also purchased amplifiers to raise the volume of the patient's voice above the beeps and machines humming in an ICU.
• St. Charles Madras has adopted the use of an advisory council made up of people from the Latino communities to help provide culturally competent care to Latino patients.

Introduction

Adding More Interpreters and Telemedicine Technology

•  Brigham and Women's Hospital has a mission to "accelerate discoveries that improve human health."
• One solution that Brigham and Women's Hospital in Boston implemented to specifically cater to some of its problems related to Spanish-Speakers or Hispanics was to add more interpreters and buy more iPads so that remote workers could see Spanish-speaking patients.

• When the COVID-19 pandemic started, clinicians at Brigham and Women's Hospital in Boston realized that when they couldn't communicate clearly with Latino patients who didn't speak English in the Hospital's Covid-19 units, it negatively affected the services the Hospital was offering and the patient's health outcomes since the patients had a 35% greater chance of death.

• According to Dr. Karthik Sivashanker, who worked as the medical director for quality, safety, and equity at Bingham hospital at the time, the Hospital was getting safety reports that warned about language being a huge problem. Per Ana Maria Rios-Velez, a Spanish-language interpreter at Brigham, the Hospital started to get overwhelmed, did not know how to respond, and staff panicked.
• Interpreters did not know whether they could enter a Covid-19 positive patient's room and how close they could get to a patient if they went in due to the risk of infection. Interpreters also struggled to gain a patient's trust from behind a mask, face shield, and gown when in full personal protective equipment.

• The information the Hospital gathered helped it to look for possible solutions to rectify the situation. To minimize the risk of infection, the majority of the interpreters were advised to work from home. However, speaking to patients over the phone created new problems as patients with breathing difficulties, and those that were constantly coughing had muffled voices. Talking to patients over the phone also meant that interpreters lacked the chance to look patients in the eye to build a connection and put them at ease.

• According to Dr. Karthik Sivashanker, to resolve the problems, the Brigham Hospital responded by adding more interpreters and buying more iPads so that remote workers could see patients. The Hospital also purchased amplifiers to raise the volume of the patient's voice above the beeps and machines humming in an ICU. The Mass General Brigham network also started a pilot program using interpreters to carry out video translations in primary care offices.

• The Hospital's goal is to guarantee that every patient who requires interpretation services gets them. Sivashanker is happy that the Hospital is providing interpreters for most patients who make the request. He adds that the bigger challenge for him and the Hospital is offering an interpreter to patients who don't request one yet may need the services. Mass General Brigham is now expanding a centralized translation service for the entire hospital network.

• In addition, to ensure that all employees received timely updates as pandemic guidance changed, Brigham started translating all the Coronavirus messages into Spanish and sending them via text so that workers busy all day were more likely to read them.

• Mass General Brigham leaders plan to take any lessons from the COVID-19 pandemic to expand the remedies across the hospital network. Sivashanker says more interpreters, iPads, and better messaging to non-English speaking employees, have improved the patient and employee experience and count as a success.

 

Source

 

Charles Madras Uses Advisory Council to Improve Cultural Competency

•  St. Charles Madras "is a critical access hospital with 25 licensed beds and 240 staff members."
• The Hospital has adopted the use of an advisory council made up of people from the Latino communities to improve cultural competency.
•  St. Charles Madras is a hospital serving Jefferson County in Oregon. Although its service population includes one-third Latino people, the nursing staff is mostly White, with only one Latina nurse.

• Using patients' and employees’ feedback, St. Charles Madras learned that its staff members were not doing enough to provide culturally competent care to Latino patients. Patients shared instances when hospital staff treated them with a lack of understanding or disrespect of their cultures.

• Chief Nursing Officer Candy Canga-Picar, born in the Philippines, completed a capstone project to promote racial equity in healthcare for her doctorate. She found evidence-based education and training in cultural competency and took her findings to St. Charles Madras.

• Canga-Picar worked with the St. Charles Madras Hospital leadership to apply for a Small Rural Hospital Improvement Project grant through the Oregon Office of Rural Health to create a pilot project to serve its Latino patients better. The project gathers feedback from patients and community leaders and uses employee training to improve cultural competency.

• As per Canga-Picar, many inpatient providers completed the initial cultural competency training and education, exceeding the objectives set at the start of the pilot project. In addition, the Hospital’s human resources department and nurse bosses have rewritten the nursing job description to incorporate the requirements to participate in cultural competency activities. The Hospital also updated its artwork in and around the Hospital to ensure it is a better reflection of its patient population.

• Leaders from the Latino communities also participate in the newly formed Patient Family Advisory Council (PFAC), a formal group that meets regularly with healthcare providers to weigh in on policy and program decisions. The PFAC acts as the voice of patients and their family members created to assist the Hospital in improving the quality of care.

• In addition, the PFAC advised St. Charles Madras to change from a mailed patient satisfaction survey to a telephone survey since many community members in the service area preferred to share their experiences and opinions verbally instead of in writing. The Hospital's staff members have already seen an increase in the number of patients responding to their surveys, from very few people to about 25 per fiscal quarter.

• The results of the pilot project have been encouraging. The Hospital Consumer Assessment of Healthcare (HCAHPS) scores for St. Charles Madras Hospital indicate that there has been an increase in survey participants who would recommend the Hospital to other patients. The figure has risen from "60.9% in 2018 to 67.1% in 2019 to 69.9% in 2020." St. Charles also saw a drop in the number of patient complaints, from 59 to 13.

• Community members have indicated that they felt the project was the first time anyone had asked for their input and made changes based on that feedback. St. Charles Madras started using a simple, genuine assessment of where the Hospital was not meeting the needs of its patient population. The Hospital has promoted patient advocacy and empowerment and ensured that the community is part of that process.

• The work has grown to impact the facility and other institutions significantly. Apart from patients appreciating the work being done by St. Charles Madras, other organizations have reached out to the Hospital, including the Oregon Medical Board, to learn more about the initiative. The Oregon Office of Rural Health is also looking into the possibility of replicating the project throughout the state.

 

Source

 

Research Strategy

• To provide two solutions that the hospitals or health systems have implemented to specifically cater to some of their problems related to Spanish-Speakers or Hispanics, we leveraged information from medical reports and news databases such as the Rural Health Information Hub, NPR, and the American Hospital Association.