Hospitals in pursuit of excellence

Providing Education and Training to Improve Cultural Competency

Children's Mercy Hospitals & Clinics
Kansas City, MO
265 Beds

The Problem
The patient population at Children’s Mercy Hospitals & Clinics has become more diverse as the Kansas City metropolitan area population has changed demographically. In addition to collecting race, ethnicity and language data, Children’s Mercy emphasizes educating and training all staff on diversity and inclusion issues and providing more in-depth cultural competency and language training for front-line admissions staff as well as clinicians. Work on diversity and equity issues at the hospital is guided by an Office of Equity and Diversity and an Equity and Diversity Council composed of staff members at all organizational levels.

The Solution
The hospital’s Office of Equity and Diversity worked with the Service Excellence Steering Committee to implement an organization-wide strategy on diversity, inclusion, service excellence, and cultural competence. Between 2008 and 2010, more than 6,000 employees at Children’s Mercy completed a required course entitled “Honoring Diversity.” New employees now complete the training online. In addition, Spanish-speaking admissions staff can enroll in a Spanish proficiency assessment program. Participants who complete and pass a testing process then receive a pay differential. Testing is repeated annually to ensure ongoing competency. The hospital’s Equity and Diversity Council is exploring an organization-wide rollout of this competency assessment process. Children’s Mercy offers other Spanish language courses to health care workers, all with the aim of providing better care for Spanish-speaking patients and families.

At the hospital’s Pediatric Care Center, at least a quarter of the 45,000 visits each year are for Spanish-speaking families. In response, Dr. John Cowden created the CHICOS Clinic (Clinica Hispana de Cuidados de Salud). This program trains select pediatric residents with moderate or better Spanish proficiency to complete a bilingual cross-culture care curriculum as part of their primary care training. Residents speak Spanish with patients with an interpreter in the room as a “safety net,” and a bilingual attending doctor provides role modeling and coaching. The program’s goal is to develop certifiably bilingual and culturally sensitive clinicians.

The Result
Equity and diversity have become part of the culture of safety and service excellence at Children’s Mercy. The organizational structure has provided stability and strategy for wide-ranging improvement activities. New hospital standards for assuring language competency and excellent communication have resulted in critical conversations about how patients have been treated in the past and a vision for more equitable care moving forward.

Participation in the CHICOS Clinic has increased to 11 residents, from 3 the first year. The feedback from patients at Children’s Mercy Hospital and the community has been impressive, and patient satisfaction has increased. Physicians and other health care workers enjoy the improved ability to interact with and treat patients. Many patients previously lacked an access point for care, partly due to language barriers, but they now can receive individualized care and improved access to follow-up treatments due to improved communication. In addition, the Office of Equity and Diversity is planning an organization-wide cultural competency assessment to evaluate its current strengths and weaknesses and assist in developing future programming.

Contact Information
Gabriela Flores
giflores@cmh.edu

This case study was originally featured in the HPOE guide: "Eliminating Health Disparities: Implementing the National Call to Action Using Lessons Learned," published February, 2012.