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Service Delivery Innovation Profile

Community Liaisons Facilitate Access to Culturally Competent Care for Orthodox Jewish, Chinese, and Arab Patients


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Snapshot

Summary

The Lutheran Healthcare Community Liaison Program facilitates access to high-quality care by assigning a culturally competent liaison to serve the needs of three of its major patient groups—Orthodox Jewish, Arab, and Chinese. Liaisons serve as patient guides and advocates, maintain relations with community service providers and members, and provide support to Lutheran departments, programs, and services. The program has increased access to Lutheran services for the target patient groups, enhanced the patient experience, and improved coordination across Lutheran providers.

Evidence Rating (What is this?)

Suggestive: The evidence consists of anecdotal feedback from patients, family members, nurses and other frontline staff, and managers.
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Developing Organizations

Lutheran Healthcare
Brooklyn, NYend do

Date First Implemented

2007
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Patient Population

Vulnerable Populations > Non-english speaking/limited english proficiencyend pp

Problem Addressed

As the number of minorities grows and the population becomes more racially and ethnically diverse, providers have struggled to provide care and services responsive to the various cultures, traditions, beliefs, and languages of the patient populations they serve. Many lack the knowledge and/or resources to provide culturally competent care on their own.

  • Struggling to meet diverse patient needs: Many health care providers struggle to transcend their own learned patterns of language and culture when serving patients from different backgrounds.1
  • Inadequate knowledge, resources to provide culturally competent care: Culturally competent care can help to improve outcomes and reduce racial and ethnic disparities in health by allowing providers to understand and address the needs of various patient populations, and hence offer services respectful of and responsive to their beliefs, practices, and cultural and linguistic needs.1 Many providers, however, lack the knowledge, time, and/or resources to deliver such care on a consistent basis. For example, an internal analysis found that staff at the Lutheran Stroke Center did not have the requisite knowledge to address the religious standards and observances of Orthodox Jewish patients, nor did the center have the personnel necessary to provide the guidance and support these patients needed to navigate the rest of the Lutheran system after discharge.

What They Did

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Description of the Innovative Activity

The Lutheran Healthcare Community Liaison Program facilitates access to high-quality care by assigning a culturally competent liaison to serve the needs of Orthodox Jewish, Arab, and Chinese patients and their families. Available 24 hours a day, these liaisons serve as patient guides and advocates, maintain relationships with community service providers and members, and provide support to Lutheran departments, programs, and services. They serve as the "face" of the organization, supporting the well-being of patients in a culturally sensitive manner. Key program elements include the following:

  • Introducing program services to new patients: Based in the hospital, liaisons receive a printout each morning of new and current patients for the group they represent. They introduce themselves and their role to all new patients and their families, leave a card with their contact information, and encourage the family to contact them at any time (24 hours a day) if they need assistance. As needed, they also follow up with other patients they have previously served.
  • Culturally sensitive guidance and support in the hospital: To address cultural gaps in knowledge, liaisons come from backgrounds similar to the populations they serve. For example, to better support the predominately Muslim community served, the Arab community liaison is Muslim. While in the hospital, liaisons provide a wide range of guidance and support not only to patients/families, but also to Lutheran staff, as outlined below.
    • For patients and families: Liaison activities might include obtaining and providing interpretation services, explaining administrative procedures to family members, explaining the concept of hospice to terminally ill patients and their families, and helping family members make arrangements for home care. On the typical day, liaisons help approximately 30 (25 existing and 5 new) patients.
    • For staff: Liaisons may be asked to explain to physicians and nurses the cultural influences that affect patients’ interactions with medical staff, present information on dietary restrictions to kitchen staff, and help a nurse calm a patient having difficulties.
  • Community representation: As the organization's representative to the community, liaisons work with a variety of public and private organizations, including houses of worship, youth centers, schools, and police departments. They also maintain direct relations with affiliated service providers to facilitate a coordinated continuum of care for patients/clients. Their work includes:
    • Building community relationships: Liaisons establish and maintain relationships with individuals and representatives of community organizations who may serve as intermediaries and partners for the provision of medical and social services. To nurture these relationships, liaisons attend meetings, participate in sponsored activities, and serve as a resource for all community members.
    • Program and service planning: Working closely with Lutheran's Department of Community Services, the liaisons consult on the development and implementation of community-based programs and services that address a wide range of needs, such as early childhood literacy, trauma and grief, and English for speakers of other languages.
  • Facilitating access to Lutheran services: Through their relationship-building activities, community liaisons become the “go-to” person when a member of the community needs to access a Lutheran service or program. Examples of this type of support include finding housing for an ailing senior and arranging for transitional home care services after a patient is discharged from the hospital. Liaisons also help to facilitate transfers between Lutheran facilities. For example, they may help a resident of a Lutheran senior housing facility obtain social services, arrange for the transfer of a hospitalized patient to the Lutheran rehabilitation center, or facilitate transportation from a Lutheran family health center to the hospital.
  • System-wide support: Community liaisons work closely with all Lutheran departments, especially patient relations, communications and marketing, and pastoral care. Key roles include the following:
    • Training and communications: Liaisons participate in staff training sessions on cultural competence, write articles on cultural competency, and help promote cultural celebrations at Lutheran.
    • Facilities management: Liaisons work with clergy to make sure facility sanctuaries are furnished appropriately; review hospital signage for accuracy, clarity, and cultural appropriateness; and consult with food service managers on selecting vendors that can provide culturally appropriate food.

Context of the Innovation

Lutheran HealthCare, a faith-based social ministry, provides health and community-based services through its hospital, family health centers, rehabilitation facility, senior housing facilities, school-based health services, community-based programs, and home care services. The organization developed the Community Liaison Program to enhance its ability to support the needs of the Orthodox Jewish, Arabic, and Chinese communities it serves. The impetus for the program came from senior staff within the Department of External Affairs, Cultural Competence, and Patient Care Services, who realized that stroke center staff lacked the requisite knowledge and resources to provide Orthodox Jewish patients with culturally competent care (as noted earlier). Although Lutheran generally had a strong reputation for cultural competence, this finding convinced senior management that meeting the distinct cultural and linguistic needs of these growing patient populations required dedicated staff. As they considered the potential roles and responsibilities for the community liaison position, they further realized the benefit of having culturally competent representatives coordinate care with community service providers and act as an internal liaison between various Lutheran departments and providers.

Did It Work?

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Results

The community liaison program increased access to Lutheran services for Orthodox Jewish, Chinese, and Arab patients; enhanced their experience as patients; improved coordination across Lutheran providers; and enhanced cultural responsiveness from community providers.

  • Enhanced access to services: Since implementation of the program, Lutheran has experienced steady increases in use of its medical and community-based services by Orthodox Jewish, Chinese, and Arab patients. In 2010, the liaisons made 5,617 visits to patients—2,056 to Chinese patients, 2,066 to Orthodox Jewish patients, and 1,495 to Arabic patients (starting in May 2010).
  • Better patient experience: Anecdotal feedback from patients, family members, and nurses suggest that Lutheran staff are meeting patient needs in a more culturally competent manner since implementation of the program. The Chinese and Arabic liaisons provide interpretation services for patients averaging 20 and 10 (respectively) patients per week. Members of the Chinese community have been very pleased with the increased availability of interpreters who speak Mandarin and Cantonese. Several members of the Arab community have expressed satisfaction with Lutheran providers' increased awareness of their religious and cultural norms. As word about the program has spread, Lutheran has received more requests for medical care from individuals living in several Middle Eastern countries.
  • Improved coordination across Lutheran providers: Managers and frontline staff believe the program has improved coordination between the medical center and Lutheran's community-based service providers.
  • Enhanced cultural responsiveness from community providers: Recurring feedback from community physicians and social service and community-based providers indicates that their ability to provide culturally responsive care and services to the individuals they serve has improved greatly, as a result of the community liaisons program.

Evidence Rating (What is this?)

Suggestive: The evidence consists of anecdotal feedback from patients, family members, nurses and other frontline staff, and managers.

How They Did It

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Planning and Development Process

Key elements included the following.

  • Obtaining senior leadership support: Senior staff made a formal presentation to the chief executive officer (CEO) on the need for and benefits of a community liaison program, including sharing findings from the stroke center on its inability to provide culturally appropriate care with existing resources.
  • Designing program: After securing preliminary support from the CEO, senior staff developed a comprehensive program description that delineated the liaison's roles, responsibilities, requisite skills, and knowledge; the roles of various departments in working with the liaisons; and reporting mechanisms and funding. As the program evolved, senior staff rewrote job descriptions, consulted the legal department regarding Health Insurance Portability and Accountability Act rules and regulations, and developed internal reporting procedures to monitor program activities and effectiveness.
  • Garnering buy-in from department heads: The CEO spearheaded the effort to secure the support of department and program leaders. As part of this process, department leaders had to commit to sharing resources and information with the liaisons and to integrating their work into existing practices (which required some redefining of staff interactions with patients and families).
  • Hiring liaisons: Senior staff took responsibility for hiring the liaisons, beginning with someone to work with the Orthodox Jewish community. They conducted an extensive interview process designed to find someone with indepth knowledge of patient care and the Orthodox Jewish community, good public speaking skills, and knowledge of the press. In addition to using traditional mechanisms to advertise the position, they made use of community publications and contacted local leaders to identify potential candidates. This first experience provided guidance for the subsequent hiring of two additional liaisons to serve the Arab and Chinese communities.
  • Orientation and training: The vice president for cultural competence provides ongoing, on-the-job training to the liaisons. The initial orientation focuses on learning about internal departments, services, policies, and procedures, and getting to know key Lutheran staff and community leaders. Ongoing training addresses effective strategies for internal relationship building, working with the community and the media, and building organizational cultural competence.
  • Introducing program to staff and patients: Lutheran used a variety of media to introduce the program to staff and patients. Staff learned about it through e-mails, employee newsletters, and presentations, while the public learned about it through press releases, announcements in local newspapers, feature articles in the ethnic press, and letters to community organizations. Lutheran continues to send out periodic reminders about the program to staff and the community at large.
  • Reporting relationships: Although the director of community relations is responsible for the day-to-day supervision of liaisons, department heads from patient relations, cultural competence and external affairs take on supervisory roles for work pertaining to their departments. Liaisons attend patient relations and external affairs staff meetings and meet individually with community relations and cultural competence department heads.

Resources Used and Skills Needed

  • Staffing: The program employs three full-time liaisons, one for each community.
  • Costs: Program costs consist primarily of salary, benefits, and reimbursement of out-of-pocket expenses for liaisons. Salaries average roughly $60,000 a year (excluding benefits).
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Funding Sources

Lutheran Healthcare
Lutheran funds the program out of its internal budget (as an overhead expense).end fs

Adoption Considerations

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Getting Started with This Innovation

  • Build case for program: Program developers need to build a case by clearly delineating the unmet needs of specific patient populations; identifying the benefits the program can provide to these populations and to the overall organization; and explaining how the program can be integrated into the organization’s existing structure.
  • Structure program to win CEO and department support: Because insurers do not reimburse for liaison services, the program generally must be funded internally. Securing such funding typically requires the support of senior leadership. To that end, Lutheran senior management explicitly designed the program to support—not compete with—departmental procedures, thus making it easy for the CEO to support the concept and promote it to department heads.
  • Find right community liaisons: To be effective, community liaisons must have a passion for improving the well-being of all community members; the political sensitivity necessary to serve as the organization’s representative to these disparate community members; and the flexibility to respond to a variety of personal, organizational, and administrative demands. Lutheran faced a significant challenge in finding individuals with the right blend of skills, knowledge, and interpersonal skills to work effectively across departments and service providers while simultaneously serving the needs of individual patients, families, and the community at large.

Sustaining This Innovation

  • Regularly promote program: Send out frequent reminders about the liaison program to department heads and staff, especially during the first year of operation. On an ongoing basis, share information about the program's activities and accomplishments.
  • Advise department heads to inform liaisons about pertinent issues: Department heads need to keep liaisons apprised of any difficulties they encounter when caring for a patient from a particular community. When possible, leaders should invite liaisons to staff meetings at which they address such patient issues. Department staff should also be reminded that the community liaison serves as the "face" of the organization, and hence will often be contacted when problems occur.
  • Maintain positive community presence: Community liaisons need to balance the role and position of the health care system with the needs of the patient and the community. To maintain a positive community presence, they must establish clear expectations as to what they can and cannot do. For example, they might be able to facilitate "VIP" treatment for an important community member but not provide funding for an event sponsored by a community service provider (due to a lack of resources). When asked by community leaders to address community concerns, liaisons need to listen but may not necessarily be able to provide a solution. Above all, the community liaison must maintain a neutral position and clearly communicate the organization's goal of providing the best possible services in a culturally competent manner.

More Information

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Contact the Innovator

Ms. Virginia Tong
Vice President for Cultural Competence
Lutheran Healthcare
5800 Third Avenue
Brooklyn, NY 11220
Phone: (718) 630-7236
Fax: (718) 210-1087
E-mail: vtong@lmcmc.com

Innovator Disclosures

Ms. Tong has not indicated whether she has financial interests or business/professional affiliations relevant to the work described in this profile.

References/Related Articles

For more information on cultural competence, visit the Office of Minority Health Web site available at: http://minorityhealth.hhs.gov.

Training tools for physicians and other professionals can be found at: http://www.minorityhealth.hhs.gov/templates/browse.aspx?lvl=2&lvlID=12.

The national standards for Culturally and Linguistically Appropriate Services in Health Care are available at: http://www.minorityhealth.hhs.gov/templates/content.aspx?ID=87

Footnotes

Comment on this Innovation

Disclaimer: The inclusion of an innovation in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality, or Westat of the innovation or of the submitter or developer of the innovation. Read more.

Original publication: August 03, 2011.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: April 09, 2014.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: July 16, 2013.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.

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