Culturally Competent Care Across the Continuum:

1. The following resource was submitted with the purpose of distributing to AONE members as part of the AONE Diversity in Health Care Organizations Toolkit Submitted by: Lutheran Medical CenterContact person: Rosanne Raso, RN, MS, CNAA Senior Vice President, Nursing Services Brooklyn, NY

2. Sample ad Culturally Competent Care Across the Continuum: Designing and Implementing Culturally Competent Care for the Chinese Population in Brooklyn, New York Virginia Tong, Vice President for Cultural Competence, Lutheran HealthCare PLANNING • Hospital Data • Collected primary language of patients. • Y2K - new computer system installed and started to capture interpreter preferred and language data. Patient language data now available. • Lutheran HealthCare had few Chinese-speaking staff. Need to increase number of bilingual staff. • 2005 - Conduct language survey of all staff. Implement new employee language screening and include in employee database. Include language skills and competence. • Track increases in bilingual staff utilizing employee database. Staffing • Overview • Lutheran HealthCare, composed of its’ ambulatory arm, The Lutheran Family Health Centers network, and inpatient component, Lutheran Medical Center, designed and implemented plans to provide culturally and linguistically competent services to the immigrant Chinese population that began to grow in the community in the 1990s. • Data collection • 1989 - The Sunset Park Health Council, the community advisory board for the ambulatory care center, notices more Chinese residents on the subway. • 1990 - Funding by the United Hospital Fund (UHF) enables a partnership with the Brooklyn Chinese American Association and Chinatown Health Clinic to conduct a community health needs assessment. • 5,000 surveys are conducted in the Chinese community in Sunset Park. • Survey Results: The majority of the Chinese residents living in Sunset Park, Brooklyn travel to Manhattan Chinatown, almost 1 hour away, to seek medical care. They do not know about health services available in the community nor have they ever heard of any of the hospitals in Brooklyn. They need care delivered in the Chinese language. • Created job descriptions with language required (or preferred). • Union supported changes. • Internal and external recruitment strategies which utilized resources such as: • Chinese Advisory Group, Cultural Access Task Force • Community Organizations: Chinatown Manpower Association, Chinese-American Planning Council • Ethnic newspapers: Ming Pao, Sing Tao, World Journal • Job Fairs - Asian Job Fairs • Diversity Websites - Asian-Jobs.com Sunset Park Demographics 2005 Language Survey • Training Provided • Staff were trained in: • Cultural Competence (full day - mandated) • Chinese Culture, Values and Beliefs • Area specific trainings - Adult/Internal Medicine, Women and Maternal Care, Behavioral Health • Death & Dying customs and practices • Medical Interpreter Training • Census Data • 2000 - 25% of the Sunset Park community is Asian.

3. Culturally Competent Care Across the Continuum: Designing and Implementing Culturally Competent Care for the Chinese Population in Brooklyn, New York Virginia Tong, Vice President for Cultural Competence, Lutheran HealthCare DEVELOPING PRIMARY CARE SERVICES • Site 1: Family Practice FHC • 1990-1994 - In consultation with the Brooklyn Chinese American Association and Chinatown Health Clinic, make an existing site, the Family Practice Family Health Center, appropriate for the Chinese community: • bilingual signage • bilingual reception and medical assistant staff • bilingual social worker • bilingual health education materials • bilingual staff to assist with information and applications for health entitlements • 1995 - Over 40% of Family Practice FHC are Chinese, the site is over-crowded and additional space is needed. • CHP (Child Health Plus) applications & assistance. • The site makes referrals to Family Practice FHC and the Hospital. • Construction and Development: • 99% Bilingual staff including all leadership staff - Site, Medical & Nursing directors • Chinese décor, artwork, signage - Chinese interior designer, waterfall for good fortune • Feng Shui considered in design • Staffing includes social worker and financial counselors • Hours of operation are Sunday through Thursday (many Chinese people work in occupations where they do no work on Sunday) with evening hours one day a week. • Model of Practice - Private practice model, only physicians, no residents, follow patients into the hospital including deliveries and newborn/pediatric visits. • June 2002 - Site opens. • 2005 - Site is open 6 days and evenings per week. Over 30,000 medical and dental visits were provided in CY 2005. • Site 3: Brooklyn-Chinese Family Health Center • 1995-2000 - Identify space in the heart of the community that is affordable and large enough to develop a primary care space for the Chinese community. • 1997 - Space on a side street, in a new building was identified. However, no funds for construction or rent are available. • 2000 - Acquired funding from NYC Primary Care Initiative, NYS Dept. of Health, & NYC Primary Care Development Corporation for construction and operations. Sign lease for 4,000 square feet of space. • Site 2: Health Education and Resource Center • 1995 Develop site to increase financial access for patients, in the heart of the community, that is a one stop shop for: • WIC (Women, Infants, Children) applications and services. • PCAP (Prenatal Care Assistance Program) applications and assistance.

4. Culturally Competent Care Across the Continuum: Designing and Implementing Culturally Competent Care for the Chinese Population in Brooklyn, New York Virginia Tong, Vice President for Cultural Competence, Lutheran HealthCare DEVELOPING INPATIENT SERVICES – THE CHINESE UNIT • Changes at the hospital • 1990-2000 To provide access to the patients: • Developed multilingual signage • Hired bilingual patient relations representatives for both the outpatient and hospital departments • Recruited bilingual volunteers (funded by the United Hospital Fund) • Develop multilingual telephone coverage • Developing the business case for the Chinese unit • The Chinese population represents 25% of the Sunset Park community and 3% of hospital patients. Potential market. • Chinese-speaking attendings complained that their patients have difficulty with language access in the hospital particularly in the evenings, nights and weekends. • Competition - Two other local hospitals in the community are marketing to the Chinese community. • Developing the Chinese Unit • 2004 decision by the CEO/president to develop the unit. • 6 beds in the medical/surgical unit converted. • Physicians and community organizations raise $10K to provide artwork and decorations. • Changed room numbers from 4400’s to 4800’s as 4’s are “bad luck”. • Prepared to cook Chinese meals including accommodations for gas heat and wok. • Chinese Unit Staffing • Used existing positions.No new positions created, no staff terminated. Bilingual Chinese-speaking staff cover 24/7 including: • Nurses, Nurse Aides • Housekeeping and Food Service Workers • Security Guards • Social Worker • With union support: • Chinese chef to make Chinese meals and congee • Transferred a few non-Chinese speaking staff off the unit to have vacancies on unit • Recruited Chinese-speaking home care workers and created training program to train them to be certified nursing assistants • Hired 7 of the 9 students (2 hired by our nursing home) who completed the training

5. Culturally Competent Care Across the Continuum: Designing and Implementing Culturally Competent Care for the Chinese Population in Brooklyn, New York Virginia Tong, Vice President for Cultural Competence, Lutheran HealthCare CHALLENGES • Budget • No additional funds. • Used grant funds: • United Hospital Fund • NYC PCDC (Primary Care Development Corp) • NYSDOH - Community Health Care Conversion Demonstration Project • NYSDOH - Primary Care Initiative • Fund raising from physicians and community organizations. • Union (1199) supported programs - Certified nurses aide project. • Training Challenges • Dilemma as to whether training should be Mandatory vs. Voluntary. • Funds for training ended 9/30/06. • Releasing workers for training. • Certification of language competence skills. • Results • Increase of Chinese patients from 3% to 10% and increased patient satisfaction • “Chinese unit” replicated by 2 hospitals in Manhattan, New York • Expansion of “unit” from 6 to 24 beds • Increase in the number of Chinese patients in Lutheran HealthCare – In both Lutheran Family Health Centers netwrok, the ambulatory component of Lutheran HealthCare, and Lutheran Medical Center, the inpatient component. Human Resource Challenges • Supervisors were resistant to change. • Supervisors were unhappy with the length of time to fill positions with bilingual requirements. • Conflicts between job requirements vs. language requirements. • Frustration with the lack of available pool of bilingual technicians and professionals. Comments & Questions:Should you have any questions or comments, please contact: Virginia S. Tong, Vice President, Cultural Competence, 718-630-7236, VTong@lmcmc.com