Developing an Action Plan for a Linguistically Competent

Organization: Lessons from the Field

Presented by:

Virginia S. Tong, LMSWVice President, Cultural CompetenceNYS Conference on Increasing Language Access to Healthcare: Toward Effective State and National PoliciesUniversity at AlbanyApril 25, 2007

Established in 1886

Located in Sunset Park, Brooklyn

System includes:476 bed teaching hospital and Level 1 Trauma Center

Ambulatory care system (600,000 visits)

Nursing home

3 senior housing developments

Managed care company (Health Plus)

Community services division (ESL, GED, daycare, meals on wheels, …)

LutheranHealthCare

Lutheran HealthCare’s Mission and Vision Statement

Lutheran HealthCare has no reason for being of its own; it exists only to serve the needs of its neighbors …

Lutheran HealthCare understands a hospital is not a collection of buildings, machines and beds, but a staff of talented, creative and committed people who serve

the community as they are needed...

Lutheran HealthCare works in partnership with its neighbors, each relying on the other as friends who

care about and assist each other…

(Adopted by the Lutheran Medical Center Board of Trustees, October 24, 1990 and reaffirmed annually since.)

Neighborhood Profile

Located in Sunset Park, Brooklyn, along the waterfront 1880’s: LMC est. in 1880’s – Norwegian immigrants 1960’s: Predominantly Scandinavian and Puerto

Rican residents 1980’s: Chinese immigrants 1990’s: Arabic, Russian, Dominican and Mexican

immigrants, expansion to include Caribbean population

Annual documented need for 40+ languages and dialects Institution-wide average number of annual patient visits

that require an interpreter close to 200,000 (excluding part-time clinics)

Our Demographics

LMC Patient Demographics

White32%

Hispanic42%

Asian7%

African American5%

Other Race5%

2 or More Races9%

Sunset Park Demographics

White19%

Hispanic49%

Asian25%

African American3%

Other Race1%

2 or More Races3%

Governance

Community members are members of the Health Council for Lutheran Family Health Center and the Board of Trustees of LHC

VP Cultural Competence reports to CEO

Cultural Access Task Force Composed of senior management of hospital, nursing

home and ambulatory network, interdisciplinary staff, providers, administrators, representatives of major ethnic communities in Southwest Brooklyn

Committees include: Dietary, Language Bank, Education, Telecommunications, HR, Signage, Translation, and Spiritual Care (Holiday committee no longer meets)

Governance

Advisory Groups Provide community and staff input to cultural and

spiritual initiatives Arab Initiatives Committee Latino Advisory Board Chinese Advisory Board LGBT Advisory Board ADA Subcommittee Senior Initiatives Tanenbaum Center Project AdHoc- Chinese Unit Advisory Board, Mosque

Advisory Board, various focus groups (ie Russian)

History of Cultural Competence at Lutheran Healthcare

1990- Asian Initiative w/ Chinatown Health Clinic 1995- Cultural Access Task Force 1996- Partnerships with Russian providers 1997- Open Park Ridge HC (w/ mosque),

Hire Cultural Initiatives Coordinator 1998- Open Caribbean Health Center 2000- Mexican Health Project 2002- Open Chinese Health Center 2004- Korean Initiative 2004- Appoint Vice President for Cultural Competence

Responsible for all matters related to cultural competence and working with all staff on the planning and implementation of cultural competence initiatives in operations and program planning

Accomplishments Multilingual signage (5 languages- FHC, 6

language- LMC); Most major forms translated in 4 languages IT changes- added interpreter, language and

ethnicity fields All staff attended mandatory cultural competence

training in 2004 Nearly 200 staff trained in medical interpreter

training in Spanish, Cantonese, Mandarin, Russian and Arabic- including intermediate Spanish

Celebration of over 30 ethnic and religious holidays

Latino, Chinese, Kosher and Halal menus

Translated Documents and Signage

Accomplishments Foreign and sign language assistance

services managed by Patient Relations and the Cultural Initiatives Coordinator: Language Bank, interpreter telephones, video conferencing, bilingual and bicultural Patient Relations agency and freelance interpreters

Eight representatives and advocate, who speak LHC’s four key languages

Centralized written translation service system -professional resources and in-house reviewers, sometimes community base organizations

Accomplishments

Immigration policies and information distributed to all HR staff

Inclusion of cultural competence measures in annual employee evaluation

Amended job descriptions include a cultural competency statement and bilingual skills needs (required vs. preferred)

Uniform language policy and procedure Numerous cultural trainings and

incorporation of cultural competence into all trainings including: customer service, telephone techniques, conflict resolution, sexual harassment, patient safety etc…

DemographicsLMC Employee Demographics *

Other Race0%

Hispanic27%

Black21%

White34%

Asian or Pac. Island

18%

LMC Patient Demographics

White32%

Hispanic42%

Asian7%

African American5%

Other Race5%

2 or More Races9%

Accomplishments Recruitment of

bilingual/bicultural employees as dual role interpreters through active HR efforts: 58% of approx. 3,500 staff members self identify as bilingual - major employer in the community

Language proficiency screening of job seekers’ language skills in collaboration with HR

Computerized reports of language capabilities of staff members by department

Keys to Success Organization’s Mission and Vision Support from Board and Key Leadership Dedicated staff – VP for Cultural Competence,

Cultural Initiatives Coordinator Dedicated Budget Involvement in Strategic Planning Support from organized labor Collaboration, and communication with critical

departments- Human Resources, Organizational Learning, Pastoral Care, Food Service, Nursing, Medicine, External Affairs, Finance, Social Services, Facilities, IT, etc…

Partnerships with community organizations

Challenges Resistance to change Allegations of racism, reverse discrimina tion Lack of resources- staff, marketing, translation,

training, screening Lack of pool of bilingual professional staff Lack of “best practices” Length of time to fill position Job requirements vs. language requirements Need to develop alternate strategies Issues with dual role interpreters and volunteers

(linguistic competency, confidentiality, union issues)

Lack of interpreter training and screening standards

Thank You!

Should you have any questions or comments, please contact:

Virginia S. Tong Vice President, Cultural Competence

Lutheran HealthCare5121 2nd AvenueBrooklyn, N. Y. 11232718-630-7236 / vtong@lmcmc.com