Good morning, my name is Caroline Jacobs and I am the Senior Vice President for Safety and Human Development at the New York City Health and Hospitals Corporation (HHC). I am pleased to have the opportunity to provide testimony on HHC’s programs and initiatives to provide culturally competent healthcare.
Each year, HHC provides care for approximately 1.3 million very diverse New Yorkers. While such diversity presents challenges to delivering care, HHC has made – and continues to make – investments in training and services and is an industry leader in providing culturally competent and linguistically appropriate services. We are committed to providing care to all of our patients that is safe, responsive, understandable and effective.
The provision of culturally competent care is required by current laws, regulations and accreditation agencies’ standards. At HHC, we ascribe to the belief that the provision of culturally competent care:
HHC’s efforts to provide culturally competent health and behavioral health services are guided by:
Culturally Competent Workforce
The underpinning of HHC’s organizational commitment must be an awareness of the needs of our patients and implementation of evidence-based interventions that effectively address identified needs. As you can imagine, this is an ongoing, dynamic process that requires periodic assessment of the cultural competency of our workforce, ongoing evaluation of the effectiveness of our diversity training programs, and formal and informal linkages with the communities that our facilities serve. As part of our ongoing efforts, I am happy to announce this morning that we will roll out a new cultural competency staff orientation curriculum in the middle of next year.
Even as we develop the new curriculum, every HHC employee currently receives cultural diversity training to improve his/her assessment, diagnostic, treatment and care management skills in order to more effectively work with patients from different cultures. Beyond the initial training that a new employee receives, ongoing training is periodically conducted by HHC’s facilities that include workshops for staff, Grand Rounds on cultural diversity for clinicians, and continuing education classes on cultural competency.
One example of our ongoing investment is the inclusion of a mandatory component to our staff training curriculum regarding awareness of the health needs of lesbian, gay, bisexual and transgender individuals to help to reduce health disparities related to sexual orientation and gender identification. HHC was the first public healthcare system in the nation to mandate this training.
Some HHC facilities have instituted additional training to focus on the LGBT community. For example, medical residents and other students at Coney Island Hospital receive training focused on the unique needs and concerns of LGBT adolescents. The objectives of their training include finding risk factors faced by LGBT youth, discussing how homophobia contributes to LGBT youth’s health outcomes, and identifying elements of competent LGBT healthcare delivery.
Our efforts to provide culturally competent care are not limited to training staff. They extend to the implementation of unique programs tailored to meet the needs of individual communities. Some examples of these initiatives include:
The 1.3 million patients who receive health care at HHC facilities belong to many different ethnic groups, speak a myriad of languages and come from the different cultures that comprise New York City. We recognize that being able to speak a patient’s language is very important in the care delivery process and later in this testimony I will discuss our language assistance services. But speaking someone’s language is just one aspect of cultural competence. Consider that of HHC’s patients: 43% are Hispanic, 35% are Black, 8% are Asian, 6% are White and the balance are from other racial backgrounds. The ethnic groups represented include African-Americans, West Indians (of French, Dutch or English cultural backgrounds), Hispanics from Puerto Rico, Central and South America and parts of the Caribbean, Asians (including India, Pakistan, China and Korea), Africans, and people from the Middle East and Europe.
In 2007, in order to assist HHC’s facilities with challenges inherent in meeting the LEP patient population’s language access needs, HHC created the Center for Culturally and Linguistically Appropriate Services (CLAS). The role of CLAS is to oversee the implementation of the HHC Language Access Plan by providing centralized support and resources for the provision of culturally and linguistically appropriate services throughout all HHC facilities. Some of the work that the CLAS office performs includes:
Language Access Services
A Limited English Proficient (LEP) individual is a person who does not speak English as his/her primary language and who has limited ability to read, write or understand English at a level that permits the person to interact effectively with health care providers and social service agencies. Addressing this barrier is directly related to HHC’s goals of providing quality health care and ensuring patient safety. According to an analysis of U.S. Census Bureau data, slightly more than one-half of the adult population in communities served by HHC speaks a language other than English at home and 25% of HHC’s patients are Limited English Proficient. On average, HHC provides interpreter services in more than 160 languages per year. In Fiscal Year (FY) 2011, HHC’s facilities provided more than 600,000 language interpretation requests in more than 160 languages at an estimated cost of more than $5 million. Between FY 09 and FY 11, these figures grow to more than 1.5 million language interpretation requests at an estimated cost of more than $10.4 million, The most prevalent languages other than English include: Albanian, Arabic, Bengali, Chinese (both Mandarin and Cantonese), French, Haitian Creole, Hindi, Korean, Polish, Russian, Spanish, and Urdu. Of these languages, Spanish is the most prevalent accounting for 67% of interpretation requests. HHC’s corporate wide initiatives to address persons who are LEP include:
Installation of appropriate signage in multiple languages within HHC facilities has been a priority. The signage informs HHC’s patients that interpreter services are available, free of charge, and guides them to the appropriate locations within each facility.
Expanding interpreter capacity is an ongoing process for all health care facilities and it is particularly challenging given the demographic changes that occur and the resources required. In collaboration with the City University of New York and several other organizations, HHC worked to establish the CUNY Healthcare Interpreter Program 4 years ago. This program builds workforce capacity by training bilingual and multilingual CUNY students and HHC staff to serve as qualified healthcare interpreters to help limited English speakers. Just this past week, a graduation ceremony was held at Lincoln Medical and Mental Health Center for the third year of graduates from this program. Fifty-four (54) students who speak Spanish, Polish and/or French successfully completed a 45 hour program that focuses on interpreting clinical information, recognizing and dealing with ethical issues and cultural conflicts, and understanding clinicians’ roles and expectations. Students also learn medical vocabulary and use role-playing exercises to master interpreting skills that emphasize accuracy, which is essential for patient safety.
Interpreter services include both in-person (also called face-to-face or proximal) interpreters and the use of telephonic interpreter services. The in-person interpreters are both HHC staff who have been trained and tested to qualify as medical interpreters and professional qualified agency interpreters. Those agencies are selected during our bid process with very strict quality criteria to ensure best service to our diverse patient population. Telephonic services are used for languages not covered by in-person interpreters, or if the patient is uncomfortable with having a third person in the examination room. These services are available on a 24 hour basis. All HHC facilities have an interpreter hotline that will allow staff to dial in seamlessly and efficiently (from any phone in the facility), to access both telephonic and face-to-face interpreter services.
Another component of HHC’s LEP efforts is the translation of written materials, such as informed consent forms and patient instruction and education materials, into the languages most spoken by our patients. In 2003, HHC launched a CLAS intranet website for staff on which all key documents, patient instructions and education material, and links to additional patient care information in multiple languages are available for staff to download.
New York City’s public healthcare system strives to provide high quality health care services in a linguistic and culturally appropriate manner to a diverse patient population. I thank you for the opportunity to provide testimony. I am happy to answer any questions that you may have.