There is probably no place where the old adage "communication is key" means more than in healthcare, where a failure to understand what a patient needs or what a doctor is asking can mean life or death. As southeast Michigan plugs into the global economy and its immigrant populations grow, the need for meaningful communication between physician and patient becomes more and more vital.
At Dearborn's Oakwood hospital, communication has always been mission critical, but recently that mission has been expanded well beyond the norm. In the mid-nineties, the healthcare provider implemented its Trans-Cultural Strategic Task Force, a program that sought to better understand their consumers' healthcare beliefs, practices and wants. Their findings revealed that they had three very large ethnic communities in their backyard --Arabs/Arab-Americans, Latinos and African-Americans—and each had very specific ideas and needs with regard to care. Oakwood had to make some quick changes to its system.
With Dearborn having one of the largest concentrations of Middle Eastern Americans in the country –slightly more than one third the city's population-- it was essential for the hospital to accommodate the community's specific cultural needs, not the least of which was expanding services provided by the hospital’s interfaith chapel (they have a full time Imam), turning beds toward Mecca, and ensuring that meals met particular dietary requirements in order to be considered Hallal. While these are important external shifts for Oakwood to make when it comes to understanding and accommodating the needs of its diverse patient community, for Rose Khalifa, Oakwood's Community Liaison, it’s also about creating an atmosphere of "cultural competency for all of its stakeholders, not just the external consumer." And those stakeholders include medical and support staff, as well as patients, their families and visitors.
A global approach
Oakwood's approach to that cultural buzzword—"diversity"— is pretty unique. For many industries, working with cross-cultural populations is limited to "diversity training," where employees are given routine information about being sensitive to different cultural and racial groups. But at Oakwood, diversity awareness and sensitivity is a constant and evolving process that is summed up in the phrase frequently used by Khalifa, "cultural competency."
Cultural competency is about understanding that "we are all global citizens," Khalifa says. When the Trans-Cultural Strategic Task Force was initiated, staff members were through a nationally certified training program on cultural competence, encouraging them to embrace their approach to diversity rather than looking at Oakwood's foreign-born patient populations as 'others' with extraordinary needs.
It's a shift in perspective that isn't always easy to make.
Staff members who have continual direct contact with patients and their families go through an even deeper training regimen than non-medical staffing order to empower their patients and forge a more meaningful connection with their caregivers.
According to Khalifa, "Cultural competence is not a destination but a journey, and it is necessary to be always evolving, engaged, attentive to and aware of cultural differences and different cultural approaches to health care, so that healthcare providers can communicate well with patients."
For example, most institutions might label a diabetic Arab-American patient who isn't cooperating with a doctor's prescribed dietary restriction as "non-compliant." Oakwood, because of its unique patient population mix, attempts to understand where cultural or religious restrictions might be influencing the situation and adjust their approach. In this case, the prescribed diet is 'translated' into one that is more closely aligned with the patient's ethnic preferences.
Communication is key
According to the last census, roughly 30 per cent of Dearborn's population speaks Arabic as their first language. When it comes to medical issues, "you can't afford to have information lost in translation," says Khalifa, and thus Oakwood handles interpretive needs for patients in two ways. They not only have a fully trained translation services staff fluent in medical terminology and available 24/7, the hospital also utilizes a telephonic interpretation company that provides translations in over 180 languages for call-ins or those situations where demand for interpretive services outstrips their local resources.
Oakwood considers the old model of relying on family members to interpret as unacceptable. There are simply too many variables that could hinder proper diagnoses and care. In time-sensitive emergencies they may allow it, but a trained staff member is brought in as soon as possible for follow up.
Communicative language is not confined to verbal expression for Oakwood either. The hospital stresses the importance of understanding cultural nuances, active listening, body language interpretation and, for the hearing impaired, signing and TTY. Engaging their interpretive services staff in a direct way is a priority because the face-to-face interaction helps to ensure the best possible outcome.
Evolving through outreach
When looking at Dearborn's foreign-born populations, it became glaringly obvious that Oakwood would need to make sure its staff better reflected the community it hoped to serve. An aggressive diverse recruitment program added healthcare professionals from the Arab and Chaldean communities while the hospital rethought some of its outreach programs.
Going out into the community and providing screenings, medical information about healthcare issues and risks specific to the city's various populations became a key strategy to winning the trust of people that might otherwise have reservations about a prominent U.S. hospital. Not surprisingly, the education went both ways. As culturally diverse groups learned more about Oakwood's approach with its patients, Oakwood educated itself about the populations it hoped to serve.
It speaks to the hospital's commitment to its quickly changing community that as Dearborn's demographics shift, so too does Oakwood's approach to patient care. The 55 year-old healthcare provider's Trans-Cultural Strategic Task Force is proof positive that its evolving and expanding cultural competency has lead to the kind of clinical competency many institutions strive for, but few achieve.
Erika-Marie Geiss is a work-at-home 'mompreneur.' She runs Red Pencil Editing Services and is the editor-in-chief and publisher of theWAHMmagazine. This is her first article for Metromode.
Oakwood hospital patient, Angelica Lopez, with her newborn, Ricardo
Elizabeth Santos-Pate, Medical Interpreter, Angelica Lopez, Patient & Deborah Gizicki, Perinatal Educator, Oakwood Hospital & Medical Center.
Oakwood hospital's interfaith chapelRose Khalifa, Oakwood's Community Liaison
Oakwood Pharmacy, located in Oakwood hospital's atrium
Photographs by Marvin Shaouni
Marvin Shaouni is the managing photographer for Metromode & Model D.