Healthcare Utilization
Many questions that need to be answered for patients who are first exposed to the public healthcare facility. The Medicare system may have to be explained because the cost of health care is a major barrier to utilization of services. Those who are paying for their treatment because they do not qualify for Medicaid/Medicare rebates need to be fully informed of all costs involved.
CULTURAL COMPETENCY IS ESSENTIAL TO HEALTHCARE UTILIZATION
The St. Elizabeth Family Medicine Practice facility and the St. Elizabeth Medical Center of which it is a part, serves a culturally diverse clientele, including healthcare recipients who have lived all of their lives in the Utica community and those who have just arrived as refugees and immigrants. Like other healthcare facilities in the United States, St. Elizabeth’s patients are members of different races and ethnic groups, but also have other cultural differences including language, gender, socioeconomic status, sexual orientation, mental ability, and religion. As administrators at the Family Practice facility discovered when dealing with the Latino community, for example, the departure of a Spanish-speaking doctor resulted in their Latino clients seeking health services elsewhere.
FIVE ESSENTIAL ELEMENTS FOR ESTABLISHING CULTURAL COMPETENCY
The National Center for Cultural Competence, Georgetown University Child Development Center, lists five essential elements which contribute to an organization’s ability to become more culturally competent. These include the following which are quoted verbatim:
Valuing diversity;
Having the capacity for cultural self-assessment;
Being conscious of the dynamics inherent when cultures interact;
Having institutionalized cultural knowledge; and
Having developed adaptations of service delivery reflecting an understanding of cultural diversity.
"These five elements should be manifested at every level of an organization, including policy making, administration, and practice. Further, these elements should be reflected in the attitudes, structures, policies, and services of the organization." [Cultural Competence: A Journey, U.S. Department of Health & Human Services; Health Resources & Services Administration, p. 6. Web address: www.bphc.hrsa.gov.]
Also see, Cross, T., Bazron, B., Dennis, K., & Isaacs, M., (1989) Towards A Culturally Competent System of Care Volume I. Washington, D.C.: Georgetown University Child Development Center, CASSP Technical Assistance Center.
APPLICATIONS TO HOSPITAL/CLINIC PROCEDURES AT ST. ELIZABETH'S
Cultural competency should pertain to every aspect of a patient’s progress through the healthcare facility including admission/discharge procedures, and utilization of the pharmacy. At St. Elizabeth's, there are hospital procedures that must be followed by all patients, including walk-ins:
After reporting to the front desk, and stating the nature of their illness, they are evaluated. Based on the severity of the illness, they are placed in line to receive medical attention (Triage). Some patients will be seen immediately and admitted; others will be seen briefly and given an appointment to be seen at a later date.
Patients are responsible for their appointments and administration of their medications. However, many communications issues arise with regard to patient's understanding of instructions if he or she is from a different cultural background. This is especially important since, the medical residents in St. Elizabeth's Family Medicine Residency Program also come from several African and Asian countries and do not speak English as their primary language. For general guidelines, please see Language and Communications Styles.
St. Elizabeth Family Medicine Residency Program has established the Refugee Clinic in association with the Mohawk Valley Resources Center for Refugees. The Clinic is operated once a week, on Thursdays. The Center for Refugees provides translators or English classes and healthcare for up to three months for new refugees.
Cultural Diversity
