As the demographic profile of the nation continues to change, especially over the past 40 years, so has the profile of the nation’s patient population. Patients are becoming more geographically diverse, bringing with customs, cultures and languages from around the world. What is significant about the globalization of health care is that only a handful of health care companies own or operate hospitals overseas.
However, day in and day out, hospitals have to continually adjust the delivery of care based on a different form of globalization. As a result of both legal and illegal immigration, migration and birth rates, the patient population that health care providers serve is becoming more global.
Among the many challenges that domestic hospitals face on a daily basis are cultural behaviors and practices that do not have their origins in North America. The culturally diverse populations have very different practices when it comes to birthing, grieving, blood transfusions, folk remedies, grooming, diet and expressing pain and joy, just to name a few examples. Challenges of religious differences, the role of gender in the delivery of care and the process of establishing trust varies around the world. Hospitals address them every day in every community.
All hospital administrators must now analyze these four questions:
- Do our racial and ethnic minority patients have a longer length of stay?
- Do our racial and ethnic minority patients provide lower patient satisfaction scores?
- Do our racial and ethnic minority patients have a greater percentage of re-admissions?
- Do our less English-proficient patients experience more avoidable errors than the general patient population?
- Has our organization experienced more than three Equal Employment Opportunity complaints this year?
Among the most critical issues is the language barrier. In 2000, about 18 percent of the population, or 47 million people, spoke a language other than English at home. Today, 55 million people speak a language other than English at home. A 2007 report issued by the Joint Commission — the regulatory organization that accredits hospitals and health services providers — noted that “a majority of the hospitals surveyed had mechanisms for identifying linguistics needs of patients and written policies on language services.”
A 2006 report entitled “Hospital Language Services for Patients With Limited English Proficiency,” issued by Health Research and Education Trust of the American Hospital Association, found that more than 15 languages are frequently encountered by at least 20 percent of the nation’s hospitals. Further, 63 percent of all hospitals treat Limited English Proficient patients daily or weekly, as reported by the Agency for Healthcare Research and Quality.
Like the private sector, the importance of accurate communication can make the difference between a satisfied and an unsatisfied customer. Unlike the private sector, the lack of accurate communication in health care can result in harm, millions of dollars in unnecessary tests, penalties resulting from re-admissions, disparities in outcomes based on race, ethnicity or gender, and even death. One Spanish speaking patient almost died when she misread her English prescription which said take once a day, which she interpreted as 11 times a day because “once” means 11 in Spanish.
The globalization taking place inside health care is ironically domestic and is being addressed under the broad heading of culturally competent care. In recent years, hospitals have applied greater financial resources and placed greater emphasis on ensuring language differences between providers and patients are being addressed. This commitment to service and quality is worthy of recognition because hospitals are not reimbursed for this expense in most states.
The health care field has come a long way in closing the gap on cultural differences to keep pace with the changing patient demographics and new regulatory requirements. The Institute for Diversity’s “Benchmarking Study of Diversity and Disparities in U.S Hospitals” found from a sample of 924 hospitals, or 16 percent of the total hospital count, that 77 percent of the hospitals are collecting race, ethnicity and language preference data on all admitted patients. Furthermore, 81 percent of hospitals are educating their clinical staff about how unique cultural and linguistic factors affect the care delivery process and medical outcomes (cultural competency).
In fact, many of the conceptual categories that constitute diversity, such as diversity in leadership and in governance, the presence of diversity in the hospital’s strategic plan, the commitment to reducing disparities, supplier diversity and similar features, are now in the forefront of hospital planning. Further, most hospitals are now providing their staff with cultural competency training, which includes awareness, knowledge, skills and action planning to promote culturally competent health care for their patients. A step in the right direction.
