Culture Care ConneCtion - Stratis Health

StratiS HealtH Culture Care ConneCtion
Community University Health Care Center (CUHCC)
CUHCC is not only a multiservice
community health center for non-English
speaking and multicultural patients—it’s
a multicultural community, where people
are welcomed, educated, and have their
medical and non-medical needs met.
Opened more than 40 years ago, CUHCC
(kook) has a long and broad history as
the go-to place for new and not-so-new
immigrants to Minnesota, populations
of color, and other medically underserved
populations. CUHCC sees more than
11,000 patients annually. More than 75
percent of its patients and 50 percent of its
staff represent multicultural groups, and
33 percent of patients require language
services. Director of Development and
Programs Colleen McDonald explains
that “CUHCC is really different. People
come in for many issues. We have a
huge dental program and a mental
health program that serves 2,400 people
diagnosed with mental health issues.”
CUHCC’s entire front desk staff is
bilingual and provides a welcoming
environment for patients. Patient Services
Director Amy Shellabarger says, “People
are more comfortable speaking their own
language. It’s a better way to connect with
patients and reduce the risk of getting the
wrong demographic information.” Amy
always asks new patients and staff if they
speak other languages. For rare languages
and dialects, such as Karen, the clinic
seeks interpretation services from outside
agencies and phone-to-phone interpreter
services. CUHCC provides the majority
of immigration physicals for Minnesota’s
Karen population.
Colleen says, “At CUHCC we use a team
approach to care. The role of each staff
member—whether interpreter, doctor,
case manager, or nurse practitioner—is
integral to whether the patient has a good
outcome.” Job satisfaction at CUHCC is
high. People who are interested in this
work gravitate to the clinic. “We focus on
professional development, encouraging
and mentoring staff, and passing on our
legacy. That’s what we are all about.”
examples of signage for some of the many language
translations CUHCC provides for its patients
Even with a long history of providing
culturally competent care, CUHCC
showed statistically significant improvement
on Standard 3, the CLAS Assessment
standard that addresses ongoing
staff education. Amy explains, “We now
send regular emails to staff, including
the Stratis Health newsletter, about the
cultural framework our patients come
from so that they can understand how
to address health issues of our patient
community, such as diabetes and obesity.
For example, staff need to know what
their patients eat and what their cultural
practices are in order to encourage food
choices patients will accept.”
The clinic is a teaching facility and
provides an intensive orientation for
incoming medical residents. Medical
residents at the clinic learn that certain
standard practices might not work for
patients, who often do not speak English
and have a different cultural framework
and orientation toward conditions,
treatment and health care in general. For
example, Amy describes how in the exam
room, crossing your legs and showing
the soles of your feet is considered
offensive in Muslim culture. In Hmong
culture, the expression of an outcome
is different—don’t say, “you might
die”—rather, “you may not live.” Residents
are encouraged to talk to the interpreters
and debrief during and after exams: Is
there something culturally that I’m missing
here? Is there a better way to ask that?
Residents are interested in these patients
and are motivated to provide great care.
CUHCC is the perfect environment for
them to practice medicine.
Amy and Colleen couldn’t say enough
about the value of their interpreters and
bilingual staff, and the ongoing daily
education they impart to their colleagues.
Amy says, “The interpreter office is such
a happy place—they create a wonderful
environment for learning. In addition to
their formal obligation as an interpreter,
a lot of informal language education
happens.”
Interpreters are also largely responsible for
following patients across the continuum
of care—acting as care coordinators when
patients go to the hospital. Amy says, “Our
interpreters and bilingual staff know our
patients—their diagnoses, culture, home
life, and economic status. They serve as
our collective memory of our patients.”
The Culture Care Connection initiative
provided a stimulus for CUHCC to
re-energize and act on results of the
assessment tests. Using the Stratis Health
assessment tool, the clinic is moving
forward with work that will involve
additional staff. Colleen says, “Even
though we have a history of working with
multicultural populations, we always
learn something new. We are never done
learning how to implement culturally
competent care.”