Patient Engagement: How Hospitals Use Diversity For New Reimbursement Rules

By Debby Scheinholtz

With new rules that went into effect Oct. 1 as part of the Affordable Care Act, hospitals now have financial incentives for improving quality of care and patient satisfaction while keeping readmission rates low. Engaging patients is essential to improving these metrics.

How are hospitals utilizing their diversity resources to boost patient engagement Here are some best practices.

Cross-Cultural Communication

Mayo Clinic has a cross-cultural communication program that is required of new physicians. Physicians complete a four-hour training that includes participating in scenarios in the Mayo Clinic Multidisciplinary Simulation Center, where actors portray patients from different cultures in common clinical situations. Dr. Onelis Quirindongo-Cedeno, the physician champion for the training, says the program is “an opportunity for physicians to discuss what is culturally competent care, what is cultural humility, and explore their own biases and assumptions.” The program includes instruction on how to work with medical interpreters, and how to elicit health and healing beliefs from patients.

  • One goal is to get physicians to understand the broad aspects of cultural differences, says Dr. Quirindongo-Cedeno. “Sometimes you think about cultural competency or cross-cultural care when someone looks different from you, but we want to teach [physicians] about the overall aspects of culture that involve religion, sexual orientation and disability.”
  • One simulation might involve a Latino patient who is diabetic and wants to use some complementary therapy, such as tea or herbs, to try to control the diabetes rather than take the prescribed medication. The physician will go into this simulated situation, interact with the patient actor and then receive feedback from a group of physician observers.

Results: The latest data show that 90 days after completing the program, at least 85 percent of physicians say that participation has improved the quality of patient care they deliver.

Health Literacy

New York’s North ShoreLong Island Jewish Health System, a group of 16 hospitals, includes several locations in Queens, one of the most ethnically diverse regions in the world, with a population representing more than 100 nationalities and speaking more than 170 languages. Dr. Jennifer Mieres, Senior Vice President, Office of Community and Public Health and North Shore-LIJ’s Chief Diversity Officer, heads the Office of Diversity, Inclusion and Health Literacy, which has implemented several web-based programsto increase understanding of various cultures and also to educate employees about health literacy.

  • A web-based health-literacy course is available to all employees for continuing-education credit and has been used by more than 2,700 people to date. “It’s case-based, and it focuses on the importance of communication and health literacy in getting patients to be a 50/50 partner in their health,” explains Dr. Mieres. Tactics include using plain language rather than medical jargon; using the “teach-back” method to encourage patients to explain back what the medical professional has just explained to them; and the implications of nonverbal communication such as facial expression, gestures, contact/touching and personal space.

Results: At all system hospitals that measured HCAHPS scores on the question “During this hospital stay, how often did nurses explained things in a way that you could understand,” scores rose from 68.6 percent to 73.1 percent in less than one year.

Patient-Centered Care

Cleveland Clinic was one of the first academic medical centers to establish an Office of Patient Experience, and it was the first to appoint a Chief Experience Officer, Dr. James Merlino. He says the hospital has invested heavily in “activities that align our workforce around our patients.” Last year, Cleveland Clinic put all 43,000 of its employees through half-day training.

  • Each session included people from different backgrounds, departments and locations.”We had conversations around what our mission, vision and values are; what it means to put patients first; how everyone in the organization contributes to that. We talked about expected service behaviors: how we want to treat each otherwith respectand we want to make sure that we’re treating patients appropriately,” says Dr. Merlino.
  • It took a year to put the entire employee population through the program, which cost $11 million.

Results: Since the training was implemented, patient complaints have significantly declined and caregiver engagement has significantly climbed. In 2012, Dr. Merlino says, caregiver engagement was in the 57th percentile, “which is the highest ever. We have been steadily increasing since 2008.

Simplifying Patient Communications

Cleveland Clinic recently redesigned its discharge packet. Every patient gets a patient-friendly discharge summary without medical jargon. A nurse sits down with each patient and goes through the discharge summary and a checklist of followup care, says Dr. Merlino.

  • Staff members also call patients after discharge to check in on them. “It’s been great for patients because there’s this gapthey get great care, they don’t quite understand what they’re supposed to be doing when they get home, they get very nervous, and things slip through the cracks,” Merlino says. “But really taking time, stopping, going over everythingit’s had a great impact.” He adds that Cleveland Clinic’s Patient Relations department is brought in when a patient might be reluctant to follow a care plan due to cultural beliefs. “You can’t just assume one size fits all,” he says. “You have to be sensitive to those disparities.”

Results: For its HCAHPS patient-satisfaction score on the discharge process, Cleveland Clinic is now in the 95th percentile nationally.

Resource Groups

Mayo Clinic’s 18 resource groups, known as MERGs (Mayo Employee Resource Groups), are called upon to improve cultural competency and impact patient engagement, says Dr. Sharonne Hayes, Director, Diversity and Inclusion.

  • A group of representatives from MERGs at Mayo’s Rochester, Minn., location have been brought together as Mayo initiates its Destination Medical Community initiative, a joint effort between Mayo and the city of Rochester to welcome patients and their families who are traveling to use Mayo’s services. The MERG members “will make not only Mayo but also Rochester a better community for those patients who come in, and will help us better meet the needs of our diverse patients,” says Dr. Hayes.
  • Mayo also has a transcultural patient-family advisory council (PFAC), “One World,” which wascreated to give a voice to those who might not be heard in other circumstances, often because of language and cultural barriers. While PFACs are a commonly used practice, says Dr. Hayes, Mayo did not have diversity of patient representation across all subspecialties.

Results: Efforts like these likely contribute to Mayo Clinic’s high HCAHPS score for “Willingness to Recommend.” This measure averaged 70 percent nationally; the score across Mayo Clinic’s four main hospitals (two in Minnesota, one each in Arizona and Florida) averaged more than 85 percent.

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