Recorded presentation

Edward Martinez, MS, Linda Cummings, PhD, Marsha Regenstein, PhD, and Donna Sickler, MPH. National Public Health and Hospital Institute, 1301 Pennsylvania Avenue, NW, Suite 950, Washington, DC 20004, 202-585-0135, emartinez@naph.org

OBJECTIVE: To identify promising and innovative practices designed to improve the quality of care for cultural and linguistic minorities and address the issue of health disparities at large safety net institutions across the country.

METHODS: A preliminary list of participating institutions was developed from the 100+ membership of the National Association of Public Hospitals and Health Systems. The initial group of participating institutions was geographically dispersed across the country and included hospitals and health systems located primarily in large urban areas with a highly diverse patient base. Over a six-month period in 2002 and 2003, two rounds of structured interviews were conducted by telephone with senior executives at 35 public hospitals and health systems. The initial interview gathered information about programs and activities related to cultural competence in each institution; assessed how organizational values regarding cultural competence were communicated to staff, patients and the community; and collected information about performance management, interpreter services, staff training, and information technology. A second interview was conducted with senior staff in those institutions with significant cultural competence practices. The second interview focused in greater detail on organizational values and leadership, clinical services, and planning and monitoring. In addition, a focus group was conducted with the CEOs of major safety net institutions to examine the elements of an organizational vision around culturally and linguistically appropriate practices. Case studies on selected institutions were developed to illustrate the findings of promising approaches to serving diverse patients and addressing health disparities.

RESULTS: Public hospitals and health systems have undertaken the provision of culturally and linguistically appropriate services because they are a fundamental component of their mission. A range of practices exists in safety net institutions to serve diverse patient populations. Leadership is crucial to sustaining practices that focus on disparities, and many public hospital leaders are committed to providing quality care that is culturally and linguistically proficient. The use of technology to further these practices is highly promising. Timely data is essential to measure institutional performance in providing culturally and linguistically appropriate care and to assess the impact on disparities.

CONCLUSIONS: Initiatives to provide health care in a culturally and linguistically appropriate manner are central to services provided by safety net institutions but they generally result from entrepreneurial activity by executive staff. Initiatives are undertaken usually without supplemental resources, burdening already constrained hospitals and health systems.

Learning Objectives: