A cross-cultural health care approach to improve veteran health services in an academic community hospital

High quality health care provision requires clinicians to align diagnostic and treatment regimens with their patients' (and families') cultural backgrounds and preferences. Military service (for active duty, guard and reserve component personnel as well as the over 20 million veterans) is a significant component of cultural background that can contribute to overall health status, morbidities and use of health care services.

Even though Veteran Administration health services are available throughout the country, community (civilian) hospitals are a primary source of health care for many veterans. Sixty percent of veterans receive health care in the civilian medical system (VA, 2011). Veterans may exhibit service-related symptoms that will go undiagnosed (and untreated) without clinician knowledge of past military experience. Understanding a patient's military background will facilitate the delivery of cross-cultural, patient-centered care. Beyond biomedical conditions, veterans and their families have social needs that clinical encounters or hospitalizations can address.

Lehigh Valley Health Network (Allentown, Pennsylvania) launched a veteran health initiative in 2012 to enhance cross-cultural care for patients (and their families) with current and past military experience. Strategies have included: • Standard screening of all patients to record and track past and current military service, • Clinical education on veteran-specific morbidities and support systems, • Peer support for patients and employees who are veterans, as well as those employees with family members on active duty, and • Special events to increase awareness of and appreciation for military personnel and veterans within our organization and community.

Specific aspects of this initiative have been critical to its success, including: • Leadership endorsement (several c-suite officers are veterans, and their advocacy gave the initiative legitimacy and significance within the complex organizational culture), • Alignment of this approach within the health network's cultural awareness initiative (this linkage framed the veteran health project within an already familiar network program and promoted recognizable cross-cultural skills, a patient-based approach, that were applied to patients with current and past military service), • Engagement of health network employees with military background in the planning and implementation of initiative strategies, and • Collaboration with other regional health care organizations that share the same overall goal of improved veteran health.

Ecological approaches such as this one are critical to the delivery of equitable health care for veterans.