For many of us, even minor medical issues and routine tests are enough to be causes of confusion and concern. Just being in a hospital or doctor’s office setting, having to absorb new and complicated medical terminology, can be a source of anxiety in itself.
Now try imagining that you don’t speak English, and how stressful it would be also to have to deal with a language barrier during a medical situation.
According to U.S. Census data, nearly 17 percent of Harrisonburg’s population is foreign born, and almost 19 percent of the city’s residents are Hispanic—percentages that are both higher than U.S. national averages. As the area’s demographics have changed over the past few decades, the number of non-English-speaking patients at Sentara RMH also has grown. This shift led the hospital’s leadership to prioritize improvements to the organization’s interpretive services and cultural competency, in order to continue providing high-quality, patient-centered care. And today, Sentara RMH is helping patients navigate the healthcare system through the use of interpreters and the implementation of a cultural diversity program.
A Diverse Region
The Harrisonburg area is home to a large Hispanic population from countries like Mexico, El Salvador and Honduras. Many of these families arrived in the 1990s to work in the then-booming Shenandoah Valley poultry business, and to escape high levels of crime in Central America.
“Harrisonburg is a nice community,” says Silvia Garcia-Romero, manager of the hospital’s cultural diversity program. “It’s a great place to raise a family. A lot of the immigrants and refugees here are very family-oriented and prefer smaller communities.”
Nowadays, many immigrants work in the service, construction, restaurant and hotel industries, says Garcia-Romero, whose own family immigrated to the area from Mexico when she was 10 years old. She remembers going to her small Catholic church in Harrisonburg when she was a girl. Today the church is much larger, and full of Spanish-speaking members on Sundays, she says. Various other Spanish-speaking congregations of other denominations have come together over the past couple of decades as well.
Harrisonburg is also home to large numbers of refugees who were forced to leave their countries due to war, natural disaster and persecution. Many were resettled in the area through the Church World Service Harrisonburg Immigration and Refugee Program, which has operated in the area since the late 1980s.
The top three languages spoken by Sentara RMH patients, besides English, are Spanish, Arabic and Russian. The majority of the Arabic speakers are from Iraq. There’s also a large Kurdish population from various Middle Eastern countries. Others in the area hail from places like Pakistan; Eastern European countries such as Ukraine, Bosnia, Croatia and Serbia; and a growing community from Eritrea, which has one of the world’s worst human rights records.
Improving Patient Care
The cultural diversity program at Sentara RMH is a leading-edge effort to serve these varied populations and bridge cultural differences in a way that provides the highest levels of care for all patients. In addition to providing essential interpreter services, the program engages in community outreach, provides scholarships and facilitates hospital staff training.
“It’s unusual for a hospital to have such an extensive focus on cultural diversity,” says Garcia-Romero. “The program makes us a leader in dedicating resources to improve care for our diverse community.”
In many other hospitals, cultural diversity isn’t a separate program, according to Garcia-Romero. Instead, it’s often a part of patient advocacy or guest services departments.
“When it comes to diversity, we strive to lead the way on multiple initiatives,” she adds.
Breaking Down Language Barriers
The greatest need and biggest challenge for the Sentara RMH diversity program is communicating with non-English-speaking populations.
“The population of patients who don’t speak English has been growing in our community,” observes Garcia-Romero. “Speakers of more and more languages are coming into our community.”
A big piece of language services involves getting hospital staff to understand the importance of using Sentara RMH’s interpreter services. While using patient family members might seem like a logical solution, family members aren’t typically suitable interpreters because limited medical vocabulary can increase the potential for errors in communication, according to the Agency for Healthcare Research and Quality. Instead, staff at Sentara RMH make use of trained on-site staff interpreters, phone interpreters and video remote interpreters. Bilingual staff also are trained and tested, so they can serve as interpreters on their units.
“When it comes to medical interpreting, it’s important not to use family or friends, because they tend to omit things, and they are not trained in medical terminology,” notes Sentara RMH staff interpreter Ina Mattson. “They might use the wrong term, and that can lead to misunderstandings. Family members also tend to answer for the patient, which can lead to other problems.”
Born and raised in Chile, Mattson moved to the U.S. to be with her American-born husband. She and other team members answer the phones and go wherever they’re needed in the hospital to provide interpreting services. On a typical day, she might translate for patients getting an MRI or echocardiogram, for a mother having a C-section, or for patients visiting a medical specialist.
“For any procedure during which the patient will be awake and receive instructions, an interpreter is needed,” Mattson says. “We are the bridge, and our job is to communicate and interpret exactly what is being asked and what is being answered. We make sure communication is completely flawless, so there are no misunderstandings.”
Staff interpreters translate for Spanish-speaking patients, while other languages are handled by contractors or via phone and video.
Hospital staff interpreters like Mattson and others on her team also serve as unofficial patient advocates, she says. If they realize a patient doesn’t have insurance, they can request an evaluation for Medicaid services or help patients fill out financial aid forms. Interpreters also educate patients about available community services. If an Emergency Department patient needs to make a follow-up appointment with a provider, Mattson, who recently received Sentara RMH’s Safety Champion Award, will call and make the appointment on the patient’s behalf.
“These types of follow-up appointments help ensure the continuation of care,” she says. “Many times patients won’t schedule an appointment because they don’t speak English and think it’s too difficult. That is one of the most gratifying parts of the job, when you’re able to help them and ease their anxiety.”
Going out into the community helps Garcia-Romero and others build relationships and better understand people’s needs. Sentara RMH staff attend community festivals like the Harrisonburg International Festival, the Harrisonburg-Rockingham African-American Festival and the Harrisonburg Hispanic Festival. “These events help us share what we’re doing with the community, so that they know about the services we offer,” says Garcia-Romero.
Sentara RMH awards the Diversity in Healthcare Scholarship to local students from diverse backgrounds who pursue healthcare careers. One such scholarship recipient, Nawar Altuna, now works as a registered nurse at the hospital. He graduated from medical school in his native Iraq but had to start his professional education over when he came to the U.S. Altuna is now working on his Bachelor of Science in Nursing degree.
The hospital also sponsors Camp RMH, a weeklong program for middle-school students that introduces a diverse group of young people to the many different professions in health care, as well as to the skills, education and salaries associated with those jobs. After a competitive application process, Camp RMH students participate in hands-on activities at the hospital.
“The hope is that by exposing these young people to the healthcare profession, they’ll consider pursuing jobs in the field,” says Garcia-Romero. “We want to grow the healthcare profession, but it’s also important to look at the makeup of our community. Patients want healthcare professionals who speak their language and understand their culture.”
Having a more diverse workforce also helps to create a more culturally competent group of employees, says Garcia-Romero. Something as simple as a nurse from a different background interacting with her work team in an informal way can help educate her co-workers about her culture. This exposure in turn helps her co-workers develop a better understanding of the needs of their culturally diverse patients.
A staff-led Diversity and Cultural Competence Council oversees the diversity program at Sentara RMH, providing guidance and pushing for improvements in patient services. In addition to training staff to use interpreters, the hospital also provides training and workshops on cultural diversity. Sentara RMH also promotes education through celebrations of heritage months, like Asian-Pacific Heritage Month, during which staff members bring in dishes to share featuring ethnic foods. Celebrating different cultures through food encourages dialogue and conversation, Garcia-Romero notes.
Cultural diversity and sensitivity to patients’ needs aren’t just about the non-English-speaking population, either. The program also serves those who are deaf or hard of hearing, those with visual impairments, and nonreaders.
“Cultural diversity is about serving all of our patients,” Garcia-Romero says. “Diversity is about age, abilities and disabilities, hometowns, sexual orientation, and more. Just because someone is local, white and mainstream Protestant doesn’t mean they don’t have unique needs as far as spirituality, how they feel about being touched, diet, decision-making and family. Each one of us has different needs because of our backgrounds and our cultures.”
A Necessary Patient Service
“Cultural diversity services is a vital program for Sentara RMH patients,” says Garcia-Romero, who notes the program assists about 50-60 patients with language needs each day.
Not all of the hospitals in the Sentara system have such a diverse patient population or the need for such an extensive program, she notes, but Sentara RMH has stepped up to meet this community need.
“Our leadership has been very supportive and very open to implementing different things to help,” says Garcia-Romero. “They understand the challenges for patients and their families, and also the communication challenges our staff members face. People here at Sentara RMH appreciate how important the cultural diversity program is to making sure all of our patients receive the best possible care.”