In September 2011, Kings County Hospital Center (KCHC) implemented a Care Management Department that developed a culturally competent process designed to improve communication and collaboration with patients and families; resulting in improved outcomes of care and greater patient safety. To understand our patient population, research was conducted on migration histories, health disparities and cultural beliefs of the population served. Cultural competence and compassion proved to be the innovation that spawned understanding of our population and improved collaboration with patients and families. We reduced CHF 30 day re-admissions, decreased Emergency Room visits and hospitalizations for patients with complex or multiple chronic diseases.
Cultural competence is critical for effective communication and will lead to greater patient safety through understanding. Through patient interviews, we learned that 80-90% of our African American patients are from North and South Carolina. This information allowed us to better understand how past experiences may foster mistrust of the health care system, which may contribute to the perception that patients were non-compliant with their care plans. Improving our cultural competence allowed us to address past negative experiences and engage patients more effectively. We identified Caribbean Islands from which our patients migrated and identified language resources needed for effective communication. We developed an innovative approach to educate staff on the “historical baggage” that can affect patient beliefs and trust. For example, the Tuskegee Study and Jim Crow Laws may have impacted some elderly African-American patients. The herbal medicines used in the Caribbean population were given high importance as well as a comprehensive social history that goes beyond “No Toxic Substance.” A patient from South Carolina said, “I don’t trust you doctors.” Rather than involving Psychiatry for paranoid ideation, we should ask, “Why don’t you tell me about your health care experience?” If the patient’s story is horrible, apologize for what happened because of the importance of removing the patient from the past and place them in the “here and now.” KCHC staff is trained to understand that the word “patient” is not the sum total of the complexity of an individual, and there are health and financial costs associated with negative terminology. We eliminated the use of negative language, such as frequent flyers, non-compliant without “why” or drug seekers, as it creates a culture of callous disregard. The Care Management team transformed each patient experience by designing the interventions based on what was learned about the patient with the following questions: Who is the individual? What are their fear factors? What is important to the individual? Where is the individual in the acceptance of the disease? Armed with the answers to these questions, the team works with patients, families, health plans and home care services to improve care coordination and to successfully transition patients back to their homes through the use of the following interventions:
- Some medications were not prescribed by KCHC physician
- Herbal medicine
- Prescription not filled by pharmacy even though dosage was changed
- The intervention was a new process requiring documentation of home medication reconciliation.
According to Consumer Report in 2012, KCHC CHF 30-day readmission for the first time is in compliance with the national norm and has a low projected penalty percentage .26% for readmissions in 2014. In-hospital data- CHF 30-day readmissions for 2011 and 2012 were respectively 23.9% and 21.1% ED data- 7-day revisits for 2011 and 2012 were respectively 10.2% and 7.3%