Bienvenidos: The Initial Phase of Organizational Transformation to Enhance Cross-cultural Health Care Delivery in a Large Health Network

By James Geiger, Judith Natale Sabino, Eric Gertner, Jarret R. Patton, Llewellyn J. Cornelius and Debbie Salas-Lopez.

Published by The International Journal of Organizational Diversity

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Statistics from the U. S. Census Bureau continue to demonstrate that the racial and ethnic makeup of many communities is diversifying. In order to provide high-quality, equitable, and culturally sensitive healthcare, many hospitals and health care organizations are responding to their changing patient demographics. The following article will demonstrate how Lehigh Valley Health Network (LVHN) in Allentown, Pennsylvania, had a seemingly minor patient encounter that ultimately was responsible for transforming the health network’s method of delivering high-quality and culturally appropriate care for its diverse patient population. This case study highlights “Bienvenidos,” which started from an interaction with a patient, a play center director, and a physician. This interaction ultimately led to an organizational metamorphosis at one of the health network’s hospital sites that spread across the entire network. We present six key factors that led to this kind of organizational change across the network: 1) Transformational Event(s), 2) Leadership Commitment, 3) Creating a Shared Vision, 4) Assessment and Strategic Program Planning, 5) Engaging Champions, 6) Outcome Measurement and Communication. These steps have led to a reduction in no-show rates and an increase in patient satisfaction. Since “Bienvenidos,” many network-wide strategies, such as explicit employee behavioral expectations regarding respectful interactions across cultures; modification of patient race, ethnicity, and language preference data collection; addition of questions about cultural needs on patient satisfaction surveys; mandatory staff education on diversity and cultural awareness; as well as senior management-level incentive goals, have been put into place that have helped LVHN continue to provide high-quality, culturally appropriate care. This commitment to cultural awareness remains strong—with support from a full-time diversity/cultural awareness liaison, a dedicated physician leader, and a 16-member Cultural Awareness Leadership Council. In these and other ways, respect for difference and cultural awareness has become a part of daily operations and interactions, in many ways because of the initial foundation formed by the “Bienvenidos” initiative.

Keywords: Health Care Organization, Organizational Cultural Transformation, Latino, Cross-cultural Health Care, Equitable Health Care, Leadership, Community Health, Language Interpretation and Concordance, Microsystem and Macrosystem Approaches, Education

The International Journal of Organizational Diversity, Volume 12, Issue 4, pp.25-36. Article: Print (Spiral Bound). Article: Electronic (PDF File; 411.238KB).

James Geiger

Senior Vice President of Operations, Administration, Lehigh Valley Health Network, Allentown, PA, USA

James F. Geiger, MPA, FACHE is currently Senior Vice President of Operations for Lehigh Valley Health Network in Allentown, Pennsylvania. Jim’s responsibilities include oversight of the LVH-17th St. Community Practices, Perioperative Services and Orthopedics Service Line, Support Services, Women’s and Children’s Service Line, cultural awareness and diversity, and the Division of Public Safety. In his current position, Jim works closely with the department chairs for medicine, surgery, pediatrics, family medicine, obstetrics and gynecology, dental medicine, emergency medicine, and community health to develop sound business plans and performance improvement initiatives. Additionally, Jim develops and presents program updates and proposals to senior network, board, and community leaders, with particular emphasis on the provision of culturally sensitive services for a richly diverse patient population. Jim is board-certified in healthcare management and is a Fellow as well as past Regent in the American College of Healthcare Executives.

Judith Natale Sabino

Diversity/Cultural Awareness Liaison, Administration, Lehigh Valley Health Network, Allentown, PA, USA

Judith N. Sabino, MPH, CDP is Lehigh Valley Health Network’s diversity/cultural awareness liaison. In this role, she is responsible for facilitating the network’s cross-cultural health care initiatives, which include quality improvement projects related to addressing health disparities, patient race and ethnicity data collection, language assistance services, network-employee and clinician education, and strategies to recruit and retain diverse employees. She serves as co-chair of the health network’s Cultural Awareness Leadership Council. As a public health practitioner, Judy has developed, implemented, and evaluated a wide-range of health improvement projects in such areas as access to care, substance abuse prevention, tobacco control, health status assessment, and pre-hospital emergency care. Her research interests include cross-cultural health care, community health improvement, and access to care. Judy holds a Master’s degree in public health from the Yale University School of Medicine and a Bachelor’s degree in English/Communication from DeSales University.

Dr. Eric Gertner

Associate Chief of External Programs, Division of General Internal Medicine, Department of Medicine, Lehigh Valley Health Network, Allentown, PA, USA

Eric J. Gertner, MD, MPH, FACP is the Associate Chief for External Programs for the Division of General Internal Medicine at Lehigh Valley Health Network in Allentown, Pennsylvania. Currently he serves as co-lead of the health network’s patient-centered medical home initiative. He received his undergraduate degree from Princeton University, and his doctor of medicine from UMDNJ – Robert Wood Johnson Medical School. He completed his residency in internal medicine at the Medical College of Pennsylvania, and a Master’s degree in public health at the Drexel School of Public Health. He was inducted as a Fellow of the American College of Physicians in 2002. Dr. Gertner is the former co-chair of the LVHN Cultural Awareness Leadership Council, where he oversaw the development and implementation of a strategic plan for cultural awareness, including cultural awareness education, disparity reduction, and recruitment and retention of a diverse workforce. Dr. Gertner continues to publish research in reducing disparities in health care and promoting quality medical care for everyone. He and his colleagues were recognized by the American College of Healthcare Executives with the 2011 Edgar C. Hayhow Award given to the Best Article of the Year for their manuscript, “Developing a Culturally Competent Health Network: A Planning Framework and Guide,” published in the May / June 2010 issue of the Journal of Healthcare Management.

Dr. Jarret R. Patton

Medical Staff President-Elect, Pediatrics, Lehigh Valley Health Network, Allentown, PA, USA

Jarret R. Patton, MD, FAAP has been an advocate for children for many years. Currently, he is the Medical Staff President-Elect and has served as the Medical Director of Ambulatory Pediatrics at the Lehigh Valley Health Network. He takes pride in taking care of many of the underserved or uninsured children in Allentown, PA and the surrounding Lehigh Valley. In 2008, Dr. Patton completed the Cultural Competency Leadership Fellowship with the Health Research and Educational Trust in conjunction with the American Hospital Association. Through this fellowship opportunity, Dr. Patton is a part of a team leading change within his institution that will promote better health care for people of all cultures and ethnic backgrounds. He has continued interest in research fields surrounding health disparities and cultural competence. He received his BS from Xavier University of Louisiana (chemistry), MD from Case Western Reserve University, and residency training at New York University/ Bellevue Hospitals. Currently, he is an assistant professor of pediatrics at the Morsani College of Medicine at the University of South Florida. Dr. Patton’s professional memberships include the American Association of Pediatrics, the American Medical Association, and the National Medical Association.

Dr. Llewellyn J. Cornelius

Professor, School of Social Work, University of Maryland, Baltimore, MD, USA

Llewellyn J. Cornelius, PhD, LCSW has more than 17 years of experience in Community-Based Participatory Research and more than 30 years of experience in social justice research as well as survey and evaluation research. He has worked in tandem with researchers, administrators and consumers in the design, implementation and evaluation of interventions that focused on improving the health and well-being of under resources communities. He has trained more than 150 professionals in designing and conducting outcomes research, coached 36 mid-career social workers in leadership development, mentored 26 doctoral students, trained 10 post MD/PhD early career minority researchers as part of the Association of American Medical Colleges Minority Health Services Research Program and taught more than 2,000 MSW programs in the second largest MSW program in the United States. For the last 13 years he taught a doctoral research practicum, where he assisted students in the development, pilot testing and fielding of surveys. In addition to teaching survey research, he has been involved in the design and implementation of a multitude of studies, including the fielding of a statewide survey which examined the cultural competency of mental health providers; the evaluation of community based HIV prevention efforts and the development and implementation of surveys which assessed the use of technology in social work. Dr. Cornelius’ prevention research focuses on developing community-responsive, culturally appropriate educational, attitudinal and behavioral change interventions as well as examining the barriers to the adoption of successful interventions by individuals, practitioners and communities. He received his doctorate from the University of Chicago's School of Social Services Administration and has extensive research experience in examining access to medical delivery and the outcome of care for African Americans and Latinos.

Dr. Debbie Salas-Lopez

Leonard Parker Pool Chair, Department of Medicine, Lehigh Valley Health Network, Allentown, PA, USA

Debbie Salas-Lopez, MD, MPH is the chair of the Department of Medicine at Lehigh Valley Health Network, and a professor of medicine at the University of South Florida's College of Medicine and College of Public Health. She completed medical school and her residency in internal medicine at New Jersey Medical School and obtained her Master’s degree in health policy and administration at the School of Public Health, Rutgers University, and UMDNJ. She has been a visiting scholar at the Harvard Institute of Healthcare Policy and completed fellowships with the National Cancer Institute and the Association of American Medical Colleges Health Services Research Institute. She is a member of the Northeast Consortium on Cultural Competency and Medical Education. She is a standing National Institute of Health (NIH) reviewer and the principal investigator of an NIH-Select Award to establish a Neighborhood Community Cancer Center Program in Lehigh Valley. She leads initiatives in quality improvement, cost containment, and patient–centered medical homes. She has numerous publications and is a nationally recognized speaker and educator in the area of women in leadership, culture, healthcare disparities, and the impact of social and economic factors on access to care.