Cultural Competence in the Health Care System in Jerusalem Report on 2011 Activity March 2012
Summary of 2011 Impact: Leading National Processes Publication of a Directive for Cultural Competency by the Ministry of Health in February 2011 and follow-up toward implementation. This directive, for the first time, delineates national principles and standards for cultural accessibility in health care organizations and institutions. Throughout 2011 we worked with the Ministry of Health to further clarify roles and personnel required to implement this new directive, as well as held 2 training workshops for 25 cultural competency managers from throughout the country, to help them present action plans to the Ministry of Health. 9 workshops and lectures were given to 200 people from Sha'are Zedek, Maccabi, Hebrew University Medical School and others. Continued development of training and resource materials the guide to Cultural Competency and the Film Kit. Bikur Holim Hospital For the first time, the medical translation course for 33 staff members included translation into Yiddish. This course was covered in the English-language press (attached). 3 basic training workshops for 80 staff members. There were about 30 formal requests for translation per month, on top of the countless other informal translations that were performed on an ongoing basis. Jerusalem Center for Mental Health Breakthrough planning work with Jerusalem Center for Mental Health, which is responsible for all public mental health care services for the Jerusalem region. In 2011 planning began for multi-level activities that will begin in 2012. Hadassah Mount Scopus Medical translation unofficially spread throughout the hospital, and in Ein Kerem a telephone translating service is in pilot stages. 6 basic cultural competency workshops for 115 medical staff. The Patients' Information booklet and other forms were translated into Arabic. 60 70 people requested the translation service each month about 800 850 people throughout the year, most of them Arabic translation. Because some 28,000 people are admitted to Hadassah Mount Scopus each year, with about half of them Arab, these services can affect some 14,000 people. Alyn 25 new staff members underwent basic cultural competency. Work was continued in adapting the physical facility, including signage and forms. Alyn admits more than 3,300 patients (including day and long-term) each year, who are helped by more culturally sensitive staff. Clalit Basic training courses to staff at the Neve Ya'akov clinic. Follow-up session for 25 senior staff members at primary care clinics in the Jerusalem region. Tens of thousands of patients of the 5 primary care clinics throughout Jerusalem benefitted. 2
Detailed 2011 Impact: Imagine seeking medical or psychological / psychiatric care, only to find that you are a stranger in a strange land, a place where you don't speak the language. You don't understand the therapists, doctors or nurses and they don't understand you. This is neither a theoretical problem nor a transient one. Since 2008 the Jerusalem Foundation has been developing this project together with the Jerusalem Intercultural Center (JICC). Cultural competency programs are designed to ensure that language and communication in a health care setting is understood by both patients and caregivers. Using a multi-pronged approach, activities in this project included: Consultation, planning and development on a national and institutional basis. Medical Translation and Interpretation, a 40 hour basic medical translation and interpretation courses, usually for current staff and / or volunteers; Follow-up meetings included more advanced phraseology; and translation of materials and forms. Cultural Sensitivity Training for Medical Staff, a half-day or full-day workshop that introduces basic concepts of cultural competency; introductory workshops; and followup consultation sessions. Following are details of 2011 activities. 1) Leading National Processes The publication of the directive on Cultural Competency by the Ministry of Health in February 2011 delineated principles and standards for cultural accessibility in health care organizations and institutions on a national level, and required compliance within 2 years. This will include translation services, education and training of medical staffs, environmental adaptations of the institutions, and more. While this was a groundbreaking document in the recognition of the importance of cultural competency in health care, it also raised many issues how were large hospitals and health care organizations to implement and assimilate cultural competency, without additional resources from the Ministry of Health? Throughout the year, the JICC continued to consult the Ministry of Health on the appointment and role of the cultural competency manager, which resulted in a definitive description, published on June 23. In parallel, the JICC held 2 workshops for 25 cultural competency managers, from all over the country, to help them - individually and as a group - design action plans to be submitted to the Ministry of Health. The workshop helped to position the JICC as a central source of knowledge on cultural competency, and, in light of the workshop, ongoing working relationships were formed with Rambam Hospital in Haifa, Western Galilee Hospital in Nahariya, Meuchedet HMO, and other health care institutions.
2) Bikur Holim Hospital Bikur Holim is located in the city center, near the ultra-orthodox neighborhoods of Geula and Mea Shearim. It is the smallest of Jerusalem's major hospitals, but because of its location in central Jerusalem, serves a critical role in the health care system. Over the past few years the hospital has struggled financially, but continues to operate. Activities in 2011 included: A Medical Translation course for 33 hospital staff members, most of them nurses, in June 2011. Despite the cloud of financial uncertainty, participants were both excited and very cooperative, and demand for the course was high. This course was the first time in Israel in which phrasing classes were given in Yiddish, in addition to Arabic, Russian and Amharic, based on a mapping of the hospital's present and most pressing needs. Almost all of the course participants took part in a follow-up meeting in October 2011. It is estimated that there have been some 30 formal requests for the translation service per month, or 150 requests from August December 2011, since the program was instituted. This is in addition to the informal translation that takes place between patients and doctors and nurses on an ongoing basis. 3 Cultural Sensitivity training sessions for a total of 80 staff members. The Cultural Competency coordinator reported that as a result of the training, cultural competency is now a part of the regular discourse in the hospital. In addition, the JICC advised the staff on designing a translator protocol (similar to that of Alyn) and advancing other areas of cultural competency (adaptation of the workplace, for example). Because some 17,000 people are admitted to Bikur Holim each year, these services can affect thousands of people per year. 3) Jerusalem Center for Mental Health The Jerusalem Center for Mental Health includes the Kfar Shaul Mental Health Center, Eitanim Mental Health Facility, and others. These public municipal centers for mental health serve the entire Jerusalem region, including east Jerusalem. It is physically, culturally and linguistically distant from the needs of the population it is intended to serve. Fortunately, the management is aware of these deficiencies and complexities, and, after more than a year of meetings, has begun a process of rectifying them The JICC began meeting with senior staff in 2010, and continued in 2011 to develop a comprehensive plan.. A number of meetings were held with the Administrative Director, who has convened a Steering Committee of senior staff, which has begun to plan a comprehensive, multi-year program of cultural competency / sensitivity. 4
At the end of 2011 it was decided that this process would be kicked off at the senior management staff's annual 2-day retreat in March 2012, which put a special emphasis on cultural competency. The JICC presented 2 introductory workshops for the 60 senior hospital management staff during this retreat, enabling the process to begin in earnest. 4) Hadassah Medical Center - Mount Scopus This was the first of Jerusalem's major hospitals that instituted a pilot translation service at the end of 2010, preceded by a medical translation course. The translation service was in such demand that there were over 100 requests for the service within the first 2 weeks of its opening in December 2010. Activities in 2011 included: Official expansion of the Medical Translation to an additional 7 departments, mainly focusing on translations to and from Arabic. In practice the service is used throughout the hospital. At the end of 2011 a pilot telephone translation service began at the Ein Kerem campus, which will affect the entire hospital. A half-day follow-up conference for translators in September 2011. Translation of the Patients Information booklet, forms from maternity, gynecology, and other departments into Arabic. 6 Cultural Sensitivity workshops for 115 staff in 7 departments. This first-time training at Hadassah involved all senior relevant administrators, including the Hospital Director, Prof. Zvi Stern. There are 60 70 requests for translation per month, bringing the annual total to 800 840, mostly into Arabic. Because some 28,000 people are admitted to Hadassah Mount Scopus each year, with about half of them Arab, these services can affect some 14,000 people. 5) Alyn Rehabilitative Hospital Alyn was the first hospital we began working with several years ago. Today Alyn is a national model of a hospital in the height of the cultural competency process. It is the only hospital in the country in which there is a computerized protocol for ordering translation services. Today it advises other health organizations (such as Bikur Holim Hospital) who are in the beginning of this process. Activities in 2011 included: 5
4 follow-up sessions for staff who had completed the basic Cultural Sensitivity workshop. 25 new staff members underwent an hour-long training workshop during staff orientation on cultural sensitivity. They received additional instruction in the staff handbook that is distributed to new staff. 2 basic training courses to its 25 new staff members Adaptation of Physical Facility included: Full mapping of all the internal and external signs at the hospital to confirm that all the signage is in 3 languages (Hebrew, English, Arabic). Beginning of adapting the entire hospital site to 3 languages. This process should be completed by the end of 2012. Consulting regarding culturally competent care to be given to Russian speaking patients. Alyn admits more than 3,300 patients (including day and long-term) each year, who are helped by more culturally sensitive staff 6) Clalit Medical Organization The JF and the JICC have been working with the Clalit Medical Organization, the largest public health insurance company in Israel, since it began the cultural competency project in 2008. Activities in 2011 included: 2 follow-up meetings for up to 25 senior staff each time at primary care clinics throughout Jerusalem. The region seeks to hold 4 such meetings in 2012. 2-day basic Cultural Sensitivity training course was given in October to the staff of the Neveh Ya'akov Clinic.. Tens of thousands of patients of the 5 primary care clinics throughout Jerusalem benefitted from a more culturally sensitive staff. 6
7) Additional Health Care Organizations During 2011, 13 workshops and consultation meetings were also given at: 2 basic Cultural Sensitivity workshops for 50 nursing students (25 each time) at Shaare Zedek hospital 2 basic Cultural Sensitivity workshops for 50 staff (25 each time) at Sheba / Tel Hashomer (in Tel Aviv) 2 basic Cultural Sensitivity workshops for 50 staff and 4 consultation meetings at Maccabi Health Services 3 lectures to medical students at Hadassah (as part of the Man and Medicine program). 8) Development of Materials and Aides for Cultural Competency Directors A) Guide to Cultural Competency Since the summer of 2011, the JICC staff has developed the Guide to Cultural Competency, which will help Cultural Competency coordinators implement cultural competency measures in his or her specific organization. Because the Ministry of Health directive does not include practical steps of implementation, the guide will address: Why is it worthwhile for an organization to be culturally competent? Language and translation How to train the staff How to adapt the human resources department Today the Guide is in advanced stages (more than 60 pages), and it will be finalized during 2012. B) Film Kit This set of 4 short films (6 minutes each) will enable cultural competency coordinators and the JICC to incorporate the subjects and modules developed over the past few years into standardized resource materials. This will be achieved through the use of materials from Israel and movies from abroad. An example of a success story: An Arab boy from east Jerusalem arrived at Alyn with severe burns and trauma. He was accompanied by family, but none of them spoke Hebrew. As part of his care he needed to meet with an occupational therapist, who was to help him regain his fine and gross motor skills in the hospital's playroom. Only through a skilled translator could the occupational therapist and the boy build a trusting relationship, which helped the boy work through the intense physical and emotional pain toward recovery. Both the family and the therapist agree that this process could not have happened without the translator. 7
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