center for diversity and cultural competence

BJH Diversity Ann Rpt 2008-New Size:Layout 1 4/4/08 4:45 PM Page 2 BARNES-JEWISH HOSPITAL center for diversity and cultural competence annual report 2007

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BJH Diversity Ann Rpt 2008-New Size:Layout 1 4/4/08 4:45 PM Page 1 Dedication to diversity is the right thing to do. 1

BJH Diversity Ann Rpt 2008-New Size:Layout 1 4/4/08 4:45 PM Page 2 a vision for 21 st century health care At Barnes-Jewish Hospital, taking exceptional care of people in a diverse community requires us to create an environment of inclusion and respect. We do this because we know it will encourage more people to seek treatment, enhance access, build trust, promote compliance and improve quality of care. The Barnes-Jewish Hospital Center for Diversity and Cultural Competence is leading the charge toward this vision for better, more patientcentered care. Established in 2006 with a gift of $1.56 million from the Barnes-Jewish Hospital Foundation, the Center is dedicated to reducing health disparities and raising cultural awareness in the St.Louis community. The Center s success hinges upon its collaboration with various Barnes-Jewish Hospital departments and affiliated partners within the Washington University Medical Center and beyond. Its goals are to improve health care by: Best Regards, Recruiting and retaining diverse residents, fellows, nurses, pharmacists, technicians and other staff Fostering sensitivity for different worldviews, norms and values in service delivery Eliminating language barriers and cultural assumptions that affect patient safety Engaging patient communities in ways that influence lifestyle changes for better health Supporting research and providing data for programs to reduce health care disparities Our Center has made exciting progress in its first year. We are pleased to share our successes with you in this report. 2 Andy Ziskind, MD President Barnes-Jewish Hospital Brenda Battle Director, Center for Diversity and Cultural Competence Barnes-Jewish Hospital

BJH Diversity Ann Rpt 2008-New Size:Layout 1 4/4/08 4:45 PM Page 3 SUPPORTERS Barnes-Jewish Hospital is grateful for its supporters, whose generous financial backing makes the Center s work possible: Barnes-Jewish Hospital Foundation for its seed funding and support of the Residents and Fellows Diversity Initiative Barnes-Jewish Hospital Plaza Auxiliary Board and Pfizer, Inc., for funding the Xavier College of Pharmacy Educational Outreach Initiative St. Louis Affiliate of the Susan B. Komen Race for the Cure for supporting the Daylight Program Plowsharing Crafts for supplying cultural art to the Center COUNCIL FOR DIVERSITY AND INCLUSION Established in January 2007, the Council for Diversity and Inclusion comprises 25 change agents who have volunteered to oversee the movement of diversity and inclusion throughout Barnes-Jewish Hospital. The Council is charged with setting the Center s vision, providing oversight and ensuring accountability by setting and monitoring success metrics. It also serves as a resource for departments pursuing diversity and inclusion goals. The Council reports diversity and inclusion outcomes to the Barnes-Jewish Hospital Board of Directors and its Committee on Diversity. In 2007, Council members participated in a three-day grassroots training session on inclusion and diversity held by the National Conference for Community and Justice (NCCJ). An expert in promoting institutional change through the principles of inclusion, NCCJ empowers leaders to build their respective institutions into productive, respectful and just communities. CROSS-CULTURAL ADVISORS As the only hospital in the region offering on-staff interpreter services, Barnes-Jewish Hospital responds to the cross-cultural needs of new American populations and limited English proficient patients. An advisory group of interpreters, translators, hospital ethicists and Center leaders was created to track and bulid awareness of current issues to better serve our community. 3

BJH Diversity Ann Rpt 2008-New Size:Layout 1 4/4/08 4:46 PM Page 4 the beginning On Nov. 15, 2006, the Center for Diversity and Cultural Competence opened with an event that celebrated Barnes-Jewish Hospital s rich and diverse heritage. Several community leaders, legislators, affiliated partners and hospital staff attended the celebration. 4

BJH Diversity Ann Rpt 2008-New Size:Layout 1 4/4/08 4:46 PM Page 5 The changing face of health The St. Louis region comprises 2.78 million people in Missouri and Illinois. The Center s vital role The St. Louis region comprises 2.78 million people in Missouri and Illinois. In the City of St.Louis, where Barnes-Jewish Hospital is located: African Americans represent 52% of the population. Almost 22% of all families live below the poverty line. Nearly 35,000 refugees and 56,000 immigrants call it home. St. Louis city is third in the nation for the degree of diversity of refugee new arrivals. 17% of families use a language other than English at home. 12% of public school students are enrolled in an English as a Second Language program.1 The need for the Center is clear given the growing number of groups in our community that are historically tied to certain health disparities: Members of racial and ethnic subgroups encounter more barriers to care, a greater incidence of chronic disease, lower quality of care and higher mortality than Caucasian Americans. Racially and ethnically diverse Americans receive fewer diagnostic tests and treatments for cancer than Caucasians, and have less access to leading edge treatment for HIV. Black children are about three times more likely than Caucasian children to be hospitalized for asthma. Diabetes rates are 30 percent higher among American Indians and Latinos than among Caucasians. Current studies show that creating a workforce and educational environment that is culturally sensitive improves access and quality of care for all patients, which will ultimately improve the overall health of the nation.2 Barnes-Jewish Hospital must be prepared to competently respond to the variety of cultures, languages and backgrounds it will encounter. 1 Source: U.S. Census Bureau 2004 and 2005 American Community Survey 2 Source: Sullivan Commission on Diversity in the Healthcare Workforce, September 2004. 5

BJH Diversity Ann Rpt 2008-New Size:Layout 1 4/4/08 4:46 PM Page 6 programs Residents and Fellows Diversity Initiative The goal of the Residents and Fellows Diversity Initiative is to recruit, retain and increase the number of under-represented minority physicians providing medical services at Barnes-Jewish Hospital. Members help recruit candidates to Barnes-Jewish Hospital residency and fellowship programs, as well as mentor multicultural students attending Washington University School of Medicine. They also participate in community services such as health fairs and provide shadowing experiences for multicultural high school students interested in pursuing medical careers. The program s first year marked an unprecedented rise in the number of Washington University School of Medicine minority graduates who chose to stay at Barnes-Jewish for post-graduate training. During the initiative s second year, 26 out of 55 applicants were selected, and are now training under nine of the 13 Washington University School of Medicine teaching programs. PROGRAM GOALS The Residents and Fellows Diversity Initiative began with only 19 members; now there are 26. Members represent multiple ethnic groups, all interested in the same goal to increase diversity on the medical center campus and to eliminate health disparities for diverse populations of patients. For the first time in the history of Barnes-Jewish Hospital, under-represented minorities comprise 20 percent of its medical resident staff. 6

BJH Diversity Ann Rpt 2008-New Size:Layout 1 4/4/08 4:46 PM Page 7 Arghavan Almony, MD A world of difference Arghavan Almony, MD, a third-year ophthalmology resident, knows all too well the importance of cultural competence in health care. At age 7, she came to the United States with her family as a religious refugee from Iran. As a member of the Baha i faith, as a woman, as a Middle-Easterner in the United States, and as someone in an interracial marriage, I know firsthand the importance of the recognition and appreciation of diversity in all aspects, she says. The Residents and Fellows Diversity Initiative is the kind of program that shows where Barnes-Jewish Hospital s priorities are. medical student at the University of Southern California, she did her rotations at the Los Angeles County Hospital, where most of the patients only spoke Spanish. She recalls a time when a parent brought in her child with an ear infection. It made a world of difference that the physician could speak Spanish, and that the physician understood the parent may not have a refrigerator at home to keep certain liquid antibiotics for the child, she says. Sometimes it s the big issues, but often it s understanding subtle cultural cues that allow for the best care of patients. As a physician, Dr. Almony has seen how racial disparities affect health care decisions. When she was a 7

BJH Diversity Ann Rpt 2008-New Size:Layout 1 4/4/08 4:46 PM Page 8 Barbara Bogomolov, RN A career and a lifelong passion Barbara Bogomolov, RN, began her career at the Jewish Hospital of St. Louis in 1981 as an emergency department and critical care nurse, where she witnessed firsthand the impact of poverty and limited health literacy in St. Louis. Patients in the medicine clinic were bounced from one provider to another and did not receive culturally appropriate care. The experience fueled Bogomolov s vision to revamp the way Jewish Hospital cared for the underserved, a vision in which patients received regular, coordinated care from medical residents. When Barnes and Jewish Hospitals merged in 1996, Bogomolov left the medicine clinic to form Refugee Health and Interpreter Services. The program aims to eliminate language and cultural barriers when providing health care to patients with limited English proficiency, particularly the refugee and immigrant populations in St. Louis. As manager of the interpreter service, Bogomolov provides case consultation in both ambulatory and inpatient settings, coordinates screenings and immunizations to newly-arrived immigrants in the community and serves as the primary clinical educator on refugee health for Barnes-Jewish Hospital, St.Louis Children s Hospital and Washington University School of Medicine. It s a 24-hour commitment that is supported by her husband, Mikhail, a Russian immigrant, as they raise their teenage son and daughter. Mikhail was her pronunciation tutor when she was learning to communicate with her Russian-speaking patients in the late 1980s. The work is intellectually, emotionally and spiritually challenging, she says. But it gives me the opportunity to interact with people who are reminders of the power of the human spirit as they recover from traumatic experiences in their native countries. 8

BJH Diversity Ann Rpt 2008-New Size:Layout 1 4/4/08 4:46 PM Page 9 programs Refugee Health and Interpreter Services St. Louis is one of the largest resettlement communities in the nation with close to 100,000 refugees and immigrants making St. Louis their home. Many refugees require medical care soon after they arrive. Cultural and language barriers can lead to medication errors and delayed treatment, making the need for interpreter services especially important. Barnes- Jewish Hospital s Refugee Health and Interpreter Services improves outcomes for new Americans and patients with limited English proficiency by bridging cultural gaps between patients and the medical staff. In 2007, 33 interpreters participated in 35,302 encounters in 74 languages. The service provided translation of essential written medical information and discharge instructions, as well as four kinds of sign language and translation in Braille grades 2 and 3. These services are available to patients and their families 24 hours a day, 365 days a year. Daylight Project: There is a cultural perception within immigrant communities that a diagnosis of breast cancer means certain death from an unspeakable and shameful disease. The Daylight Project is a multidisciplinary effort that promotes linguistically and culturally appropriate dialogue about breast health and breast cancer that supports healthy choices by women in refugee and immigrant communities. It also seeks to create and sustain systems that reduce the many barriers to education, screening and treatment for refugee and immigrant women with limited English proficiency. The program is grounded in a model of empowerment, equipping newly arrived women to become voices for health, sister advocacy and physical and spiritual healing. The Daylight Project has led to measurable differences in attitude and willingness among new arrivals to seek and accept screening and diagnostic services. 9

BJH Diversity Ann Rpt 2008-New Size:Layout 1 4/4/08 4:46 PM Page 10 programs Xavier College of Pharmacy Educational Outreach Initiative They dreamed of becoming pharmacists and were attending one of the best, most diverse pharmacy programs in the country, in the heart of New Orleans. Then Hurricane Katrina struck. The Xavier College of Pharmacy Educational Outreach Initiative brings 15 to 20 Xavier students per year to St. Louis for clinical training at Barnes-Jewish Hospital and local pharmacies, offering doctoral students a place to learn as rebuilding continues for the hospitals, clinics and retail pharmacies surrounding Xavier. A historical black college with an outstanding college of pharmacy, Xavier is a leader in recruiting underrepresented minorities into its pharmacy program. U.S. News & World Report ranked the college among the top 50 Southern Master s universities in the country in 2007. Xavier alumnus and Barnes-Jewish Hospital outpatient pharmacy manager Steven Player, PharmD, MBA, created the initiative to benefit the future of these promising students, the hospital and the community. We hope this program will lead students to advanced practice positions or to seek residency here, says Player. Ultimately, we want to train a diverse staff to improve health care disparities in this community. In the first year of the program, 10 Xavier College of Pharmacy students completed clinical rotations at Barnes-Jewish Hospital, with one staying in St. Louis to work at Barnes-Jewish after graduation. More than 20 Xavier pharmacy students applied for the original rotation slots a level of interest that did not wane with the second round of applicants. 10

BJH Diversity Ann Rpt 2008-New Size:Layout 1 4/4/08 4:47 PM Page 11 Steven Player, PharmD, MBA Creating opportunities to make a difference When he was a kid, Steven Player thought he wanted to become a doctor until his junior year of high school. That s when he discovered the pharmacy profession during a summer program at Xavier University of Louisiana. Dr. Player eventually pursued his pharmacy degree at Xavier, one of the few historically black colleges and universities in the United States with an outstanding diverse pharmacy program. My training and experiences at Xavier prepared me not only for a career in pharmacy, but also taught me the importance and value of working in a diverse setting and giving back to the next generation, says Player. Dr. Player interned at Barnes-Jewish Hospital for three summers then joined the full-time staff in 1998. He has been instrumental to developing educational and mentoring opportunities for aspiring pharmacists ever since. Under his leadership, Barnes-Jewish Hospital launched a 10-week internship program for pharmacy students to gain experience in a hospital setting. He also collaborates with BJC HealthCare human resources to recruit graduating students to Barnes-Jewish. With the support of the Center for Diversity and Cultural Competence, Dr. Player launched an initiative to offer clinical rotations to Xavier pharmacy students affected by Hurricane Katrina. Currently, he is working with Express Scripts and St. Louis College of Pharmacy to encourage minority high school students to consider careers in pharmacy. Dr. Player loves helping people, especially youth, realize their career aspirations. I love helping them pursue opportunities they never before imagined or thought were available, he says. 11

BJH Diversity Ann Rpt 2008-New Size:Layout 1 4/4/08 4:47 PM Page 12 diversity outreach Ethiopian Medical Book Drive On a recent trip to Addis Ababa, Ethiopia, Rahel Nardos, MD, member of the Residents and Fellows Diversity Initiative, visited Black Lion Hospital, the main medical teaching institution in the country. She witnessed residents and medical students using extremely outdated medical references that also were in short supply. The lack of resources greatly compromised their education, in a country where the number of medical professionals is already dangerously low. After returning to the United States, Dr. Nardos contacted Ato Petros Demilew, head librarian at Addis Ababa Central Medical Library, who expressed a desire to obtain modern reference books. This inspired the Center to collaborate with the Association of Black Biomedical Graduate Students, Washington University Chancellor s Graduate Fellowship and the Office of Diversity Programs on a drive to collect medical books and funds for the library. English as Second Language (ESL) Classes Based on a desire expressed by new American staff and students to have ESL classes easily available, the Center collaborated with the BJC Center for Lifelong Learning to establish ESL classes on the medical center campus. The classes also include orientation to the culture of Missouri health care. Diversity Calendar The Center features a monthly display on a variety of cultural themes in the main lobby of the Barnes- Jewish Hospital South campus to enhance our celebration of diversity. 12

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BJH Diversity Ann Rpt 2008-New Size:Layout 1 4/4/08 4:45 PM Page 1 center for diversity and cultural competence Barnes-Jewish Hospital One Barnes-Jewish Hospital Plaza Mailstop 90-72-427 St. Louis, MO 63110 314.362.8899 phone 314.362.8955 fax www.barnesjewish.org