Salinas Valley Memorial Healthcare System serves a culturally diverse population. This includes the 26% of its patients who view Spanish as their preferred language; in the SVMHS Mobile Clinic, the number of Spanish speakers jumps to more than 55%.
Determined to ensure these Spanish-speaking patients have the best possible experience when they need medical help, in the summer of 2021 Chief Operating Officer Clement Miller, MSN, RN, NEA-BC, and Chief Nursing Officer Lisa Paulo, MSN, MPA, RN, CENP, asked Patient Experience Manager Cynthia Vargas to create a Culturally Sensitive Care Committee. The purpose was to work with Spanish-speaking patients and their families to better understand their SVMHS experience and to use those conversations to build a better patient experience for all.
The effort has already begun yielding results. By creating a set of specific questions and diligently monitoring responses, the team has demonstrated significant improvements in a number of key areas, including communication with nurses, staff responsiveness and communication about medications.
An Enthusiastic Group of Staff Volunteers
Originally, the initiative inspired a groundswell of enthusiasm from SVMHS staff. When Miller put out a call for volunteers, approximately 40 people responded, including physicians, nurses and representatives from units throughout the hospital.
“These staff members all had different experiences,” Vargas says. “Some come from non-English-speaking families and have real insight into the challenges these patients face.”
“It’s important for our patients to be understood and to feel comfortable with their medical decision-making process,” says Mary Dominguez Munoz, RN. “I wanted to be able to bring back the patient’s perspective to the committee.”
The first meeting was in July 2021. Soon thereafter, committee members began asking hospitalized patients about their willingness to speak about their experience. For those who were willing, committee members followed up with a phone call once the patients had settled back in at home. “What patients tell us helps us make care more patient- and family-centered and more culturally sensitive,” Vargas says.
Speaking the Language Is Just Step One
By October, the committee had established four workgroups. One researches educational topics to incorporate more cultural sensitivity into new hire orientation and onboarding.
A second group reviews and researches interpreter services. A third strives to improve the communication competencies of staff to support Spanish-speaking patients. The fourth reviews and researches learning opportunities through Press Ganey’s Equity Partnership program, including ways to measure whether the group is successfully enhancing the experience for its Spanish-speaking patients.
“I kept thinking how scary and uncertain it must be having all these invasive and very personal moments and discussions clouded by a language barrier.”
Stephanie Fierro, BSN, RN, CCRN
Because language is such a critical part of cultural sensitivity, the group initially focused on ways to better use existing interpreter services at SVMHS. The health system has interpreter teleservices and the ability to download the application service to personal devices for use anywhere, at any time. There are dedicated certified interpreters and 103 certified nurses and other interdisciplinary staff to support translation. To leverage these resources, the committee is raising awareness among staff and patients about the availability of interpreter services and how to easily use those services. Key to this effort was collaborating with other department leaders, practice councils and team members to ensure when staff approach patients, the preferred language is noted through visual cues to alert staff that a patient does not speak English.
“We have to first address the language barrier because if staff can’t communicate with patients and families in their preferred language it can make people uncomfortable and lead to misinterpretation,” Vargas says.
Stephanie Fierro, BSN, RN, CCRN, agrees. “I was raised in the Salinas Valley but did not really learn to speak Spanish until a few years ago,” she says. “[But] the more time I spent with patients, the more I wanted to be able to communicate. I kept thinking how scary and uncertain it must be having all these invasive and very personal moments and discussions clouded by a language barrier.”
Fierro worked hard to improve her Spanish and noticed the difference in her patients as she became more proficient with the language. “They have been so appreciative,” she says. “Even when I say things wrong, they are more at ease knowing someone understands them.”
“There is a difference between providing great quality clinical care and providing an exceptional patient experience,” says Dominguez Munoz, noting that effective communication is critical to the latter and the committee’s focus on communication is enabling patients and their families to be heard more effectively in the medical decision-making process.
Language is also important because conversations with patients and families have led to a number of other lessons learned, including the need to include multiple family members in conversations about a patient’s status and the need to provide compassionate, respectful care regardless of mental status.
“As an organization, we [must also] focus on the cultural aspects of care,” Fierro says. “It’s those unspoken aspects of the care we deliver that can often be even more impactful than the language barriers.”
