Copyright © 2014 ACHI – 155 North Wacker Drive, Suite 400, Chicago, IL 60606 | communityhlth@aha.org | 312-422-2193 |www.healthycommunities.org

Webinar Series

Wednesday, June 4, 2014 1 pm CST / 2 pm EST

Healthways is the proud sponsor of the 2014 ACHI Educational Webinar Series

The Blue Zones Project™ is a community well-being improvement initiative designed to make healthy choices easier through permanent changes to environment, policy and social networks. Learn more at bluezonesproject.com

Today’s session awards 1.0 contact hours. To successfully complete

this activity and earn contact hours, participants must attend the entire

session and complete the evaluation.

ACHI does not endorse any commercial

products discussed in conjunction with this

activity.

• Mina Kini, Marjeta Daja and Donna Piket do not have anything to

disclose.

The Association for Community Health Improvement is a designated provider of continuing

education by the National Commission for Health Education Credentialing (MEP3728), the

American College of Health Care Executives and the National Board of Public Health Examiners.

Disclosures

Copyright © 2014 ACHI – 155 North Wacker Drive, Suite 400, Chicago, IL 60606 |

communityhlth@aha.org | 312-422-2193 | www.healthycommunities.org

Presenters

Mina Kini

Senior Director

Multicultural & Community Health

Improvement

Texas Health Resources

Donna Piket

Language Services Specialist

Texas Health Presbyterian Hospital Dallas

Improving the Health of Vulnerable

Populations

Marjeta Daja

Diversity Consultant

Multicultural & Community Health

Improvement

Texas Health Resources

Improving health of vulnerable populations:

The Burmese care coordination

journey at Texas Health Resources

Mina Kini, MS, MSW; Marjeta Daja, MBA, MHA; Donna Piket, MPH

Discussion Focus:

• Texas Health Resources as the system of care

• Mission, Vision & Values

• Our Burmese Community in Dallas

Organizational Context

• Defining Project Objectives and Outcomes

• Project Process

• Coordination of Care for Burmese Patients

Project Description • Lessons Learned

• Next Steps and Advancing the Strategy

Resources & Tools

Today’s Journey – 60 minutes

TEXAS

HEALTH

DALLAS

1

2

Woman’s

Health

Center

Labor &

Delivery

4

Pediatric

Clinic

3

Newborn

Refugee

Service

Organizations

COMMUNITY

Coordinating Care

Geography

Refugee Arrival Data - Burmese

Where in the world is BURMA

Burma is located in

South-East ASIA

USA

The Burmese Population

REFUGEES - Different ethnicities: language, culture, experiences

Kachin Chin Karen Mon Kayah

Genetics Diet and Nutrition

Immigration & Acculturation

Cultural Practices & Behavior

Income & Financial Status

Physical Environment Social Support

& Network

Stress & Mental Health

Education

Food Access

Employment

Personal Behaviors & Coping Skills

Health Navigation & Preventive Care

Sense of Belonging

Health Literacy

Access to Health Services

Determinants that impact Individual and Community Health

The Expressed Need

Started with

Language

Issues

• Accessing a Burmese

interpreter

• Identifying the right

dialect

• Time to explain and

seek understanding

of the care process

Other Related Issues

• CULTURAL Issues

• Access to care and

Understanding the

Western Medicine

model and care

expectations

• Medication Adherence

• Preventive Care

processes

Discussion Focus:

• Texas Health Resources as the system of care

• Mission, Vision & Values

• Our Burmese Community in Dallas

Organizational Context

• Defining Project Objectives and Outcomes

• Project Process

• Coordination of Care for Burmese Patients

Project Description • Lessons Learned

• Next Steps and Advancing the Strategy

Resources & Tools

Today’s Journey – 60 minutes

LEAN Process – Multidisciplinary Team

Project Sponsor : Dale Leach, Mina Kini (THR)

EE Leader: Jazz Patterson, Clint Abernathy

Nursing: Debra DuBois, Erin Smith, Melissa Morton, Shanna Brown

Kendra Henderson, Molly Montgomery, Julie Anderson, Patti

Marks, Chris Brooks, Krisi Ingram, Jean Tan, Rosa Belgard,

Kelli Raibick, Shawna Gonzalez, Myesha Bryant

WHC, ED, L&D, OB/GYN, Post Partum, Nursery/NICU, Pedi Clinic, Education

Operations: Marjeta Daja (THR), Teresa Cannon (ITS), John Engelhard

(Pastoral Care), Nancy Hetherington (Admissions), Ruby

Manuel (Patient Services), Sandra Pinkerton (THRE), Elsa

Phelan (Community Health)

Community Members: Luke Saw, Wilma Montz, Kari Brasselero, Julie

Access to Care Getting Treatment (In

Patient) Discharge & Prevention

Patient Centric Process Design

Problem Identification

Team & Stakeholder Identification

Team Charter & Objectives Definition

Key Focus Areas

Issues

Articulated:

Interpretation

Needs &

Cultural

Issues

Using

Patient/Family

Journey Flow:

– Clinical,

Operations &

Community

Partners

•Using LEAN &

CAP

approaches

•Patient

Throughput

Analysis

• Identified by

Clinical Area

Needs

MULTIDISCIPLINARY WORK -TEAM

Challenges for Clinicians

Basic communication challenges

Informed consent (concept unknown)

Deliver quality care in an appropriate and safe

manner

Educate staff about effective care practices

Resource Considerations: Time, Budget, etc

Patient Arrives at the

WHC or Physicians

Office

Patient Calls

WHC or

Physicians Off.

For an Appt.

Patient Care Given Patient Returns for

F/U

Patient Presents at

L & D Admitting

Patient Registers and is

Directed to Location of

Delivery

Patient Fills Out

Consent Forms and

Gets Initial Teaching

Patient Receives

Care from L & D

Patient(s)

Transported and

Admitted to New

Area

Patient Gets Initial

Teaching Patient Receives

Care

Patient Receives

Care Teaching

Patient Receives

Discharge

Teaching

Patient Arrives at

Emergency Room

Process Map

Patient Arrives at

the WHC or

Physicians Office

Patient Calls

WHC or

Physicians

Off. For an

Appt.

Staff Gives

Literacy Test

Staff Informs Depts of

Patient Status (L& D,

NICU, PP, Gyn, High

Risk, Special Care,

Newborn)

Patient Care

Given

Patient Tour

Scheduled

Patient

Returns for F/U

and goes on

Tour

Staff Uses

Check Sheet to

Document

Understanding

Patient

Presents at L &

D Admitting

Patient Registers

and is Directed to

Location of Delivery

Patient Fills Out

Consent Forms

and Gets Initial

Teaching

Patient

Receives Care

from L & D

Patient(s)

Transported

and Admitted

to New Area

Patient Gets

Initial Teaching

Patient

Receives Care

Patient

Receives Care

Teaching

Patient

Receives

Discharge

Teaching

Staff Uses

Check Sheet to

Document

Understanding

Patient Arrives at

Emergency

Room

Patient Education

Graphics/ Interpretation

No Planned Change

Department Coordinat.

ER Path Only

Project Core Focus Areas

Interpretation

Services

Education

Graphical & Instruction

Tools

Community Outreach

Care

Coordination Team

Coordinating Care:

Process, Tools and Structure

Interpretation Services

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

SPANISH

BURMESE/ KAREN

Top 2 Language Line Groups Minutes

Language

Monitoring

Language

Identification tools

Effective Communication

Language

Assistant @

WHC

Burmese Staff Interpreter, Mona Mon

Cultural Connection

Mona Mon

(pictured in center)

Education: Patient Tours

WHC – L&D – Newborn Nursery – Post Partum – Pedi Clinic - Pharmacy

Care Coordination Tour

Patient Tours: Patient Understanding Check

Sheets – Bilingual Translated Forms

Educational Modules

Clinician Education – Cultural Competence

Cultural Intelligence - For Healthcare Providers to

provide Culturally Competent Care

Patient Education

tools/Materials

Care Tools –Focus on Health Literacy

• Focus on health

literacy and Visual

teaching aids

• Graphic Explanation

& Accuracy of

technical details

• Exploring various

methods of graphical

representation

Patient Education tools/Materials

Care Tools – Family & Self-Care

• Visual teaching aids

• Breast feeding

Education

• Self-care videos

IRC Language Assistance Card

Translation & Interpretation

• Visual display of Burmese Friendly meal options

• Burmese interpreter direct response for food order

Care Coordination through EHR -

Patient

Information

Tool – Patient

History for WHC

Process, Systems and Department Coordination

Audience: Inpatient OB Clinicians Purpose: Visualize documentation of Primary Language and Need for Interpreter as documented in WHC or ED Date: June 2010 Documentation of Primary Language and need for interpreter is documented in the Patient Learning Assessment in the Patient Education Activity WHC and L&D and can be reviewed by all clinicians in the Patient Learning Assessment report in the Patient Summary Activity.

ED and Inpatient documentation of Primary Language and Interpreter needed, can be found in the Professional Exchange Report.

Care Connect

Standardization

Community Outreach

Partnership with

Community

Organizations

resettling refugees

Exploratory

Care Models:

Care Navigation

Partnership for

Action Research

on Social

Organization

Community Engagement .

Discussion Focus:

• Texas Health Resources as the system of care

• Mission, Vision & Values

• Our Burmese Community in Dallas

Organizational Context

• Defining Project Objectives and Outcomes

• Project Process

• Coordination of Care for Burmese Patients

Project Description • Lessons Learned

• Next Steps and Advancing the Strategy

Resources & Tools

Today’s Journey – 30 minutes

Tracking Data 2010-2014 Clinical Outcome

Interpreting Encounters

Cultural & Emerging Needs

May 2010 – 2013: 144 family tours

Care bags for infants and mothers

Bilirubin testing on Saturdays

Staff Interpreter and Over the Phone Interpretation:

2012: 684 patients

2013: 1,163 patients & 18,949 minutes

2014 (Jan-Apr): 330 patients & 6,799 minutes

Accessing appropriate medical services

Utilizing self-care tools and teaching methods

Burmese Staff Interpreter, Mona Mon

Provider Perspective

“She stresses the importance of parents taking responsibility for their child’s health and well

being and learning to navigate the health care system. She holds them accountable to the rules

of the clinic and helps us teach when it is appropriate to go the emergency room or how

important it is to keep specialty appointments. She is an ally, but not a crutch. She is stern with

patients when needed, but very loving and understanding, as well.”

Ashley Eckstein, APRN, CPNP-PC Pediatric Nurse Practitioner

Improve

Health &

Wellbeing

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Q & A

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38

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