Kaiser Permanente Women's Health Center of Excellence in Culturally Competent Care

In 2002, Kaiser Permanente (KP) launched its Women's Health Center of Excellence in Culturally Competent Care in the KP Northern California Region's Greater Southern Alameda Area (GSAA) Service Area, which includes the KP Fremont and Hayward Medical Centers. The KP National Diversity Program Offices' Institute for Culturally Competent Care made this designation of excellence possible. The Institute has awarded designation of Center of Excellence in Culturally Competent Care to KP facilities that are hallmark models of health care delivery to KP's diverse membership. The designation is an internal KP award. Centers develop innovative approaches to delivering clinical care customized to respond to the unique cultural beliefs and health practices of diverse member populations.

The KP Women's Health Center of Excellence establishes the GSAA Service Area as a leader in delivering personalized health care, education, and services for women. The Center will integrate three necessary principles for delivering health care in the 21st century:

• Awareness and knowledge of diversity;

• Respect for individual beliefs, customs, and practices; and

• Culturally competent care.

The GSAA Service Area continues to reflect a growing multicultural and multilingual population that is highly diverse and has substantial language requirements: At least 56 languages have been identified among KP members in the East Bay. According to the 2003 Meteor Survey, the GSAA KP membership is 49% white, 20% Hispanic, 20% Asian, and 6% black. Current data indicate that marketing efforts are not penetrating a substantial Asian population—in particular, the Chinese and Latino populations, which will continue to grow. Women with limited English proficiency are known to go to extra lengths to access and receive health care services for themselves and for their family members.

Recent data from the KP Fremont and Hayward Medical Centers show that women are the major users of health care services. Women are the largest group of patients in all departments except urology and pediatrics, where male children surpass females by a small percentage. Despite these statistics, KP continues to provide medical care in a mostly traditional manner.

The Women's Health Center of Excellence has four primary goals:

• To assemble and analyze background data used for implementing program interventions and to expand culturally competent care and services for women;

• To compile key learnings and tools;

• To share our experiences and expertise with others internal and external to KP; and

• To develop best practices and approaches for women's health care.

The center offers learnings derived from women's health and multilingual communication programs and services initiated by such programs and services as the Multilingual Women's Health Program, the Baby-Friendly Hospital Initiative, and the Latina Breast Cancer Project. These programs and services continue to evolve along with the rapid growth of our diverse communities and member population segments.

The center's current focus includes a Women's Health Educational Series, the Breastfeeding and Cultural Norms Research Project, and domestic violence. Key learnings as well as identified gaps and opportunities will enrich these programs and services to more effectively meet the health care needs of all women.

Multilingual Women's Health Project

The purpose of the Multilingual Women's Health Project was to implement a coordinated system of care for women with limited English proficiency and their families to improve access to health care, the quality of health care outcomes, member satisfaction, and marketing outcomes. Considering each of these factors was necessary for a comprehensive ethnic marketing and revenue-generating effort. A total of 163 Spanish-, Cantonese-, and Mandarin-speaking members participated in a preliminary survey.

Medical appointments were coordinated for the patient and her family within specific agreements made between departments. Spanish and Chinese interpreter services were provided to all families during appointment visits. Ongoing follow-up with families was provided as needed to ensure follow through.

The services were most beneficial to patients who were monolingual and new to the KP system and required assistance and coordination of care because of multiple health care needs. Satisfaction of patients and clinicians also improved. The Multilingual Women's Health Project has also served as an important gateway for addressing other pressing women's health care issues, eg, breast cancer.

Baby-Friendly Health Care Services

Several years ago, the KP Hayward Medical Center decided to provide the best support possible to breastfeeding babies and their mothers. To accomplish this goal, the best approach was determined to be development of a program that would enable the medical center to receive World Health Organization (WHO) designation as a Baby-Friendly™ hospital.

With formal creation of the Breastfeeding Task Force (in 1990), the KP Hayward and Fremont Medical Centers established their mission to increase the number of mothers who choose to breastfeed their infants throughout the first six months of life. The multistep designation process ensued.

The principle of being baby-friendly is based on a set of practices called the Ten Steps to Successful Breastfeeding (Table 1).¹ After a medical facility team has implemented all ten steps, assessors from the organization Baby-Friendly USA™ visit the hospital and conduct an in-depth audit. If a hospital has fully implemented all ten steps, the hospital is awarded the Baby-Friendly™ designation.

Table 1.

Ten steps to successful breastfeeding¹

In January 2001, the KP Fremont and Hayward Medical Centers were officially notified that they had together become the 30th Baby-Friendly™ hospital in the United States. Since that time, the KP Hayward and Fremont Medical Centers have evaluated the impact of the initiative on breastfeeding rates in their combined facilities. A pediatric chart review of more than 2000 babies born in the periods immediately before, during, and after full implementation of the initiative indicated that implementation of the Baby-Friendly Hospital Initiative™ was associated with statistically significant increases both in exclusive breastfeeding and in breastfeeding combined with use of infant formula. These data have not yet been published.

Latina Breast Cancer

Of the approximately 200 women diagnosed with breast cancer every year in the GSAA Service Area, about 10% are Spanish-speaking. Latina women tend to associate cancer with myths—and these myths become cultural barriers to medical treatment. As a result, these women avoid receiving conventional medical treatment in the early stages after diagnosis and thus greatly reduce the effectiveness of treatment and rates of cure. Approximately 20% of Spanish-speaking women postpone treatment by as much as six months. In the interim, some of these women may seek alternative forms of medical therapy accepted by their culture. These women tend to eventually try modern medicine at a KP medical center, by which time the rate of successful treatment has been substantially reduced. In two recent cases, the patients delayed their treatment for more than four months.

In an informal 2002 needs assessment of Latina breast cancer patients, women reported that language barriers made it difficult to get questions answered about their treatment and that they would have preferred to be treated by Spanish-speaking clinicians. By implementing use of trained interpreters, by increasing clinicians' awareness of culturally sensitive issues regarding breast cancer, and by increasing their comfort with the use of interpreters, we reduced treatment delays and provided culturally appropriate care. To date, we have developed several specific tools and services for further improving this care (Table 2).

Table 2.

Tools and services developed by KP Women's Health Center of Excellence in Culturally Competent Care

Other Achievements of the Center

The center also conducted focus-group sessions that were titled “Body in Balance: Seeking Perspectives in Women's Health.” These sessions were conducted at the KP Fremont Medical Center attended by more than 150 participants. The focus groups were led by clinicians and discussed topics such as balance, stress reduction, heart disease, and menopause. Those areas of interest to women were identified in responses given to a survey distributed before the program began.

The center also organized a lecture series during Women's Health month. The lecture series focused on topics such as weight, menopause, alternative forms of therapies, and stress management. These lectures were well received and appreciated by members.

Another accomplishment of the center is its emphasis on birth as a celebration. The center is dedicated to providing linguistically and culturally competent care to women across the GSAA and to provide opportunities for learning with the ultimate goal of better service, efficiency, and clinical outcomes for all our patients.