New York City Council Oversight Hearing: The Delivery of Culturally Competent & Equitable Health Care Services in New York City Hospitals

Matilde Roman, Chief Diversity and Inclusion Officer
NYC HEALTH + HOSPITALS
Wednesday, September 18, 2019

Good afternoon Chairperson Rivera and members of the Committee on Hospitals. I am Matilde Roman, Chief Diversity and Inclusion Officer at NYC Health + Hospitals (Health + Hospitals), and I am joined by Dr. Machelle Allen, Senior Vice President and Chief Medical Officer of Health + Hospitals. On behalf of Health + Hospitals’ CEO, Dr. Mitchell Katz, thank you for the opportunity to testify before you to discuss “the delivery of culturally competent and equitable health care services” and the programs and initiatives at Health + Hospitals that ensure we provide culturally responsive health care.

Health + Hospitals is the safety net for the uninsured and underserved in New York City, providing health care services to one million New Yorkers each year — 375,000 of whom are uninsured. Our mission is to provide care to everyone, regardless of ability to pay, immigration status, gender identity, disability, or national origin. As such, it is a crucial part of our mission to provide accessible, culturally, linguistically appropriate services to ensure full access to comprehensive and quality care for all New Yorkers.

New York City is home to over 3 million immigrant New Yorkers. Fifty percent of New Yorkers speak another language other than English at home and nearly one million New Yorkers self-identify as a person with disability. This City is also home to the largest LGBTQ community in the nation, and as such providing culturally competent and accessible care is a business imperative.

At Health + Hospitals, patients who receive care belong to many different racial and cultural backgrounds. An estimated 30% of patients served are limited English proficient, and more than 60% of patients self-identify as either Black/African American, Hispanic/ Latino, or Asian.

Health + Hospitals provision of culturally competent, equitable health services are guided by: 1) an understanding of the important role of one’s culture, race, class, age, disability, gender, sexual orientation, and gender identity in interpersonal and professional encounters in health care; 2) an awareness of historical and socio-political factors such as racism, ableism, immigration patterns, and human rights violations and their impact on the health and well-being of minority populations; and 3) the value in collaborating with ethnic and racial minority community-based organizations to ensure appropriate responses to individual health needs.

Health + Hospitals is a leader in providing culturally competent and linguistically appropriate services by investing in trainings and initiatives to provide care for all that is safe, responsive and effective; addressing the health care needs of immigrant New Yorkers through the issuance of an Open Letter to reassure immigrant New Yorkers that Health + Hospitals is a safe place to receive care, and through our partnerships with LegalHealth to offer legal services. We also make available multi-lingual materials and collaborate with community-based organizations with close ties to the Latino, West African, and Asian communities to promote our initiatives, such NYC Care, which is a health care access program that guarantees low-cost and no-cost services to New Yorkers who do not qualify for or cannot afford health insurance.

This ongoing process requires periodic assessment of the cultural competency of our workforce, ongoing evaluation of the effectiveness of our diversity training programs, and formal and informal linkages with the communities that our facilities serve. I want to take a moment to highlight a few key initiatives that sets Health + Hospitals apart in providing culturally and linguistically appropriate services.

LANGUAGE ACCESS PROGRAM: Health + Hospitals offers free language services 24 hours a day, 7 days a week, 365 days a year in over 200 languages and dialects. We translate key patient documents, such as consent forms and patient education materials, into the top 13 languages requested by limited English proficient (LEP) New Yorkers. In Fiscal Year (FY) 2018, Health + Hospitals facilities received more than 1 million requests for interpretation services that yielded 13 million interpretation minutes. System wide initiatives to support communication for persons who are LEP include:

• Making available language access resources to inform the public of the availability of free language services, tools to ensure quicker access like language ID desktop displays, and ‘I Speak’ cards to support facilities in the delivery of language assistance services;
• Creation of a centralized database system to collect language service usage and key performance metrics to monitor for quality assurance and effectiveness; and
• Having a designated Language Access Coordinator at each facility who is responsible for overseeing the provision of language services.

LGBTQ AFFIRMING SERVICES: Health + Hospitals has and will continue to strive to provide patient centered, affirming care to lesbian, gay, bi-sexual and queer (LGBQ) and transgender and gender non-conforming (TGNC) communities. For the fourth consecutive year, all Health + Hospitals’ qualifying facilities received the designation of “Leader in LGBTQ Healthcare Equality,” by the Human Rights Campaign Foundation’s Healthcare Equality Index. This designation demonstrates Health + Hospitals strong commitment to LGBTQ health equity through our policies, programs, and ongoing training. We also have Pride Health Centers at Metropolitan, Woodhull, Bellevue, and Gouveneur, which provide general preventive care and mental health services, as well as gender affirming care, such as hormone therapy or referrals to specialists. The Bridge Program at Spring Street offers medical, mental health and other support services to LGBTQ youth and emerging adults; and at Metropolitan Hospital, we provide gender-affirming surgery. During the past year, Health + Hospitals also launched the LGBTQ Community Engagement Initiative focused on connecting, engaging and facilitating affirming services to New York City’s LGBQ and TGNC communities to improve access to affirming care.

ACCESS TO CARE FOR PEOPLE WITH DISABILITIES: Health + Hospitals is required to comply with various federal, state, and local laws requiring accessibility for all individuals with disabilities, including the Americans with Disabilities Act (ADA), Section 504 of the Rehabilitation Act, and the Affordable Care Act for new construction, major modernization projects, and barrier removal. As part of these efforts, we are also working to ensure effective communication and reasonable accommodations for individuals with disabilities, including those who are blind or have low vision, and those who are Deaf and hard-of-hearing.

Additionally, for the last several years, we have collaborated with the Independence Care System (ICS) Women’s Health Program to provide competent and accessible care to women with disabilities. Thanks to the support of City Council, this important work– $2.5 million in capital funds to upgrade four facilities – Morrisania, Sydenham, Cumberland, and Woodhull; and $275,000 in discretionary funds allow Health + Hospitals to continue this important work with ICS.

RESOURCES AND TRAININGS FOR EMPLOYEES: Health + Hospitals offers system wide training on diversity and inclusion, cultural competency, LGBTQ health, unconscious bias, and interreligious awareness through distance learning, new employee orientation, annual in-service, and other in-person trainings such as grand rounds and small facilitated dialogues offered year round.

IMPROVING MATERNAL AND INFANT HEALTH: In 2018, the First Lady and the former Deputy Mayor for Health and Human Services announced New York City’s first comprehensive plan to reduce maternal deaths and life threatening complications of childbirth among women of color. The five-year plan aims to eliminate disparities in New York City’s maternal mortality between black and white women – where the widest disparity exists – and reducing by half the number of severe maternal morbidity events in the five boroughs. As it relates to Health + Hospitals, the plan includes enhancing maternal care at our facilities by focusing on four specific strategies: 1) simulation training to assist health providers master skills to identify and respond to the two top causes of pregnancy-related deaths for women of color; 2) new maternal care coordinators who will assist an estimated 2,000 high-risk women; 3) coordination of newborn and postpartum appointments; and 4) new practices in primary care to identify women who are planning to have a child within six to 12 months. Additionally, Health + Hospitals increased screening for maternal depression through a partnership with ThriveNYC and the New York City Department of Health and Mental Hygiene (DOHMH) to enhance screening of pregnant women and new mothers in order to promote treatment of maternal depression, and 10 of our 11 acute care facilities have earned the prestigious “Baby-Friendly” designation from the World Health Organization for promoting the highest level of care for infants through breast feeding and promoting bonding between mother and baby.

IMPLICIT BIAS TRAINING: As the largest public health system in the nation, serving perhaps the most diverse city in the country, Health + Hospitals is committed to ensuring its staff is sensitive to issues of health equity and that we are delivering truly equitable care. We have made available to staff all year two e-learning modules on the Impact of Unconscious Bias on a Culture of Inclusion, and Diversity and Inclusion: A Business Imperative that was developed by Interactive Business Inclusion Solutions (IBIS). Additionally, we have engaged with Perception Institute, a leading organization who translates innovative mind science research on race, gender, ethnic, and other identities into workable solutions, usually in the form of workshops, to reduce bias and discrimination, and promote belonging. Health + Hospitals will begin training Health + Hospitals Board of Directors and senior leadership this fall. In addition, we are working hand-in-hand with DOHMH to provide train-the-trainer implicit bias training through Re-Birth Equity Alliance to provide training sessions to all of the hospitals in Health + Hospitals, as well as other hospitals participating in the DOHMH Maternal Hospital Quality Improvement Network (MHQIN). The trainings will focus on improving equity in childbirth. This training will take place next month, in October.

Other facility-based programs that demonstrate our commitment to cultural competence and equity include: The Medina Health Center operated at Harlem Hospital, which offers quality medical services to the African community, many of whom are African immigrants and members of the Muslim community. Llyria Clinic at Jacobi, which provides culturally sensitive medical care to refugees from the Balkans. Elmhurst Hospital Center operates psychiatric inpatient units that address the needs of both Spanish speaking patients and Asian patients who primarily speak Cantonese, Mandarin, or Korean. Lincoln Hospital operates the Viva Mujer (Long Live Women), Viva Los Hombres (Long Live Men) & For You, For Life! Cancer Outreach Program that promotes public education in the areas of cancer screening, prevention, and early detection.

At Health + Hospitals, we believe all New Yorkers, regardless of disability, national origin, gender, or citizenship status deserve equitable, affordable, and accessible high quality health care. True to our mission, Health + Hospitals will continue to provide health services in a culturally responsive manner to meet the needs of the City’s diverse population. Thank you for your interest and attention, and we are happy to answer any questions you may have.