Cultural Competence in Health Services | The Jerusalem Intercultural Center

Cultural Competence Training – Gonenim Clalit Clinic – November 9 and 16, 2009

After the workshops at the Clalit primary care clinics at Ir Ganim and Talpiot, we continued this week with two half-day trainings for the staff of the Gonenim clinic, conducted at the JICC premises on Mount Zion. These three clinics serve most of the Ethiopian Jewish immigrant population in Jerusalem, and we adapted our cultural competence training to focus on the needs of this group. All clinic staff members, from physicians to administrative staff, attended the workshop, as we see the response to diversity at the clinic as an integrative task.

Gonenim Clinic Training 2009

The workshop was in general very similar to the ones we conducted before. However, we used many more examples, which participants in the previous workshops raised, and based the training on case studies and simulations. This made the training closely related to the practical issues brought up by clinic staff members.

Gonenim Clinic Training 2009 – roleplaying

Following this training the Gonenim clinic now joins the support system we are creating to enhance the Clalit Health Services’ capacity in providing better and more adapted services to new immigrants. We will conduct follow-up meetings with the clinic’s management and mentor them in implementing Cultural Competence in the clinic.

Gonenim Clinic Training 2009 – roleplaying

jicc2014-04-07T20:11:50+00:00November 16th, 2009|Blog, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts|

Cultural Competence Training – Clalit Secondary Care Clinics – November 11, 2009

As a part of our project that aims to incorporate cultural competence into the Jerusalem medical system, we are working with the secondary care clinics of the Clalit medical services. It is a long process in which we are facilitating a day-long workshops to staff of these clinics from all over Jerusalem. The first training in the series was held on June 30, 2009.

Role-playing at the Cultural Competence training for Clalit Secondary Care Staff

Today we held the second training. In between these two trainings, we significantly upgraded the workshop, based on the feedback we received after the first workshop. We also developed improved case studies for the simulation and role-playing parts. By the end of the workshop today we felt that the workshop in its current version is fit for replication. The special component of the workshop is the simulation of cross-cultural cases with the help of professional actors. The cases mainly demonstrate interactions with Arab patients and with Ultra-Orthodox and Ethiopian Jewish patients.

Role-playing at the Cultural Competence training for Clalit Secondary Care Staff

The plan is to train in the coming two years all the staff in the Clalit secondary care clinics in Jerusalem. In parallel, we work to assimilate cultural competency in the clinics in additional ways, such as training bilingual interpreters, improving communication between primary-care Arabic-speaking physicians and the secondary-care physicians, etc.

jicc2014-04-07T20:08:44+00:00November 11th, 2009|Blog, Cultural Competence, Cultural Competence in Health Services|

Cultural Competence Training Demonstration – September 7, 2009

During summer 2008 we developed our first Cultural Competency in Health training. Since then, we piloted the workshop, adapted it as necessary, and implemented it with medical staff at the Alyn hospital and at the Clalit Health Services (both in Primary Care Clinics serving the Ethiopian community and in expert clinics). This was done in partnership with the Jerusalem Foundation. Throughout this process, we got tremendous help from many experts from all over Israel – physicians, nurses, management of the relevant institutes, and researchers and practitioners focusing on cultural sensitivity, awareness and competence. It was important for us to present the training to these people, hear their feedback and insights, and thank them for their valuable contribution.

On September 7, 2009, we were joined by about 20 experts at the JICC premises on Mount Zion in Jerusalem. We went through the details of the workshop in depth and shared with them our ideas for improvements. At midday, we, the cultural competence team at the JICC, felt much enriched with a lot of new ideas and advice. Some of the feedback related to specific modules and parts of the workshop, allowing for further improvement, and some contributed to the overall approach of the workshop.

For example, we realized that learning can be structured around case studies provided by the participants during the workshop, as well as cases that we prepared in advance with the help of professional actors. We now also know how to better simulate with the participants situations they describe, by applying the “Caregiver in the Shoes of the Patient” model: we ask the medical staff member who raised the case to play the role of the patient while another participant plays the role of the medical staff him/herself. Thus the theoretical and practical modules of the workshop, that previously were given as is, are now incorporated and triggered by the stories and situations raised by the participants, as well as by the pre-designed situations we prepared with the actors.

This approach makes the training much more interactive and practical, and most importantly, responsive and well connected to the needs of the participating practitioners. We discussed this new training design with today’s expert participants and they all agreed it was very promising.

jicc2014-04-04T12:56:03+00:00September 7th, 2009|Blog, Cultural Competence, Cultural Competence in Health Services, Identity Groups and Conflicts|

Cultural Competence Training – Talpiot Clinic – June 11 and 25, 2009

Today we finished a set of two training sessions on cultural competency in serving the Ethiopian community in Jerusalem. The training was delivered to all staff members of the Clalit Primary Care Clinic in the Talpiot neighborhood and was basically the same training as the one delivered to the Ir Ganim clinic. Our next step in the near future is to deliver the training also in the Gonenim and Neve-Yaakov clinics. By that we will cover all four clinics that serve the Ethiopian population in Jerusalem.

Talpiot Clinic Training 2009

It is important to note that following these trainings we continue to support the clinics in their efforts to give better and adapted services to new immigrants. In a follow-up process we found that many of the skills that were taught in the trainings are now being used in the clinics. In addition staff members report that patients demonstrate higher levels of satisfaction than before.

jicc2014-04-07T19:55:24+00:00June 25th, 2009|Blog, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts, New Immigrants|

A Call for Cultural Competency in Jerusalem’s Medical Services – an Article

We just published an article at the Jerusalem Post and Search for Common Ground (SFCG) News service on our cultural competency program in Jerusalem. Here are the links and the text:

SFCG: English, Arabic, Hebrew.

The Jerusalem Post (English).

PDF (English).

Text:

A call for cultural competency in Jerusalem’s medical services

May. 20, 2009
HAGAI AGMON-SNIR , THE JERUSALEM POST

A few years ago, my mother underwent hip replacement surgery. Before she was discharged, the surgeon gave her quite a few instructions for the period following surgery. There were some necessary accessories and equipment: a wheelchair, special pillows and devices to help lift objects. These were available for almost nothing from Yad Sarah, an organization founded by haredim that lends medical equipment to those who need it.

“If you don’t follow the directions I gave you and you don’t use the equipment,” said the surgeon, “your leg won’t function the way it’s supposed to and the effects of the excellent and expensive surgery will be wasted.” Today my mother traverses the country with her new hip and any memory of the fracture has been erased.

Lying next to my Jewish mother in the hospital were Palestinian mothers from east Jerusalem who had also fractured their hips and received hip replacement surgeries. Most of them, like my mother, were covered by national health insurance, which made them luckier than their sisters from the West Bank and Gaza who are not entitled to these benefits. The women from east Jerusalem were given the same instructions my mother received and were also sent to Yad Sarah, which has branches serving east Jerusalem for the Palestinian population.

Yet there is good reason to suspect that, unlike my mother, many of them are limping today. Research carried out in hospitals in Jerusalem shows that about half of the Arabic-speaking patients do not understand the instructions they are given for post-treatment care because they are given in Hebrew.

One third of Jerusalem’s residents are Arabic-speaking Palestinians, both Muslim and Christian. In times of need, these residents will almost always choose to go to hospitals in west Jerusalem. At some of these medical institutions, more than half of the patients are Palestinian, yet none of them are provided translation services into Arabic or any other language. Occasionally, medical staff improvise and ask an Arab hospital worker or a visitor who speaks both Hebrew and Arabic to translate, making them privy to the patient’s personal medical details. It’s not unheard of for the patient’s child to act as a translator, telling his or her mother that the doctor recommends an abortion or that a suspicious lump was found in her breast.

In addition to the lack of language services, none of these establishments provide religious services to Muslims or Christians. Nurses complain about Muslim men washing their feet in sinks designated for hand washing. The simple solution – low sinks for feet-washing before prayers – cannot be found at any of these places. On the other hand, Jews may receive visits from a rabbi, have meals provided by various religious organizations according to their specific kashrut needs, or pray in an in-hospital synagogue.

RECENTLY, THE Jerusalem Intercultural Center hosted senior directors from the Coney Island Hospital in New York City, introduced to us through our collaborative work with Rabbi Bob Kaplan of CAUSE-NY, an organization committed to the availability of health services in New York. In compliance with the law, signs at the hospital appear in five languages, and anyone entering the hospital is entitled to receive hospital services in his or her own language. Sometimes a translator is present in the room and other times (with more obscure languages) translation is provided through a phone service, called tele-interpretation.

The hospital has a synagogue, a Christian church, a mosque and a Hindu temple – in accordance with the needs of the communities that it serves. Kosher food is provided for Jews and halal food for Muslims. In the case of Indians and Pakistanis, the food is prepared and spiced in a way that is suitable for their palate.

Is this hospital anomalous? Not at all. In the past 15 years the “cultural competency” approach has become widely practiced in health systems in North America, Australia and Europe. It has simply skipped over Israel, despite much evidence showing that medical services adjusted to culture, religion and language improve the quality of care and the outcome of treatment. And, of course, such an approach is far more just and ethical.

Shocked by this state of affairs, the Jerusalem Intercultural Center and the Jerusalem Foundation have launched an initiative to encourage cultural competency. The need, by the way, exists not only for the Palestinian population in the city, but also for the Yiddish-speaking haredi community (which comprises about one quarter of the city’s residents), as well as people from a variety of other backgrounds who speak languages like Amharic, Russian, French and Spanish. We are only at the beginning of the road, but already there are medical institutions, such as Alyn hospital (for pediatric rehabilitation) and Clalit Health Services, that are now building up cultural competency in their facilities.

We hope that by introducing cultural competency into the medical services in Jerusalem we will help reduce the current inequality that exists in this field. Moreover, we believe that this is a way to teach the people of this city the value of accepting the other, being considerate of those who are different from us and to encourage people to think in terms of human rights even in a city as fraught with tensions as Jerusalem.

The writer is the director of the Jerusalem Intercultural Center and can be reached at hagai@jicc.org.il. The project Cultural Competency in Jerusalem is sponsored by the Jerusalem Foundation. This article was written for the Common Ground News Service in collaboration with The Jerusalem Post.

jicc2014-04-19T05:53:02+00:00May 28th, 2009|Blog, Cultural Competence, Cultural Competence in Health Services, Identity Groups and Conflicts, Palestinians/Arabs|

Cultural Competence Training – Alyn – May 18, 2009

Today we held the third Cultural Competence training to a group of staff members in the Alyn hospital in Jerusalem. This training is part of our efforts, together with the Alyn Hospital’s management, to transform Alyn into a cultural competent hospital, the first of its kind in Israel. The work with Alyn is a component of the Jerusalem Cultural Competence in Health Project initiated by the Jerusalem Inter-Cultural Center and the Jerusalem Foundation.

Alyn training May 2009

Towards each training in Alyn we interview several intended participants and based on their input we adapt the case studies that will be used in the training to the needs of the specific clinic. Today for example we added an extra focus on Ultra Orthodox patients and invited experts in the field to share their knowledge. We also improved two of the learning modules by using more dialogues for analysis and real-life stories. Thus the modules became more interesting and interactive.

Alyn training may 2009

jicc2014-04-07T19:26:12+00:00May 18th, 2009|Blog, Courses, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Outside Jerusalem, Ultra-Orthodox Jews|

Cultural Competence Training – Ir Ganim Clalit Clinic (part 2) – March 23, 2009

Today we held the second part of our first workshop on cultural competency in serving the Ethiopian community in Jerusalem. The training was delivered to all staff members of the Clalit Primary Care Clinic in the Ir Ganim neighborhood.

Michal Schuster at the Second workshop in Ir Ganim Clalit clinic

This time we focused on the use of interpreters (telephonic and face-to-face) in the clinic, as well as learning how to work with a cultural liaison. The Ir Ganin clinic employs a part-time Ethiopian Cultural Liaison, funded by the Ministry of Health. We used simulations to improve the learning process.

Using a cultural liaison in a simulation

Building on the positive feedback we have received, this training will be provided to the other clinics that serve Ethiopian population in Jerusalem.

A nurse participating in a simulated case

jicc2014-04-07T19:16:21+00:00March 23rd, 2009|Blog, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts, New Immigrants|

Cultural Competence Training – Ir Ganim Clalit Clinic – March 2, 2009

Following a strategic planning process for adapting Clalit’s clinics to Ethiopian patients, we held today the first workshop on cultural competence in serving the Ethiopian community in Jerusalem. The work with Clalit is a component of the Jerusalem Cultural Competence in Health Project initiated by the Jerusalem Inter-Cultural Center and the Jerusalem Foundation. In this project we aspire to make the Jerusalem district of the Clalit HMO much more culturally competent.

This specific workshop was delivered to all staff members of the Clalit Primary Care Clinic in the Ir Ganim neighborhood. The clinic serves 450 Ethiopian families, most of which arrived to Israel about 10 years ago. Our approach to cultural competence trainings, based on international experience, is to provide tools that will be relevant to other cultures in the neighborhood as well. Yet, in this training, emphasis was given to the unique Ethiopian case.

First workshop in Ir Ganim Clalit clinic

The Jerusalem Inter-Cultural Center has developed a training based on a series of case-studies. Some of the cases are raised by the participants themselves and others are formulated specifically for the training and presented by the JICC staff with the help of a professional medical actress. In Ir Ganim we were happy to work with an artist, Ethiopian by origin, that played the patient in these case simulations. Through the analysis of the cases, the participants learn relevant models and tools: how to create better patient-provider inter-cultural communication, cross-cultural communication tools, best ways to work with interpreters and tele-interpreters and, importantly, how to deal with culturally-oriented political issues that may divert the staff from its professional work. Our experience shows that in Israel, probably more than in other Western countries, political issues related to racism, religious coercion, and other inter-group tensions, may create major challenges to the staff.

Medical Ethiopian professional artist in the Ir Ganim training

The second part of the training in Ir ganim will take place on March 23. In the meanwhile, the feedback provided at the end of the training indicated that this was a very important and fruituil training experience. We all look forward to the next meeting.

Our next step following the training in Ir Ganim is to provide similar trainings in the rest of the Clalit Jerusalem district clinics serving the Ethiopian community.

jicc2014-04-07T19:11:01+00:00March 2nd, 2009|Blog, Cultural Competence, Cultural Competence in Health Services, Ethiopian Jews, Identity Groups and Conflicts, New Immigrants|

Cultural Competence Training – Alyn – February 25, 2009

Today we held the second Cultural Competence training to a group of staff members in the Alyn hospital in Jerusalem. This training is part of our efforts, together with the Alyn Hospital’s management, to transform Alyn into a cultural competent hospital, the first of its kind in Israel. The work with Alyn is a component of the Jerusalem Cultural Competence in Health Project initiated by the Jerusalem Intercultural Center and the Jerusalem Foundation.

The training, developed by the Jerusalem Inter-Cultural Center, uses cases raised by the participants, as well as case-studies simulated with the help of a professional medical actress. Through the analysis of these cases the participants learn models for better patient-provider inter-cultural communication, cross-cultural communication tools, best ways to work with interpreters and tele-interpreters, and ways to deal with culturally-oriented political issues that may divert staff from its professional work. Our experience shows that in Israel, probably more than in other Western countries, political issues related to racism, religious coercion and other inter-group tensions, may create major challenges to the staff.

The feedback at the end of the training was excellent. Specifically we realized that some changes we made following feedback from the last training significantly improved the effectiveness of the workshop. As the training workshops are part of an institution-wide program, we will continue to mentor the participants in their efforts to assimilate cultural competence tools in the hospital.

jicc2014-04-07T19:08:49+00:00February 25th, 2009|Blog, Courses, Cultural Competence, Cultural Competence in Health Services|

Interpretation Success in Alyn!!!

Just a month ago, we concluded the first medical interpretation training in Jerusalem, for around 10 staff members of the Alyn Hospital. Training graduates are currently being utilized for interpretation only sporadically, in their “spare time”, while the Alyn management prepares formal regulations for putting them into service.

But reality frequently cannot wait for regulations to be written. Following a training to municipality absorption neighborhood officers, where our model for Cultural Competence in health was presented, one of the officers approached the JICC for help. He told us about a family that immigrated to Israel from Belarus in December 2008 with a child that needs to be diagnosed and probably operated on. They were invited to Shaarei Tsedek and Alyn hospitals but the problem is that they speak only Russian. The absorption officer remembered that we work with Alyn and asked if we could assist with proper interpretation there. What seems nowadays obvious in most Western countries is still a challenge in Israel 2009 – medical interpretation is rarely available.

We could not help with Shaarei Tsedek as we do not work with them (yet…), and the family recruited a family friend to help there. However, in the Alyn hospital the check up process is six hours-long – six different professionals need to examine the child – and the family friend, who is a senior citizen, could not come for such a long time. We called Alyn and updated them about the situation.

One of the most important aspects in our model of Cultural Competence in Health is the designation of a management member of the health system to be responsible for the assimilation of the process into the hospital. This person is also the liaison between the system’s staff, the community, the patients, and us. The liaison in Alyn acted rapidly. Due to different constraints it was not taken for granted that the hospital could allocate one of the Russian-speaking graduates of the training for the whole day. But understanding that otherwise the six hours of examination will go to waste, the staff worked hard to find a solution.

Today, the family arrived to the hospital with the child and for the whole day, the Russian-speaking interpreter accompanied them from one health professional to the other. In the afternoon, we heard the feedback from all sides. The Alyn medical team thought that the interpretation was crucial and helpful. The family was most grateful and the absorption officer said that they were not only pleased with the interpretation, but also about the way the interpreter expressed her empathy and willingness to help. The whole process improved tremendously the potential for the surgery, together with the follow-up treatment instructions given to the family, will improve the medical condition of this child.

For us, this was a great example for how our systemic work with cultural competence in health can help people. We hope that soon allocating an interpreter to a patient with language proficiency needs will not be news. Just a regular procedure.

jicc2014-04-05T17:53:50+00:00January 28th, 2009|Blog, Courses, Cultural Competence, Cultural Competence in Health Services, Identity Groups and Conflicts, New Immigrants|