In Pursuit of Health Equity & Inclusion

Imagine the fear of experiencing a medical emergency in a hospital where nobody looks like you, speaks your language or knows your culture.

Imagine the frustration of having to choose between going to the doctor and buying groceries.

Imagine the distress of being a parent who isn’t permitted to make care decisions for your child because your state doesn’t recognize your marriage and your partner is the legal parent via biology or adoption.

When we incorporated diversity and cultural competency into our Health System strategic goals and launched the UMHS Office for Health Equity and Inclusion, we did so with the hope that one day these scenarios and the many others that plague underserved and underrepresented populations will no longer exist. The future of health care that we strive to create is one in which all patients have access to appropriate and timely care in a respectful and compassionate environment.

Real change comes from first understanding the problem and the underlying causes and then acting on that knowledge to alter behaviors and practices to improve individual and community outcomes. This is the “sweet spot” of an academic learning health system; this is where the intersection of our tripartite mission of education, research and clinical care can do the most good for the most people. While there is a lot of work to do in pursuit of our desired future state, we have made impactful progress toward this goal at UMHS.

For example, we have several outreach clinics throughout Michigan that focus on the needs of underrepresented and underserved patient populations, including the U-M Migrant Farm Worker Outreach Clinic in Lenawee County, Ypsilanti’s Corner Health Center for people ages 12-21, the Delonis Clinic for homeless individuals and families in Washtenaw County and the Student Run Free Clinic in Pinckney.

Since 1994, the Japanese Family Health Program run out of Family Medicine at Domino’s Farms has been implementing innovative programs that transcend cultural barriers and impact all components of our tripartite mission. Popular patient and family-centered features of the program include monthly birth center tours with a Japanese-speaking guide, prenatal group classes for mothers and fathers and an extensive library of Japanese and bilingual health education materials. Program faculty have posted medical education materials on Open.Michigan, an open source community created by the University to enable global sharing of  educational resources and research, and in 2010, the program was awarded a $1.4 million grant from the Japanese government to establish a residency training program and help Japanese doctors improve in-country family medicine practices.

Then there is the work of 31 active patient and family advisory councils throughout the Health System. These are groups of patients, family members, faculty and staff who are working together to identify and implement ways to make our practices, policies and environment more inclusive. In the future, we want to engage more individuals from vulnerable populations in the councils to better understand their unique challenges related to access, services, resources, transportation and more. Additionally, we want to expand these efforts into the ambulatory care setting and work with volunteer advisors to find ways to improve representation of diverse individuals in clinical trials. To address the latter, we are providing advisors with opportunities to participate in Patient Centered Outcomes Research by collaborating with UM investigators on the development and design of research proposals. At the same time, we are partnering with Nursing, Public Health and other disciplines which conduct community behavior research.

This is just a snapshot of initiatives under way at UMHS to address access, inclusion and equity. Certainly, there is much more to do if we are going to affect real and lasting change in our health care system.

Next month, each of you will have the opportunity to participate in a campaign led by the Office for Health Equity & Inclusion. OHEI was established to advance our health system’s equity and inclusion goals. With Dr. Carmen R. Green as the inaugural Associate Vice President and Associate Dean for Health Equity and Inclusion, I know that we will make impressive and substantial progress. Our voice as a Health System must reflect the diverse voices of the patients we serve, the health professionals we train and the people who work here. The Talk Health Care Equity campaign will be your chance to add your voice to this important conversation, and I hope that each of you will take advantage of this opportunity.

No matter who a person loves, where s/he lives, what s/he believes, how young or old s/he is or what s/he looks like, all citizens deserve access to the right care in the right place at the right time in an environment that is inclusive and welcoming. In a country as wealthy and democratic as the United States, exceptional health care should not be a luxury. It should be a right. Let’s work together to change the status quo.

10 thoughts on “In Pursuit of Health Equity & Inclusion

  1. I am part of the Native American Community and I have a friend who was born in North Carolina and whose first language is Cherokee and he didn’t even start to learn English until he was 11 years old. He has never been able to have a translator to obtain his health care information in. His grandmother did speak English, having been sent away to the Indian Boarding schools, and served as a translator until she passed away. Even the language line 800 number was never able to obtain a Cherokee translator. I wonder how many Native people are not able to fully understand their medical situations due to a lack of translators. Here in Michigan we have several native languages without any translators available. I would like to see this change! Thank you for the opportunity to share.

    • This is a very insightful comment. We have an Interpreter Services Program at UM that offers interpreters in many foreign languages, and I feel very proud to be a part of it. But you are right; I have not heard of any requests nor resources for Native Americans. It may well be that there is a great linguistic and cultural bridge that we must address.

  2. Erin Smith on said:

    I am extremely proud to be a part of an institution that is so perceptive and engaged in the betterment of medical access and care.

  3. I love that we walk the walk here at UofM! We truly put a great deal of time, effort and $ behind the mission of health care (indeed, world class health care) as a right. Great to be part of the solution.

  4. Is there some recourse if a current patient feels she is not being treated well by a UMHS physician and is a person of color? Just wondering.

  5. Allison Krieger on said:

    Hi Carolyn,

    There are several resources available to you, including Patient Relations, Compliance (offers the option of confidentiality) and the Office of Clinical Affairs. Contact information for these areas can be found on these webpages:

    Compliance: http://www.med.umich.edu/compliance/
    Patient Relations: http://www.uofmhealth.org/contact%2Bus/complaints%2Band%2Bkudos
    Office of Clinical Affairs: http://www.med.umich.edu/i/oca/

    If you would like further assistance or have additional questions, please email me at kriegera@umich.edu.

    Thanks,
    Allison Krieger

    • Celeste Castillo Lee on said:

      We are looking for include all the voices of our patients. If you would would like to pass along my email I would be very happy to talk with your friend about her expereince– ceclee@med.umich.edu

      Celeste Castillo Lee
      Program Manager, Patient and Family Centered Care, Adult Services
      University of Michigan Health System and University Hospital
      734-232-0259 (direct line)
      734-936-6267 (pager # 36223)
      ceclee@med.umich.edu
      Be The Change…..

  6. “Imagine the fear of experience a medical emergency in a hospital where nobody looks like you, speaks your language or knows your culture.” It was eye catching when I read the first sentence of Dr. Pescovitz’s article. It is the voice of our Limit English Proficiency (LEP) patients and this is exactly how patients feel when they come to Emergency Department. I work with hundreds of elderly patients who are immigrants from China. Some of them told me that they transferred care to UMHS from different hospitals because our hospital speaks their languages. At University of Michigan Hospitals, we have dedicated professional medical interpreters assist LEP patients in communication with their care providers. They do not need to ask their adult children to take time off from work and interpret for them when they coming to see their doctors at UMHS.

    The provision of Culturally and Linguistically Appropriate Services (CLAS) is one of strategies that hospitals can help in “Pursuit of Health Equity and Inclusion.” I’m extremely proud to work at this world-class medical center. UMHS Interpreter Services’ Vision: Setting the standard for excellence in healthcare interpreting.

  7. This is article highlights great examples of cross-cultural medicine. These statements:”
    Imagine the fear of experiencing a medical emergency in a hospital where nobody looks like you, speaks your language or knows your culture. Imagine the frustration of having to choose between going to the doctor and buying groceries.Imagine the distress of being a parent who isn’t permitted to make care decisions for your child because your state doesn’t recognize your marriage and your partner is the legal parent via biology or adoption.”
    remind us of the humanity in medicine and the power we have to make a difference.

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