Debbie Salas-Lopez

Defining and Targeting Health Care Access Barriers

The impact of social and economic determinants of health status and the existence of racial and ethnic health care access disparities have been well-documented. This paper describes a model, the Health Care Access Barriers Model (HCAB), which provides a taxonomy and practical framework for the classification, analysis and reporting of those modifiable health care access barriers that are associated with health care disparities. The model describes three categories of modifiable health care access barriers: financial, structural, and cognitive. The three types of barriers are reciprocally reinforcing and affect health care access individually or in concert. These barriers are associated with screening, late presentation to care, and lack of treatment, which in turn result in poor health outcomes and health disparities. By targeting those barriers that are measurable and modifiable the model facilitates root-cause analysis and intervention design.

Understanding the Role of the Promotora in a Latino Diabetes Education Program

We explore the role of the promotora de salud (health promoter) who provided diabetes self-management education to Puerto Rican diabetics in her community. The education program was developed as a hospital and community-based organization partnership. Information from both Spanish-language focus groups with 35 class participants and an in-depth interview with the promotora indicated patients appreciated having the classes taught in Spanish by a Latina promotora from their community. Respondents reported satisfaction with the program, increased ability to self-manage diabetes, and strengthened connections with other Latino diabetics. Terms patients used for the promotora included comadre, hijita, and buena profesora. Some of these words denote almost kinship-level connections, suggesting that patients were forming strong connections with the promotora. Specific promotora roles were identified but varied among patients, promotora, and the literature. This hospital and community-based organization partnership promotora model appears to be effective for providing chronic disease self-management education in an urban community setting.

Developing a Culturally Competent Health Network: A Planning Framework and Guide

EXECUTIVE SUMMARY The number of cultural competency initiatives in healthcare is increasing due to many factors, including changing demographics, quality improvement and regulatory requirements, equitable care missions, and accreditation standards. To facilitate organization‐wide transformation, a hospital or healthcare system must establish strategic goals, objectives, and implementation tasks for culturally competent provision of care. This article reports the largely successful results of a cultural competency program instituted at a large system in eastern Pennsylvania. Prior to the development of its cultural competency initiative, Lehigh Valley Health Network, Allentown, Pennsylvania, saw isolated activities producing innovative solutions to diversity and culture issues in the provision of equitable care. But it took a transformational event to support an organization‐wide program in cultural competency by strengthening leadership buy‐in and providing a sense of urgency, excitement, and shared vision among multiple stakeholders. A multidisciplinary task force, including senior leaders and a diverse group of employees, was created with the authority and responsibility to enact changes. Through a well‐organized strategic planning process, existing patient and community demographic data were reviewed to describe existing disparities, a baseline assessment was completed, a mission statement was created, and clear metrics were developed. The strategic plan, which focused on five key areas (demographics, language‐appropriate services, employees, training, and education/communication), was approved by the networks chief executive officer and senior managers to demonstrate commitment prior to implementation. Strategic plan implementation proceeded through a project structure consisting of subproject teams charged with achieving the following specific objectives: develop a cultural material repository, enhance employee recruitment/retention, establish a baseline assessment, standardize data collection, provide language‐appropriate services, and develop an education program. Change management and project management methodologies; defined roles and responsibilities; and specific, measurable, attainable, realistic, and time‐bound goals were used in the implementation. This process has supported organizational change, thereby promoting high‐quality, safe, and equitable care through widespread expectations of culturally competent care delivery across the entire network. Using this “ecologic approach” will ensure longterm success.

Getting Published in an Academic-Community Hospital: The Success of Writing Groups

Expressed barriers to writing for publication include lack of time, competing demands, anxiety about writing and a lack of knowledge about the submission process. These limitations can be magnified for practitioners in non-university environments in which there are fewer incentives or expectations regarding academic publication productivity. However, as members of professional disciplines, practitioners have both the responsibility and, oftentimes, the insights to make valuable contributions to the professional literature. Collaborative writing groups can be a useful intervention to overcome barriers, provide the necessary skills and encouragement as well as produce publications and conference presentations that make worthy additions to the professional body of knowledge. This article discusses the evolution and outcomes of writing groups at Lehigh Valley Health Network and describes how this strategy can be adopted by other academic community hospitals to promote professional development and publication.