Better for Everyone

Laying the foundation for health care environments that welcome every Minnesotan.

By Mark Engebretson

Minnesota is no longer the land of Scandinavians, if it ever was. It has become much more diverse in recent years. But is health care delivery changing to meet the needs of the new Minnesotans?

Yes—incrementally, at least—due in part to the University of Minnesota program “Better for Everyone: Improving Health Care Environments for Multicultural Communities.”

Developed by the Densford International Center for Nursing Leadership in the School of Nursing, the program was designed to create a more welcoming health care environment for all people—while ultimately reducing health disparities. The program kicked off with a three-and-a-half-day workshop last fall attended by 19 health care managers and was completed in June.

“We have more and more challenges in terms of creating health care systems to accommodate a really diverse array of people—not just different cultures, but differences in sexual orientation, religious preference, political preference,” says Joanne Disch, interim dean of the School of Nursing and director of the Densford Center. “Minnesota is becoming increasingly diverse, yet I was seeing health care organizations trying to fit everyone into the white, middle-class Minnesota model of health care—and that just doesn’t work.”

In the short term, Disch had hoped her program could at least prompt awareness. It appears to be working.

At North Memorial Hospital, nurse manager Susan R.B. Kreatz helped spread awareness by creating a poster board that outlined the first steps to creating a culturally competent organization. The poster presentation was part of North Memorial’s Magnet Fair in May. She’s also worked with others in her unit to develop a poster demonstration of an ethical dilemma involving a patient of color, and is circulating a set of video vignettes to colleagues that identify common problems in communicating with diverse patients.

Ultimately, Kreatz hopes to make multicultural competence a strategic goal for North Memorial. “I won’t be able to do it alone, but I have the total support of the administration,” she says.

Karen McConville, clinical director for maternity care at HealthEast, gained insights from Disch’s program that helped her and a colleague as they were developing a Hispanic clinic in St. Paul.

“We found that you didn’t have to launch a huge program,” McConville says. “There are many little things that you can do to make a difference.” Posting signs in different languages and placing art work from various cultures around the hospital, she says, helped create an “atmosphere of hospitality.” HealthEast also plans to hire a director of diversity.

“I was amazed by this group of people in the sense that they’re either in middle management or staff positions and yet they are very involved in change,” says Jim Begun, the James A. Hamilton Term Professor of Health Care Management in the University’s Carlson School of Management, who sat in on the workshop. “I was impressed by the positive force—the emphasis on what works, as opposed to what the barriers are.”

“Managers are the ones who really influence what goes on in a work area,” Disch says. “I felt that if we could work with them on a one-to-one basis, maybe we could create some real changes.”

The next step for Disch is to develop a sustainable model for moving the program forward. The initial program was funded by grants from the Edwards Memorial Trust, Anna Heilmaier Foundation, Children’s Health Care, and the Blue Cross Blue Shield of Minnesota Foundation. Disch anticipates creating an annual continuing education program funded by fees from participants or providing a focused program for heath care systems. The long-term goal is to decrease health disparities.

“If we can create an environment where people feel welcome, where they feel that caregivers care about them, then they’ll come back and they will seek health care and maybe they will improve their health.”