Creating incentives for cultural competence training: The role of financial rewards and employment agreements

Lutheran HealthCare (LHC), located in Brooklyn, New York, has been engaged in cultural competence efforts since 1995.  Lutheran HealthCare is a network of community and health services composed of: 1) a 465 bed level one trauma center, 2) a nine site federally qualified health center network with close to 600,000 visits, 3) a 240 bed nursing home, 4) 3 senior citizen housing with close to 700 units of subsidized housing, 5) Health Plus- a Medicaid managed care company and 5) community services such as daycare services, ESL and GED classes  and senior services such as meals-on-wheels.  Sunset Park, Brooklyn where the hospital is located, has a long history of being a community of new immigrants and is now home to the Hispanic, Chinese, Arabic, and Russian communities amongst others.  With a mission to “serve the community”, LHC has striven to provide culturally and linguistically competent services to its community and neighbors long before it was popular to do so. 
     LHC began its journey in 1995 with a Cultural Competence Task Force made up of all levels of staff and representative of the various cultures of the patient population.  In 1997, a position of Cultural Initiatives Coordinator was created to coordinate cultural competence activities.  In 2004, the commitment to cultural competence was further demonstrated when a Vice President of Cultural Competence, reporting to the CEO/President of the hospital was created.  One of the main areas of focus was identified as human resources.
    The human resources department began incorporating cultural competence as a departmental goal and focused on numerous objectives including: data collection, recruitment and retention of bilingual staff, outreach and collaboration with community-based organizations, skills assessment, and cultural competence and medical interpreter training.  Through continued efforts and strategic planning, outcomes include: data and goals on staff language capabilities; workshops in the various communities regarding health careers and training; increased bilingual staff; cultural competence measures in job descriptions and evaluations; and numerous cultural competence trainings including 2 mandatory trainings for all staff.     
    These efforts would not have been possible without the collaboration and support of organized labor, 1199 SEIU.  The union has supported the recruitment of bilingual staff including changes in job postings and descriptions.  1199 has been a major supporter of medical interpreter training, assisting in providing funds for training and organizing a major conference to high light the need for training.  When there was a need for Chinese-speaking certified nursing assistants (CNA), LHC and the union piloted a program to train Chinese-speaking home attendants to become CNA’s.   The program was very successful and now continues citi-wide to provide bilingual cna’s to all hospitals.  The union has supported LHC’s efforts to be more culturally competent through support for staff cultural competence training.  This has included collaborative and successful efforts to obtain funding of close to one million dollars for the mandatory cultural competence trainings for all staff.       
    These efforts to improve services and be culturally competent are a primary focus of the work at LHC.  The partnership model with the union has not only improved labor relations but is an integral part of the cultural competence objectives of the organization.  It is one model of how an organization can try to be responsive to the diverse community that it serves.