Background about the Kaiser Permanente, San Francisco, CA

Background about the Kaiser Permanente, San Francisco, CA

In the early 1990s, studies showed that Asian populations were the least satisfied with their health care within Kaiser Permanente’s Northern California Region. As a result, many Chinese American-owned and -operated companies were exploring health care contracts with smaller managed care organizations that were marketing services targeted to Chinese American consumers. To understand this issue better, the San Francisco Medical Center embarked on the “Chinese Initiative.” Based on findings of this initiative, Kaiser Permanente established a department of multicultural services that provides on-site interpreters for patients in all languages, with internal staffing capability in 14 different languages and dialects. A Chinese interpreter call center is also available to help Chinese speaking patients make appointments, obtain medical advice, and navigate the health care system. A translation unit assures that written materials and signs are translated into the necessary languages. A cultural diversity advisory board was also established for oversight and consultation. In addition, Kaiser has developed modules of culturally targeted health care delivery at the San Francisco facility. The multilingual Chinese module and the bilingual Spanish module provide care and services to all patients but have specific cultural and linguistic capacity to care for Chinese and Latino patients. Both modules are multispecialty and multidisciplinary. They include, for example, diabetes nurses, case managers, and 11 health educators, with the entire staff chosen for its cultural understanding and language proficiencies. Much of the stimulus for this work came from the large purchasers of Kaiser health care services, who wanted culturally competent care for their employees. Not only had it become clear that culturally competent services made good business sense for Kaiser, but there was also a need to comply with Title VI of the Civil Rights Act and the Culturally and Linguistically Appropriate Services (CLAS) Standards.d Today, San Francisco Medical Center is recognized as a center of excellence for linguistic and cultural services. On a national level, Kaiser Permanente has a director of linguistic and cultural programs. The California Endowment recently awarded Kaiser a grant to assess the outcomes of these programs and validate model programs for linguistic and cultural services. Kaiser Permanente’s Institute for Culturally Competent Care now has six current and future centers of excellence, each with a different mission and focus: African American Populations (Los Angeles), Latino Populations (Colorado), Linguistic & Cultural Services (San Francisco), Women’s Health, Members with Disabilities, and Eastern European Populations. Each center can be used as a model and site of distribution for materials, such as the culturally specific provider handbook, to other Kaiser Permanente programs. Key Lessons Learned • Use publicity, market influences (including strategies to increase market share in diverse communities), and health care purchasers to stimulate the development of culturally competent services. • Be careful in mandating cultural competence initiatives as this may lead to resentment, poor adherence to policies, and superficial responses. • Employ multicultural managers to reflect the diversity of the staff and patients and to emphasize diversity throughout the organization. • Focus the entire organization on the opportunity to improve services and business as a whole, including improvement in patient satisfaction. • Implement systemic changes such as establishing a linguistically appropriate patient call center to help patients navigate the health care system. d The federal Office of Minority Health developed the Culturally and Linguistically Appropriate Services Standards project. See 12 • Establish a cultural diversity board that includes administrators as well as a multidisciplinary group of providers (i.e., doctors, physician assistants, nurse practitioners, and registered nurses) and community representatives to help guide the delivery of culturally competent care.


Evaluate the recommendations below and suggest additional ways in which the chosen case study’s service could be improved to meet the CLAS standards. Remember that the CLAS consists of 15 standards.  

For the case study, I selected the San Fransico Medical Center to investigate further. As I was looking at the US Department of Health and Human Services (HHS) CLAS standards website, I noticed that the Kaiser Permanente initiative of providing onsite interpreters met 3 of the 15 CLAS standards. The first standard that is met is the offering of language assistance to those who do not speak English or have other needs (HHS, 2023). With this standard, the language barrier is becoming nonexistent with the use of interpreters to help aid in the communication between the provider and patient. The second standard that is met is informing all individuals of the interpreter services that are available (HHS, 2023). This again is making the language barrier between providers and patients nonexistent. The third standard is ensuring the competence of the individuals that are providing the interpreting services (HHS, 2023). These individuals are trained in speaking a foreign language to translate between the provider and the patient. A way that these standards could be improved is if the San Francisco Medical Center provide handouts in different languages as well.

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