2023 Acclaim Award Honoree

Accountable Health Communities Initiative

Acclaim Award honoree Utica Park Clinic was recognized for the following initiatives:

• Organizing patient focus groups to address issues and incorporate patient feedback into their practices’ workflows
• Dedicating a team of clinical care outreach staff to serving approximately 20,000 Medicare Advantage health plan members
• Opening “Wellness Points” where patients can receive services that do not require a visit with a provider, creating an environment that does not feel like a traditional medical clinic
• Establishing the Women@Company program to address issues facing women leaders in the organization
• Participating in local and national collaboratives, such as the American Cancer Society’s Breast Health Equity Program and the American Hospital Association’s Check. Change. Control. Cholesterol

Founded in 1982, Utica Park Clinic is a multispecialty medical group with 325 employed physicians and advanced practice providers representing 30 specialties. Annually, the practice sees approximately 260,000 unique patient encounters with over 700,000 annual visits.  Compassion for patients and families, respect for colleagues, accountability for performance, and community responsibility are the organization’s core values.

As part of the application process, each group was asked to detail their project narrative. See Utica Park Clinic’s narrative below.
 

Improving Health Equity for Marginalized Communities

Utica Park Clinic was named an honoree for the 2023 AMGA Acclaim Award. As part of the Acclaim Award application process, healthcare organizations are asked to submit narratives describing major system-wide initiatives that exemplify the goals of the award. One of the narratives from Utica Park Clinic’s application is summarized below.

The Zomi people are an ethnic minority from Myanmar, Bangladesh, and India, many of whom have found refuge from human rights violations in the United States. Tulsa, OK, is home to the largest concentration of Zomi people in our nation, where Zomi families have found comfort in surrounding themselves with familiar people and feeling welcomed in the community.

While there are many services available to these immigrants in the Tulsa area, there is a lack of healthcare services provided to them in their native language. Lack of this accommodation makes access to healthcare challenging, leading to frustration and untreated medical conditions. Often, parents were forced to bring their older English-speaking children with them to their medical appointments knowing that a Zomi interpreter would not be available on the language line.

Over the years, Utica Park Clinic has seen an increase in the need for translation services requested by the Zomi people, whose native languages are Zomi or Burmese (ZB). While Utica Park has highly trained, specialized, and educated healthcare professionals, it is difficult to have engaging and meaningful conversations about a patient’s health if they cannot fully understand the message being delivered.

Designing an Intervention

Utica Park’s goal was to find a way to provide a better, more engaging patient experience for the Zomi patients that would allow them to feel comfortable in seeking healthcare services provided by the medical group. 

Utica Park established arrangements with two major employers in the Tulsa area as their provider of choice. Both companies have a large Asian population, correlating with the Zomi population, at 35% and 40% per respective organization. Additionally, one of the largest local school districts saw the Zomi population percentage of their student census double in just three years.

In September of 2021, Utica Park hired a full-time Zomi/Burmese translator. In collaboration with the two major employers, they identified the ZIP codes where most of the Zomi population reside, allowing the medical group to determine in which clinic(s) the translator would have an office. The translator currently shares her time among three clinics. Before any process was formally adopted, it was critical to wait until the translator started to ensure the group was taking into consideration any cultural aspects that could affect services.

Implementing Change

Upon beginning employment, the translator spent time understanding the clinic workflows, went through extensive Epic training, met with providers and staff, and was introduced at various internal meetings. Utica Park essentially built these processes from scratch, from translating documents to figuring out a way to capture these visits in Epic. 

The translator spent time in the community collecting anecdotal testimonies of the Zomi people to understand what their pain points are their healthcare management. In her research, she identified several health concerns. At the top of their lists were diabetes, hypertension, lack of annual exams, and little to no understanding of preventive care. Basic instructions such as fasting for lab work, taking medications as prescribed, and making follow-up and/or specialist appointments were difficult tasks for the Zomi people to follow through with, simply because of a language barrier.

The translator began by translating key documents into Zomi and Burmese, including new patient paperwork, depression screening, OB/GYN and pediatric check-in forms, among many others. It was very clear to the translator that Zomi patients would only complete the top portion of the new patient paperwork because they didn’t understand the rest, making it difficult to understand medical history and identify chief complaints.

Once a loose process was in place, Utica Park created targeted marketing pieces in Zomi, Burmese, and English. These documents were shared with the aforementioned employer groups, local brokers and health plans, local school system counselors, Zomi and Burmese businesses and churches, and all internal staff. Once staff and patients began to realize the value of having the translator onsite during visits, she quickly became very busy.

Obstacles

Several obstacles emerged during the first few months. Initially, Utica Park believed the translator’s time would be best spent in the appointment with the patient and the provider. However, it became apparent that she needed to be at the window to greet the patient as they checked in, following the patient throughout the entire visit from beginning to end to ensure that no important steps were missed or misunderstood.

During downtime, the translator had patients schedule time with her to come into the office to fill out paperwork so they could be seen more quickly when they presented for a visit. She also began making reminder calls to the patients to instruct them on any visit-specific items. The translator also calls patients back with lab/test results, closes referral gaps in care, educates patients on provider instructions, and much more.

Once word was out that Utica Park offered this translation service, the news spread very quickly throughout the community. The group had to implement a system to ensure the translator was available when requested. Utica Park built a schedule in Epic so the translator could be selected as a “resource” to ensure she would be available for that patient and provider. Front desk staff began to make sure patients selected that a translator resource be added to their appointment and to document which language was requested.

Utica Park also encountered an obstacle within Epic that prevents them from gathering data real-time with this population. Epic does not have Zomi or Burmese listed as a selection for race or ethnicity, therefore making it difficult to get a clear picture of the total impact of this program. The translator has a process in place in which she keeps track of her daily activity, allowing Utica Park to capture growth and impact. The group has received countless patient testimonials of how lives have been saved and major costs have been avoided.

Lessons Learned

Utica Park quickly realized that their “loose” process had to be adjusted several times as patient volumes increased rapidly. Three months after the translator began employment, the group hired a nurse practitioner who was also fluent in Zomi and Burmese. This helped to alleviate some of the workflow challenges with the translator and the other providers with whom she was paired.

Another important piece of information was gained from this experience when the translator found that certain providers began to develop a passion for and understanding of this population. It was easier to schedule blocks of patients with those providers to maximize efficiency. During instances when the translator has a cancelation or a no-show, she has been available for telehealth with a provider in another clinic or with a specialist to whom she is not typically assigned. On several occasions, she has accompanied vulnerable patients to their neurology or chemotherapy appointments to ease their mind.

Sustainability of Program within the Organization and Community

This program has proven to be extremely valuable in manifold ways. Utica Park is now considered the provider of choice for this population, as they are the only health system in Oklahoma to provide this service. Although this is a unique subset of the overall population, the reality is that a large number of the Zomi people have built their lives in this country, state, and community. They have migrated their families here, have children, own businesses, and work in some of the top companies in the state. It only makes sense to offer a service that will not only help improve their health, but also the health of many generations to come.

Utica Park is improving the patient experience while also giving Zomi and Burmese families the opportunity to improve their health and their children’s health, which in turn allows them to thrive in the community. These communities are now invested in choosing the right healthcare benefits that their employers offer to ensure they can receive care where they know they will be understood. If they understand their health, they become better, healthier employees, and employers are happier because they know their employees will be taken care of.

Utica Park’s providers are extremely happy with their onsite translator. They no longer struggle and now find joy in knowing that patients walk away with a better understanding of their health issues and concerns. Patients ask questions more freely with the help of the translator, and countless lives have been saved due to this simple intervention. Patients are more adherent to their medications and follow through with follow-up appointments and specialty visits.

This program has brought great success to the community and organization. New patients are coming back for continued care. They are being contacted to discuss lab results, receive reminders for upcoming appointments, and refill necessary medications, a stark contrast to the countless unreturned voicemails left for the patients prior to this intervention. Referrals created by the provider and scheduled by the translator are followed through to ensure patients understand and seek the necessary care. 

As the program continues to grow, Utica Park is already seeing the need to possibly add another translator who is dedicated to specialty care appointments. In the meantime, the community, providers, and employers are ecstatic to have this unique and invaluable service available to them. The program will serve as a model to potentially put in place other culturally appropriate avenues to receiving adequate and proper healthcare.