Second National Conference on
Quality Health Care for Culturally Diverse Populations:
Strategy and Action for Communities, Providers, and a Changing Health System

1-4. Leadership, The Business Case, And The Challenges Of Being A Culturally Responsive Organization

Diversity Health: Marketing a Change Process in the Public Sector Health Environment

Topic Area
The Multicultural Health Unit (MHU) of the South Eastern Sydney Area Health Service (in Australia) has embarked on a major overhaul of the traditional Australian multicultural health model that emerged from the 1970's and 1980's. The MHU is promoting a model of diversity health rather than focusing exclusively on aspects such as migration history or linguistic and cultural differences.More specifically, the MHU is promoting a marketing-driven model of staff and managerial involvement in a range of aspects of diversity within the overall health service environment. These aspects include an open acknowledgement of and active interaction with communities often ignored by the traditional multicultural model such as:

• The Deaf community as a cultural and linguistic minority;
• Different faith (especially non-Christian groups such as Jews, Muslims and Buddhists) communities represented in the Area and;
• Communities where disabilities are an issue in terms of accessing health care (e.g. specific physical and intellectual conditions).

In addition, the Area is promoting an active learning environment for language skills on the part of staff, rather than simply focusing on some client's lack of fluency with English. This includes developmental modules in Cantonese, Mandarin and Auslan (Australian Sign Language) with a more extensive program under development.The overall strategy is to remove the key focus from one of looking at the patients' inability to access or maximize their use of the system. Instead the aim is to address the potential of health services and staff to better equip themselves to address the complete needs of their patients where this includes communication, religious requirements, physical and mental supports and so on.

Successes of Program
While this is a work in progress, many staff already relate well to a cultural competence model that addresses diversity rather than exclusively and narrowly defined concepts of culture and language. Two programs which are developing quickly and effectively include:

- Staff skills for working with diverse clients including workshops, seminars and conferences;
- Project grants funding for innovative projects in diversity health.

Another key developmental area that has been poorly executed in Australia to date is the ability to conduct and build a research agenda focusing on these issues. This is a priority in the coming year.

Challenges
The challenge for this Area Health Service is to develop and institutionalize this model. Current indicators are very positive but the longer-term strategy is to ensure broader and deeper buy-in on the part of staff and facilities. This must involve rewards as well as enforcement.

Practical Advice
The current focus of this Unit, with limited funds and staffing, is on developing commitment amongst staff, management and facilities to this new approach. The policy-driven approach on its own has failed to achieve meaningful involvement across the health system and we must seek to gain willing participation that has benefits for staff, patients and communities.

Hamish Robertson is a New Zealand citizen currently living in Australia, where he has been resident for 8 years. Hamish has a BA (Hons) in Geography and is currently enrolled in his MPH (Research) at the University of New South Wales. He is also co-author of two publications in the multicultural field; "Best Practice in Managing a Culturally Diverse Workforce" and "Open Up! A Guide to Cultural Diversity Visitor Studies." Hamish has worked in the telecommunications, media and insurance industries before coming to Australia. Since then, he has worked in private sector consultancies on multicultural research and marketing projects as well as for public sector research and communication strategies. In his current role, Hamish has initiated a number of new programs and initiatives including:

• Spiritual assessments in health care;
• Language learning for staff (Mandarin, Cantonese and Australian Sign language);
• Traditional Chinese Medicine and;
• Health and the Jewish community strategy (including Holocaust Survivors).

He is currently working with colleagues on the development of a comprehensive languages strategy for South East Health that includes interpreters, translations, bilingual staff, bilingual health professionals and second language acquisition for health professionals.

Hamish Robertson
Program Manager Marketing and Communications
Multicultural Health Unit
South Eastern Sydney Area Health Service
PO BOX 747
Randwick NSW 2031
Australia
Phone: + 61 2 93823355
Mobile: + 61 2 0413 742 622
Fax: + 61 2 9382-3353
Email: robertsonh@sesahs.nsw.gov.au
http://www.sesahs.nsw.gov.au/multicult/

John O'Brien commenced his health care career at The Cambridge Hospital in 1976, worked his way through the ranks to become Chief Financial Officer in 1984 and finally to Chief Executive Officer in 1986. During Mr. O'Brien's tenure as CEO, The Cambridge Hospital has undergone a dramatic transformation. Saddled with a $10 million deficit in 1987, the Hospital has reinvented itself by forming a unique partnership with its community, has restored its financial health and has become a model for building healthier communities. In 1991, The Cambridge Hospital achieved a break-even position and has been in the black ever since. In August 1993, Mr. O'Brien accepted on behalf of the staff of the Hospital, The Foster G. McGaw Prize at the American Hospital's Association annual convention in Orlando, Florida. This coveted award is given by the American Hospital Association and the Baxter Foundation to a single hospital in the United States each year, which displays its utmost commitment to improving the health status of its community through a myriad of programs. In April 1994, Mr. O'Brien received the 1994 CEO Award from the American Hospital Association's Society for Healthcare Planning and Marketing. This award is presented annually to one CEO in the United States who demonstrates excellence in the development and support of an effective strategic planning and marketing function, and who consistently communicates the mission, vision, and strategic plan to all levels of the organization.Currently, Mr. O'Brien serves as the Chief Executive Officer of a recently created public authority known as the Cambridge Health Alliance, which is comprised of two acute care hospitals (The Cambridge Hospital and Somerville Hospital), a skilled nursing facility (Neville Manor), the City of Cambridge Public Health Department and over twenty primary care sites. He also serves as the Commissioner of Public Health for the City of Cambridge.Mr. O'Brien is a graduate of Harvard College and received his Masters degree in Business Administration at Boston University. Mr. O'Brien is the Chair-Elect of the National Association of Public Hospitals, and is the Past-Chairman of the Board of Trustees of the Massachusetts Hospital Association.

John O'Brien
Chief Executive Officer
Cambridge Health Alliance
1493 Cambridge Street
Cambridge, MA 02139
Phone: (617) 665-1001
Fax: (617) 498-1003
Email: Jo'brien@challiance.org

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