Spotlight On: The Manhattan Cross Cultural Group and the Quality Interactions Program

Despite the progress we have made as a society, stereotypes about race, ethnicity, and religion still too often affect assumptions made about racial and ethnic minorities, distorting social interactions and communication. This unfortunate tendency can have a profoundly negative impact on the ways in which healthcare professionals provide care to their minority patients, leading to poor treatment outcomes and other disparities. One way to improve quality of care is through education and training designed to provide physicians with not only information about specific conditions or treatments, but also knowledge and guidance that will help them become more culturally competent and, consequently, eliminate stereotypes and other preconceived ideas about patients of a different race or ethnic background. The success of such efforts will enable healthcare providers to treat each patient as an individual. This article will describe the development, implementation, and success of an educational curriculum designed by three thought leaders actively involved in cross-cultural healthcare to teach healthcare professionals to look beyond a patient’s race or ethnicity.

Taking the initiative

The May 18, 1999 issue of the Annals of Internal Medicine featured an important article titled “Cross-Cultural Primary Care: A Patient-Based Approach.” Written by Joseph Betancourt, MD, director of The Disparities Solutions Center and Director for Multicultural Education at Massachusetts General Hospital; Alex Green, MD, MPH, senior faculty member of The Disparities Solutions Center at Massachusetts General Hospital; and J. Emilio Carrillo, MD, MPH, vice president of Community Health Development at the New York-Presbyterian Hospital, the article outlined a curriculum on cultural competency for residency training. After the article was published, Betancourt, Green, and Carrillo decided to expand on their ideas and established the Manhattan Cross Cultural Group (MCCG), with the aim of offering training and research opportunities designed to improve the quality of healthcare provided to minority patients.

The MCCG curriculum forms the basis of Quality

Interactions^®, an online, patientbased, e-learning program that is easily accessible for healthcare professionals. Tessa Misiaszek, MPH, Chief Operating Officer of MCCG, says Drs. Betancourt, Green, and Carrillo “took the curriculum and made it into a very practical, easy-to-implement cultural competency training program online [so] physicians, nurses, administrators, and everyone working for healthcare organizations can access this training quite easily.” Green says the program’s focus “is not about the conditions or diseases, as much as just interacting with the patient in the setting or interacting with another individual.” To illustrate this approach, the program features three case studies that enable program participants to “see simulated patients, ask questions, and receive responses from the patients, while at the same time learn cross-cultural communication skills based on the [patient] interactions,” says Green.

Not just for clinicians

Although the Quality Interactions program was originally designed to help clinicians improve their understanding of and interaction with minority patients, MCCG decided to expand the targeted audience to non-clinicians, such as office staff, hospital administrators, and employees working in insurance companies. Misiaszek says the program has “been broadly used to train physicians and nurses,” and that the non-clinical program, which was released a few years ago, is “being used to train a lot of general employees at healthcare organizations.” In fact, health insurance companies, such as Aetna, Blue Cross/Blue Shield Massachusetts, and Blue Cross/Blue Shield Florida, require all of their employees to participate in this program.

Success

Since the adoption of the Quality Interactions program in 2004, Misiaszek says “8,000 physicians and nurses have participated, in addition to [approximately] 1,500 non-clinical staff.” She also says MCCG is reaching out to other healthcare organizations, insurance companies, hospitals, and academic institutions and promoting the interactive, online program as an effective means of

helping increase the quality of healthcare provided to minority patients. MCCG has created two additional ways to continue the education of physicians and nurses who have already participated in the Quality Interactions program: 1) Quality Interactions refresher courses, which feature a single case study to help “reinforce the major concepts learned in the two-hour course”; and 2) Quality Interactions e-newsletters, which feature “updates on current issues in cross-cultural care, [and] provide case vignettes linking back to the same teaching points discussed in the original program,” explains Green.

This is why it matters

It is important that all physicians, nurses, case managers, and non-clinical healthcare professionals evaluate how they interact with patients of a different race or ethnicity, because according to the Census Bureau, there are approximately 100.7 million minorities live in the United States. As this number grows, it will become more important for healthcare professionals to be aware of the issues and challenges involved in treating multiple patient populations. Green says, “It is very important to understand who it is we’re serving in our hospitals and our institutions.”

Healthcare professionals who complete the patient-based Quality Interactions program can take what they learn—about effectively communicating with patients and the importance of understanding and respecting a patient’s cultural background—and apply it for the betterment of their practice. Drs. Betancourt, Green, and Carrillo created this program “to develop cultural

competency training that was more skills-based and case-based to teach physicians a set of tools and skills so they could interact with a patient from a diverse, cultural background.”

Additional Resources

Aetna launches tools to improve cross-cultural awareness, communication among healthcare providers

Blue Cross and Blue Shield of Florida offers new program to promote cultural competence

Cross-cultural medical education: conceptual approaches and frameworks for evaluation

Fostering patient-provider relationships

Integrating social factors into cross-cultural medical education

New online cultural competence training program offers patient-based learning