available, it’s unlikely that the patient will be able to follow
medical directions. In one case, a hospital staff relied
on the bilingual son of a Latino patient to explain the
Closing the details of her forthcoming hysterectomy. After the
Gap at Blue young man, appearing to point to the proper body
parts, translated for the doctors, his mother signed the
Cross and Blue consent form. But when the patient learned the next day
Shield of Florida that her uterus had been removed and she could no lon-
ger bear children, she threatened to sue the hospital.
Few states are as diverse as Florida. To close the The staff later learned that it can be considered im-
healthcare disparity gap for that rapidly changing popula- proper for a Latino male to discuss “private parts”
tion, Blue Cross and Blue Shield of Florida is dedicated to with his mother; what the self-conscious son had
becoming a culturally competent company, one that can meet explained to his mother is that doctors would
the needs of its customers regardless of their backgrounds. remove a tumor from her abdomen.
“As the state’s largest insurer and a not-for-profit company, Even when a translator is available, however,
our mission is to not only serve our customers but to also serve it doesn’t guarantee successful communication.
our communities,” says Randy Kammer, BCBSF vice president, Effective translation also requires a mutual
Regulatory Affairs and Public Policy. “A good place to start is to understanding of culture and context. To
recognize the impact of healthcare disparities on our communities.” best serve diverse communities, a number
BCBSF has invested $15 million since 2003 to recruit black, La- of organizations are investing in cultural-
tino and other underrepresented groups into nursing. A partner- competence training.
ship with historically black Bethune Cookman University allows for •Medical centers across the country are
expansion of its College of Nursing to accommodate a growing pro- regularly providing workshops to staff to
gram and to create a clinic for the underserved near the university. raise awareness of cultural differences.
An earlier million-dollar endowment created a consortium with his- •A new report from the Commonwealth
torically black Florida Memorial University, federally designated His- Fund recommends cross-cultural curricula
panic St. Thomas University and the University of Miami to increase be integrated into all graduate medical edu-
minority nurses in the community. cation to better prepare physicians to care
In 2005, BCBSF became the first insurer in the U.S. to offer Qual- for a diverse population.
ity Interactions™, a computer-based program that trains physicians •Last year, 21 hospitals, health systems,
to understand how different cultures respond to different infor- academic centers and healthcare associations
mation that might impact their treatment and health. participated in the Health Research and Edu-
“For instance, we learned that to some Chinese, the word cational Trust (HRET) Cultural Competence
‘cancer’ is taboo,” says Kammer. “If a Chinese-American brings Leadership Fellowship, a one-year program
his or her child to a visit as a translator, that child may not designed to address the needs of multicultural
be willing to tell the doctor his or her parent has cancer. A patients, develop diverse leaders and ensure
physician who is aware of that taboo may approach the effective clinician/patient communication. The
patient differently.” trust also created a Disparities Toolkit, an online
Teaming with Blue Foundation for a Healthy Florida, resource to help organizations gather accurate race/
BCBSF also supports a program to train hairdressers ethnicity and language data.
in black communities to talk to their clients about
the early-warning signs for diabetes and the im- Reflecting Diverse Communities
portance of exercise. Blacks, Latinos and Native Americans combined comprise
“Our investment in diversity will less than 9 percent of nurses, 6 percent of physicians and 5
result in healthier customers and
communities in the future,”
says Kammer. We must change the face of
med“icine to reflect our nation’s
—Dr. Darrell G. Kirch