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Training staff to help gather data on patients' race, ethnicity and language

A few years ago, Cleveland-based MetroHealth noticed that although registration staffers were supposed to ask all patients their race, ethnicity and preferred language, it wasn't happening consistently enough.

“We realized we needed to support our frontline staff with the right information and resources to consistently and appropriately ask for this information,” said Lourdes Negron-McDaniel, director of inclusion and diversity at MetroHealth.

After all, knowing a patient's race, ethnicity and preferred language can help address the wide disparities that exist in healthcare.


This personal information can offer insight into the differences in quality of care given to people of different cultural and ethnic communities. It can also help policy experts and providers understand conditions that affect specific populations and then develop appropriate treatment programs, said David Engler, senior vice president of leadership and innovation at America's Essential Hospitals.

“What gets measured gets managed,” he said. With the data, “providers can identify variations in quality and hopefully tailor interventions to specific patient needs.”

In 2011, America's Essential Hospitals along with the American Hospital Association and the Association of American Medical Colleges called on all hospitals to begin to collect race, ethnicity and language data, also called REL data, after an AHA survey found only 18% of hospitals collected the information.

But hospitals said they have trouble gathering it in a consistent and sensitive way.

“We found that there wasn't any standardized way of data collection; hospitals were doing it in all sorts of fashions,” Engler said.

And so in 2015, America's Essential Hospitals with help from developer Multimedia in Project Japan created the Ask Every Patient: REAL Module. The web-based tool trains hospital registration staff to collect REL information from patients at check-in.


Identify facilities that are having trouble collecting race, ethnicity and language data from patients.

Train staff and standardize the questions that are asked and show them how to troubleshoot any potentially difficult conversations.

Let patients know you're collecting the information and how vital it is to improving their care and experience.

For example, the module asks the user to select the best way to ask a patient his or her preferred language from three options. The correct choice—in what language do you prefer to discuss your healthcare?—is highlighted with a green check mark when selected.

The module also helps navigate trouble. For example, if a patient becomes hostile or uncomfortable when asked for race or origin information, the hospital staff will be advised to tell the patient the data is vital to their care and will remain private.

MetroHealth identified about 2,300 staff members who would benefit from the REAL module and made it a required component of their annual training in 2015.

The health system then took it one step further and gave in-person training to staff at four sites with the highest rates of incomplete REL data. MetroHealth now monitors REL data every month to flag struggling sites and gives staff more in-person training.

MetroHealth wants to have REL data that is robust enough to address health disparities among its patients. For example, the system recently identified roughly 2,000 patients who use the emergency department exclusively for primary care. The system sent out patient navigators to tell the community about other care options available.

The module has also helped break down assumptions staff may have about race and ethnicity, Negron-McDaniel said.

It prompts the user to guess based on pictures who is of Hispanic or Latino origin. The exercise shows how hard it is to accurately assume someone's race or ethnicity, she said. “The biggest aha moment (from staff) was that you really have to ask each and every person their REL.”

To help patients feel more comfortable answering the questions, MetroHealth is reaching out to patients this quarter. The health system will provide educational handouts and signage that explains why registration staff will ask about their race, ethnicity and preferred language.



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