In January 2012, Sanford Health, based in Sioux Falls, S.D., and Fargo, N.D., established its first primary care clinic in Ghana through its program Sanford World Clinic. Under this initiative, Sanford is establishing pediatric and family care clinics in areas in the U.S. and across the world that lack adequate primary care services. In addition to building models for sustainable primary care, Sanford embarked on this global health initiative to gain insight into new healthcare delivery processes.
Cultural sensitivity
"One of the reasons we made the [Sanford World Clinic] proposal was to learn from the country and world on how we could deliver healthcare better," says Ruth Krystopolski, executive vice president for development and research at Sanford Health. Rather than forcing a new model of care on other communities, the Sanford World Clinic team worked with communities to understand the most effective way to integrate primary care into their culture. For example, Sanford hires healthcare providers from the local community to staff the clinics.
Understanding how healthcare is provided in other countries requires cultural sensitivity — a recognition that the "U.S. way" isn't necessarily the "best way," and that all cultures are valid. "It was a real learning experience in adapting to cultures and challenging ourselves to say, 'A different way can be just as effective, and potentially more effective, [than our way],'" says Jim Slack, vice president of Sanford World Clinics.
Sanford has learned a cultural sensitive approach by working with diverse populations of patients in South Dakota and Nebraska, which has a large Native American population. "We had to be sensitive to their specific needs from a religious, cultural and family [standpoint]. As we've looked to other countries, we've taken the learnings from working in our own area and made sure we listen in each of the areas we've gone to," Ms. Krystopolski says. "You have to be open and listen to individuals working on the ground that live there and grew up there who truly understand the cultural dynamics."
3 lessons
Ms. Krystopolski and Mr. Slack share three lessons Sanford has learned through its work in Ghana and other countries.
1. There is a great need for access to primary care. "One thing that's been consistent across the board is there are great needs in pediatric primary care," says Ms. Krystopolski. "Access to general primary care is a huge need both in areas of our country and abroad." In addition to working in Ghana, Sanford World Clinic has established primary care clinics in Duncan, Okla., Klamath Falls, Ore., and Oceanside, Calif.
2. Implementing electronic medical records across state and country lines is complex. Sanford began implementing EMRs in its clinics in Ghana in July 2012. While the benefits are significant — the EMR shortens wait times for registration and streamlines workflows — Sanford needed to modify its software specifically for its clinics in Ghana, according to a Sanford World Clinic quarterly report.
3. Different patient flow models can be effective. Patient flow is one of the biggest differentiators between how primary care is delivered in Ghana and U.S. clinics, according to Mr. Slack. In a U.S. primary care office, typically a nurse preps patients followed by the physician rotating to different rooms to address patient needs. In Ghana, the provider remains stationary in one room while patients queue to see the provider outside exam rooms.
"One of our learnings is you don't have to move providers to create efficiency in patient flow," Mr. Slack says. "We changed our workflows in Ghana to support an efficient, effective patient flow. Now, we queue patients up for nurses in the vitals area, followed by a workflow to see the healthcare provider. As a patient finishes, the next one walks in unprompted. Through this mechanism, we're seeing in excess of 100 patients a day per provider — a volume at least double, if not triple or quadruple, what a U.S. physician is able to see."
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Cultural sensitivity"One of the reasons we made the [Sanford World Clinic] proposal was to learn from the country and world on how we could deliver healthcare better," says Ruth Krystopolski, executive vice president for development and research at Sanford Health. Rather than forcing a new model of care on other communities, the Sanford World Clinic team worked with communities to understand the most effective way to integrate primary care into their culture. For example, Sanford hires healthcare providers from the local community to staff the clinics.
Understanding how healthcare is provided in other countries requires cultural sensitivity — a recognition that the "U.S. way" isn't necessarily the "best way," and that all cultures are valid. "It was a real learning experience in adapting to cultures and challenging ourselves to say, 'A different way can be just as effective, and potentially more effective, [than our way],'" says Jim Slack, vice president of Sanford World Clinics.
Sanford has learned a cultural sensitive approach by working with diverse populations of patients in South Dakota and Nebraska, which has a large Native American population. "We had to be sensitive to their specific needs from a religious, cultural and family [standpoint]. As we've looked to other countries, we've taken the learnings from working in our own area and made sure we listen in each of the areas we've gone to," Ms. Krystopolski says. "You have to be open and listen to individuals working on the ground that live there and grew up there who truly understand the cultural dynamics."
3 lessonsMs. Krystopolski and Mr. Slack share three lessons Sanford has learned through its work in Ghana and other countries.
1. There is a great need for access to primary care. "One thing that's been consistent across the board is there are great needs in pediatric primary care," says Ms. Krystopolski. "Access to general primary care is a huge need both in areas of our country and abroad." In addition to working in Ghana, Sanford World Clinic has established primary care clinics in Duncan, Okla., Klamath Falls, Ore., and Oceanside, Calif.
2. Implementing electronic medical records across state and country lines is complex. Sanford began implementing EMRs in its clinics in Ghana in July 2012. While the benefits are significant — the EMR shortens wait times for registration and streamlines workflows — Sanford needed to modify its software specifically for its clinics in Ghana, according to a Sanford World Clinic quarterly report.
3. Different patient flow models can be effective. Patient flow is one of the biggest differentiators between how primary care is delivered in Ghana and U.S. clinics, according to Mr. Slack. In a U.S. primary care office, typically a nurse preps patients followed by the physician rotating to different rooms to address patient needs. In Ghana, the provider remains stationary in one room while patients queue to see the provider outside exam rooms.
"One of our learnings is you don't have to move providers to create efficiency in patient flow," Mr. Slack says. "We changed our workflows in Ghana to support an efficient, effective patient flow. Now, we queue patients up for nurses in the vitals area, followed by a workflow to see the healthcare provider. As a patient finishes, the next one walks in unprompted. Through this mechanism, we're seeing in excess of 100 patients a day per provider — a volume at least double, if not triple or quadruple, what a U.S. physician is able to see."
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