Recruiting, Communication Challenge Hospital

Recruiting doctors, nurses, therapists and aides is one of the biggest issues Cal Hiner faces as administrator of Tri-County Hospital in Lexington. And recruiting bilingual staff to serve the hospital's many Hispanic and African patients is even more difficult, though improving communication is a priority.

Hiner, who has headed the hospital for 25 years, saw Lexington undergo profound and significant changes when Iowa Beef Processors (IBP) bought the old Sperry-New Holland plant in 1990. The demographics of Lexington changed so significantly that the town is a completely different place than it was 20 years ago, he said. Now, the community is 50 percent Hispanic. A few people from Sudan and Somalia have also moved to Lexington to work at what is now Tyson Fresh Meats, Inc. Because of the Sudanese and Somalis, Swahili and Arabic languages have been introduced to the community in addition to Spanish. There is talk that people from other countries will soon move into Lexington, bringing even more languages and cultural complexities to this south-central Nebraska community of 11,000.

Hiner clearly remembers when he thought he had secured a married couple - both doctors - to move to Lexington to practice medicine in 1989 or 1990. When he learned that IBP planned to remodel the Sperry-New Holland plant as a beef processing facility, Hiner called the couple to tell them the news. Initially, they said it wouldn't bother them. But within two weeks, Hiner had received a letter from the couple saying they had decided not to come, suggesting that the change in the community did not meet their requirements for a place to live and raise a family. They told Hiner they didn't think they were racist, but they realized they were.

"One of the hardest things to do here is to recruit young professionals to come here and raise kids.

"And that's how it began," he said, referring to the difficulties in attracting skilled workers to Lexington. "One of the hardest things to do here is to recruit young professionals to come here and raise kids," he said, not unlike many smaller communities. For example, it took two years to recruit an additional physical therapist. Hiner said he doesn't think they'll ever find any bilingual nurses; "they're in Mexico. They don't have any reason to leave."

Communication issues are important, but difficult to manage. The hospital employs three bilingual interpreters full-time and one bilingual nurse aide. Lexington has one bilingual doctor. Hiner said the hospital staff finds it difficult to provide the same care to non-English-speaking patients as to English-speaking patients. "A component of the notion of quality care is that everyone gets the same care regardless of their status of insurability or color. That's not always all that easy to do. You understand English, but another person doesn't understand English-so are we going to be able to serve this patient who can't speak English as well as we can serve you? We need to be able to say we do that, but there are times when we can't say we do," he said.

Hiner isn't optimistic about the hospital's ability to attract interpreters who speak Swahili, Dinku, Arabic or any of the other languages spoken by the newest arrivals in Lexington, though the hospital continues to try.

The communication issue hinders the hospital's efforts to provide health education, as well. The Hispanic population is young, and there are many births in that age group. And, Hiner said, the Hispanic population has a high rate of diabetes, so the hospital provides diabetes education as well as prenatal education. Participation in these sessions isn't good enough, but is getting better. "Another thing they have to learn is to trust us," he added. He that trust will come over time, as the hospital continues to move forward and provide outreach services.

Cultural issues such as family involvement and adherence to a time schedule are other obstacles the hospital faces with both the Hispanic and African residents. A patient may arrive a couple of hours late for an appointment and expect to receive services, Hiner said, but is difficult to accommodate that sort of scheduling. "It just doesn't work," he said.

The Hispanic culture also enjoys doing things together, but Tri-County Hospital isn't set up to handle the many family members who often accompany patients to appointments, births and surgeries. The solution appears to be a new waiting area for family, which is part of the new construction the hospital is planning.

Within the next four years, Tri-County Hospital construction plans include the addition of the new waiting area, and also an expansion of the radiology department with a new MRI, an expansion of the lab, a new surgery wing, a new dietary department and an expansion of specialty clinics and health information. Part of the planned improvements have already begun, Hiner said; "we're stretching ourselves a bit to see that we have electronic medical records and a filmless radiology department." Tri-County will soon have digital mammography, too; one of the first hospitals in the region to have it.

"We're never going to have a lot of the things larger hospitals have, but we're trying to match our technology with our primary-care role and trying to keep current and on the cutting edge," Hiner said.

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