MONTEFIORE MEDICAL CENTER FINAL PROJECT 2

Montefiore Medical Centre Final Project

Montefiore is a non-profit academic healthcare centre located in Bronx, New York City.
The largely poor Bronx community forms the bulk of the patients that it serves. To keep costs
low and improve general quality of life for the community that it serves, Montefiore prioritizes
prevention strategies to deal with some of the chronic conditions that are common in the
community such as diabetes, asthma, HIV, and hepatitis c. This paper looks at the hospital’s
patient engagement activities and communication strategies, health promotion and disease
prevention strategies, and then its financial incentives and quality improvement processes.
Lastly, it provides recommendations for policies to help the centre offer culturally sensitive,
prevention-focused, and low cost healthcare.

Patient Engagement Activities and Communication Strategies at Montefiore
Montefiore has put in place patient strategies and activities aimed at enhancing patient
engagement. Just as stated in the organization’s mission and vision statements, it addresses
problems encountered by the diverse patients, hence showing its dedication to providing patient-
centered care and one that meets the social needs of its vulnerable patient population.
Translation services are provided to the patients, especially the 52.7 percent and 28.9 percent of
patients in the Bronx and New York City, respectively, who are non-English speakers (Chase,
2010). Most of the network management skills on the organization’s system have been
translated. Such translational services enhance access to care, as well as patient education.
The medical organization is committed to fulfilling the diverse needs of the patients. For
instance, it has a blend of low-tech and high-tech fixes that helps it achieve success when dealing
with its vulnerable population. It has produced educational materials that do not only aim at

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educating the English speakers in the patient population but the non-English speakers as well.
According to the case study, “Outreach workers have designed education materials to
communicate with the diverse needs of the population based on cultural, language, and
education-level needs” (Chase, 2010). However, it is not quite clear how exactly the
organization is providing these materials. For instance, apart from the translational services that
are provided, it is not quite clear whether there are printed materials that are written in other
languages other than English. Also, if such materials are available, the plan on how they are
distributed to the patient population is not stated in the case study.
The medical staff at Montefiore Medical Center deal with complex social and medical
conditions. Thus, the staff is anticipated to go past conventional methods to provide solutions to
these complex issues. The organization manages through the provision of staff training that
focuses on issues such as social needs and chronic medical care. Training takes place in
different ways. For instance, there is a team that trains specialists in different fields, such as
obstetricians and pulmonologists (Chase, 2010). The training aims to ensure that the team
delivering services to the patients integrates clinical knowledge and skills deeper into the system.
Teams have even visited developing nations to get first-hand information and skills on how to
offer care to patients with the use of minimal technology. The philosophy has transformed
critical care at Montefiore Medical Center, “It’s not the technology; it’s the people.” As such,
staff members are trained to provide critical care in spite of the prevailing external conditions.
Overall, even though the organization has put in place strategies on how to engage
patients, there still exist gaps that need to be filled to ensure that the patient experience is
improved. First, the organization deals with a disproportionately sick and poor population. It
needs to come up with policies aimed to help alleviate poverty among the population it serves as

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one way of enhancing its social responsibility towards the people. Although it is a not-for-profit
organization, the organization has not put in place policies that will enable it to provide
education to its patients on healthy living options and how to maintain good health despite their
low-income levels. However, other than the identified gaps, there is an effort from the
organization to ensure that it provides the best critical care to the patients.
Health Promotion and Disease Prevention and Management Strategies at Montefiore
Montefiore has established itself as a patient-centered organization whose main objective
is to make preventive care accessible to patients who need both chronic and acute care and direct
them on how to seek specialty care when the need arises and follow up on cases of patients
recommended to take certain tests. The organization makes an effort to promote healthy
lifestyles among its patient population. For instance, it addresses challenges related to nutrition
and dietary choices, especially related to obesity, by conducting healthy cooking demonstrations.
Patients mainly are from a vulnerable population, whose dietary choices may affect their health
negatively. As a result, staff members demonstrate how to make healthy meals in the facility’s
waiting room. Further, the organization employs health educators who provide reading programs
for young patients. The organization’s leadership has started a weekly market for farmer’s
produce, where they provide vegetables and fruits to locals in the neighborhood (Chase, 2010).
Also, it has worked in collaboration with other community groups with similar interests to fund
the creation of green markets in the Bronx. Such efforts are encouraging people to eat more
fruits and vegetables and make healthy dietary choices, thus promoting healthy living.
Montefiore Medical Center has demonstrated its commitment to the prevention and
management of diseases. It has put in place a robust information technology system that

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enhances its provision of integrated care. The availability of ambulatory services has extended
access to more areas in the locality, thus improving the management of chronic diseases.
Additionally, a huge investment was made to have a phone network that is used by staff and
patients in managing patients with heart attacks. All team members of cardiology catheterization
carry the phone, and there is one phone in the Emergency Department (ED) (Chase, 2010). The
phone network has been effective in providing access when necessary. Also, there are dedicated
pagers that are carried by all team members, and they are activated whenever there is an alert
from the ED physician. It makes the delivery of home services efficient.
The organization also offers non-programmatic services to patients that have helped
improve health among members of the vulnerable population. Children have access to primary
care regardless of their ability to pay, and this has been effective in raising school completion
rates. It provides full-time primary services in schools, and this has promoted the health of
school-aged children. Obesity has been an issue among children, with an estimated forty percent
of the children population in the Bronx having been reported overweight. In response, the staff
at the organization has launched a campaign to provide low-fat milk in schools. Consequently,
whole milk in schools has been replaced with low-fat milk, and the overall health of children has
improved. Besides, there are “comfort rounds,” which have enhanced the overall response to the
needs of patients (Chase, 2010). Emphasis has been put on clinic sites, and this ad helped the
medical center to understand the needs better and create solutions to them.
Overall, the organization has put in place measures that have helped prevent diseases
through the application of different management strategies. Even though there exist certain
deficiencies that need to be addressed to improve disease management and prevention. First,
there is a need to have onsite ambulatory services for schools as this will ensure that children in

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need of emergency care receive it in real-time. Also, there is a need for programs that can
enhance physical exercises in schools to help avert cases of obesity in children.
Financial Incentives and Quality Improvement Processes at Montefiore

Montefiore’s population health approach
Due to poverty and poor living conditions, the population that the facility serves suffers
from many diseases that are associated with poverty such as diabetes, HIV, hepatitis C, and
asthma. To effectively meet the health needs of the Bronx population, Montefiore Medical
Centre has adopted a patient-centred and population-health approach to reduce the cost of care
and improve the quality of its healthcare services.
Population health approach does not limit itself to the healthcare outcome of a single
individual; rather it adopts policies that improve the health outcome of the population as a whole
(Artiga & Hinton, 2018). Some of the characteristics of population health approach include
efforts to eliminate health disparities based on factors such as income and race, reduction of
waste, and emphasis on wellness and prevention rather than just treatment (Artiga & Hinton,
2018).
Many of Montefiore’s policies reflect this approach. For instance, the facility has
multiple medical homes that are meant to increase primary care access (Chase, 2010). This large
investment in primary care not only reduces the costs of healthcare for the patients but also
improves the quality of care. To promote the overall wellness of patients, the care facility has a
program to help the largely impoverished population learn to cook and eat healthy foods (Chase,
2010). To reduce health disparities the facility has many outreach workers that design and
distribute education materials that communicate with the patients in a manner that they best

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understand through catering to their education levels, language, and culture (Chase, 2010).
These are just some of the many policies that Montefiore medical centre has the make sure that
the overall health of Bronx’s residents improves.
Montefiore’s patient-centred approach
A patient-centred approach to care is focused on meeting the patient’s needs, preferences,
and values (McCormack & McCance, 2016). Many of Montefiore’s policies are patient-centred.
For instance, the facility has made it very easy for patients to access care. Its many medical
homes and clinics have brought healthcare closer to the people. Additionally, patients are
allowed to drop in unscheduled to its safety-net clinics (Chase, 2010). It also has Family Health
Centres which operate an extra two hours in the evening twice a week and one Saturday once a
month (Chase, 2010). This arrangement allows patients who may not be available during normal
working time for reasons such as work to meet their health needs at times that are convenient to
them. The facility also reaches out to communities it serves with the goal of better
understanding their needs and initiating programs that meet those needs (Chase, 2010).
Montefiore’s strategies for cost reduction and quality improvement
The facility has implemented strategies that are specifically meant to improve quality and
reduce cost. One of them is the use of electronic health records (EHR) which it has used over
$200 million since 1995 to improve (Chase, 2010). The system has enabled better coordination
of care givers thus improving quality of care while simultaneously reducing the cost of care
provided by the facility. Its investment in medical homes where patients can receive primary
care has also significantly reduced the costs of care.
Deficiencies in Montefiore’s population health approach strategies

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Most of the facility’s strategies to reduce costs and improve quality of care have largely
worked. There are, however, deficiencies that need to be worked on. One of them is a relatively
low number of primary health physicians. The average in New York is 148 primary health
physicians per 1,000 patients. For Montefiore the number is 106 per 1,000 patients (Chase,
2010). Additionally, its efforts to keep costs low through the use of EHR have also not worked
quite well because the facility has not found a single EHR that can effectively meet the needs of
its primary care sites and generally complex system.
Recommended Strategies for Improving Cultural Sensitivity, Adoption of Prevention-
Focused Care and Reducing Costs at Montefiore
Recommended strategies for improving Montefiore’s cultural competence
The need to develop culturally competent healthcare is borne from the understanding
that minority ethnic groups often encounter institutional, linguistic, and cultural barriers in
accessing health services (Jeffreys, 2015). Such barriers create health disparities along ethnic and
racial lines. To reduce these barriers there is need to develop health services that are culturally
sensitive.
One of my recommendations for such care is diversifying healthcare workforce by
increasing the number of healthcare workers from minority groups. Having doctors and nurses
who share the patient’s language, culture, and beliefs reducing chances of miscommunication,
misdiagnosis, and misunderstanding thus potentially leading to better quality care for the patients
(Jeffreys, 2015).
Another strategy is training of healthcare workers to care for patients from diverse
backgrounds. Healthcare professionals who have been trained in cultural competence are more

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likely to understand and take the perspective of their culturally diverse patients into account
when treating and caring for them (Jeffreys, 2015).
Recommendations for health promotion and disease prevention strategies
Health promotion strategies aim to empower communities as well as individuals to
engage in healthy behaviors. The goal of such strategies is to help communities and individuals
to reduce the risk of developing costly chronic conditions (Murdaugh et al., 2018). Disease
prevention strategies, on the other hand, are aimed at slowing down the severity or development
of chronic conditions (Murdaugh et al., 2018).
One of the strategies for health promotion and disease prevention is raising awareness
about the risk certain health behaviors pose to people’s health (Murdaugh et al., 2018). Such
behaviors include smoking tobacco, engaging in risky sexual relations, and excessive drinking of
alcohol. They also include lack of physical activities and poor eating habits. These behaviors can
be modified to reduce the likelihood of developing chronic health conditions through proper
communication. To increase effectiveness of such communication, it is important to use partners
within the communities who are trusted and respected in the community.
Recommended strategies to increase organization’s use of population health approach to reduce
costs
Population health approach can significantly reduce healthcare costs through employing a
strategy of segmenting the population based on risk (Stanhope & Lancaster, 2015). High risk
patients should be assigned a primary care giver and medical home so that their condition can be
closely monitored. Such monitoring prevents the patients from having their condition develop
into a severe one which may necessitate hospitalization. By reducing the likelihood of

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hospitalization, the strategy significantly reduces healthcare costs because it reduces healthcare
utilization costs.
Risk stratification also allows the hospital to use its resources more effectively. For
instance, for low risk persons the hospital may employ prevention methods which are generally
low cost. For medium risk persons, the hospital can develop intervention measures which, while
more expensive than prevention measures, nonetheless prevent them from developing costly
health conditions. More resources can then be freed up to deal help in achieving effective care
management for high risk segments.
Another approach involves identifying risk factors for the most common conditions in the
community and addressing them (Stanhope & Lancaster, 2015). These risk factors include
tobacco use, lack of or inadequate physical activity, and poor diets that are unhealthy. These
factors, when left unaddressed, can lead to conditions such as obesity and hypertension. Once
these risk factors have been identified the hospital can conduct regular screening so that
conditions can be identified earlier and dealt with before they become serious.

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References

Artiga, S., & Hinton, E. (2018). Beyond health care: the role of social determinants in promoting
health and health equity. Health, 20, 1-10.
Chase, D. (2010). Montefiore Medical Center: Integrated care delivery for vulnerable
populations. New York, NY: The Commonwealth Fund.
Jeffreys, M. R. (2015). Teaching cultural competence in nursing and health care: Inquiry,
action, and innovation. Springer Publishing Company.
McCormack, B., & McCance, T. (Eds.). (2016). Person-centred practice in nursing and health
care: theory and practice. John Wiley & Sons.
Murdaugh, C. L., Parsons, M. A., & Pender, N. J. (2018). Health promotion in nursing practice.
Pearson Education Canada.
Stanhope, M., & Lancaster, J. (2015). Public health nursing-e-book: Population-centered health
care in the community. Elsevier Health Sciences.