Why It Matters
In her winning Calkins Scholarship essay, medical student Joyce Kim describes how her multidisciplinary team applies QI methods to make care better for patients at the Clarkston Community Health Center.
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Improving Care for Refugees: Winner of the 2016 David Calkins Memorial Scholarship

By Joyce Kim | Tuesday, November 29, 2016
Improving Care for Refugees
Photo credit: Bryan Meltz, Emory Photo/Video - A nursing student speaks with a patient at the Clarkston Community Health Center.

Joyce Kim is a medical student at the Emory University School of Medicine (Class of 2018) and a member of the IHI Open School Chapter at Emory University. This multidisciplinary group volunteers at the Clarkston Community Health Center, which serves refugees a few miles from the Emory campus. In her winning Calkins essay, Kim describes how the team applies quality improvement methods to make care better for their patients.

Clarkston, Georgia, is a major refugee resettlement area located just outside the city of Atlanta. Since the 1990s, when the refugee resettlement program in the United States identified Clarkston as a good fit for displaced persons, this 1.1 square mile area has become home to refugees from more than 50 different countries and six continents, leading TIME magazine to dub Clarkston the “most diverse square mile in America.”

This culturally and linguistically diverse area — where more than 60 languages are spoken — faces many challenges. Between 2009 and 2013, the poverty rate in Clarkston doubled from 16 percent to 32 percent. Among foreign-born residents, the poverty rate is 56 percent. Also, despite being near large medical facilities, this community has limited culturally and linguistically appropriate resources, presenting a significant barrier to health care utilization.

In spring 2016, the Emory University Chapter of the IHI Open School partnered with Clarkston Community Health Center (CCHC), a quickly growing clinic that opened in 2015 to provide affordable primary health care to underinsured and uninsured refugees and indigent people in Clarkston. With process flow maps and spaghetti diagrams to better understand clinic flow, the team identified three core areas of intervention to improve clinic processes and volunteer and staff experiences at the clinic: patient flow, volunteer coordination, and patient forms. Using concurrent PDSA cycles, the team implemented a patient flow checklist, a task list of volunteer roles, and simplified forms to streamline the patient intake process. After implementation of these interventions, the average total clinic time decreased by nine minutes, and the majority of staff and volunteers surveyed (78 percent) reported an improvement in clinic experiences.

Perhaps even more importantly, this project allowed the team to build a positive rapport with the clinic and community members for more extensive partnerships and projects in the future. CCHC’s mission is to become a “culturally and linguistically competent facility that provides quality, affordable, accessible, and comprehensive health care services to the residents of Clarkston.” With the goal of helping them achieve their mission, I would like to expand our team to not only further improve patient flow, but also to ensure the center’s linguistic competence.

Specifically, I would like to take advantage of the valuable assets the refugee community has among its young adults. Too often, translation at various hospitals and clinics of the languages spoken by the members of the community are not available. By connecting the Emory medical student society assigned to Clarkston for its community services activities and the Emory Volunteer Medical Interpretation group, we will support young refugees to become interpreters and advocates through health literacy and translation workshops. This will not only better train these young refugees to do the tasks that they are already often doing informally for family and friends, but it can also serve as an opportunity for them to develop skills for future employment. We will measure improvement by tracking the number of patients coming to the clinic who receive appropriate translation out of the total number of patients who indicate need for translation.


Learn more about serving underserved people in our course, PFC 101: Introduction to Patient-Centered Care, and explore Chapters near you using the IHI Open School Chapter map.

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