Health Care/Business Institute Draws 600 Nearly 600 speech-language pathologists who work in health care settings or private practice filled a large conference center in Bethesda, Md., in early April for a weekend of intensive learning and collegial conversations at the ASHA Health Care/Business Institute (HCBI) 2009. An annual two-for-one educational opportunity, this year’s event ... ASHA News
ASHA News  |   May 01, 2009
Health Care/Business Institute Draws 600
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Swallowing, Dysphagia & Feeding Disorders / Cultural & Linguistic Diversity / Healthcare Settings / Professional Issues & Training / ASHA News & Member Stories / ASHA News
ASHA News   |   May 01, 2009
Health Care/Business Institute Draws 600
The ASHA Leader, May 2009, Vol. 14, 1-9. doi:10.1044/leader.AN1.14072009.1
The ASHA Leader, May 2009, Vol. 14, 1-9. doi:10.1044/leader.AN1.14072009.1

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Nearly 600 speech-language pathologists who work in health care settings or private practice filled a large conference center in Bethesda, Md., in early April for a weekend of intensive learning and collegial conversations at the ASHA Health Care/Business Institute (HCBI) 2009.
An annual two-for-one educational opportunity, this year’s event drew U.S. participants from 45 states, including Alaska—and international attendees from Israel and Canada—to hear presentations from 21 speakers, browse exhibits, shop for professional products, and share ideas about clinical practice. Participants moved freely among multiple health care tracks and the business sessions and roundtables.
“Participants at this conference reflected the high level of interest and motivation of clinicians and managers who are committed to building their knowledge in this challenging economic environment,” said ASHA President Sue Hale, who attended the event.
Three health care tracks—dysphagia, adult neurogenic disorders, and pediatric and early intervention—featured a broad range of presentations by nationally recognized experts who shared clinical case studies and engaged in lively interactions with audience members. Among the session topics were advocacy for patients with dysphagia, PEG tubes, trach-and-vent issues, voice disorders, dysarthrias, pediatric cochlear implants, parents as partners in the clinical process, traumatic brain injury in children, and autism spectrum disorders.
On the business side, sessions addressed business planning, marketing, coding, reimbursement, contracts, clinical ladders, supervision, productivity, employment law, performance improvement, and the new Medicare provider enrollment process. A session devoted to roundtable discussions gave private practitioners, administrators, and clinicians the opportunity to compare notes and learn from each other.
Meeting Colleagues—Fast
On the evening before the conference opened, 25 conference participants engaged in a one-hour “speed networking” session. Modeled on speed dating, it’s a way of meeting many people quickly and is being used at business meetings and conferences across the country.
Two participants faced each other and had an open-ended conversation for six minutes. The “referee/facilitator” blew a whistle, and half the group moved over a few seats to create new pairings. By the end of the hour, each participant had talked with about nine people.
Speed networking gave clinicians the opportunity to make new connections with colleagues across the country, “I’m interested in what makes a successful business. Everyone had great ideas!” said one participant. Another member added, “Friendships were formed that led to great conversations related to our profession and allowed us to socialize outside of our professional realm.”
Barbara Bogomolov, RN, offered a provocative and fresh perspective on cross-cultural communication in the health care arena in her keynote address at the opening plenary session (see sidebar). The presentation was sponsored by Special Interest Division 14, Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations.
After a full day of sessions, on Saturday night nearly 100 conference participants joined the ASHFoundation for a festive wine-tasting event to raise funds for Foundation grants and scholarships. The evening raised more than $4,000 to support the ASHFoundation’s student scholarship and research grant programs (visit the Foundation’s Web site for information on their programs or to make a donation).
Plan early for next year’s Health Care/Business Institute conference, which will be held in Seattle on April 24–25, 2010.
To see the full conference schedule, visit the ASHA Web site.The anthology of all conference presentations can be purchased by calling 888-498-6699 or at the ASHA Online Store.
A New View of “Worldview”

In her plenary address, Barbara Bogomolov, RN, told conference attendees the story of “Akouwa,” a refugee from an unspecified African nation who was jailed as a protestor in her homeland and escaped to the United States, finding her way to St. Louis. She met Akouwa when she was diagnosed with Stage 4 breast cancer.

“She sang constantly and joyously—so much that her roommates had to be moved,” Bogomolov recalled. “There was no word for ‘depresssion’ in her language.” She discovered that Akouwa was trying to bring her family to the U.S. and then learned that her patient’s eldest daughter had died.

“Akouwa stopped eating, and said she couldn’t swallow,” Bogomolov said. “The speech-language pathologist evaluated her and said there was no physical reason. When exit visas were obtained for her other family members, the swallowing problem went away immediately.”

Near the end of Akouwa’s life, she entered a hospice program, and the hospice staff was bewildered because no words existed for Akouwa for “no code,” “living will,” and other end-of-life medical terms. She acknowledged Bogomolov as someone who understood “the ships from my head”—the cargo of meaning beneath the words.

As a result of her experiences with Akouwa and others, Bogomolov began to rethink the idea of worldview—not as tied to ethnicity, but to a group of broader concepts rooted in beliefs and viewed as a continuum that she described as follows:

  • Locus of control: internal and external. Patients with an internal locus of control believe that they control their fate, and that they can alter their circumstances—a basic tenet of Western medicine. Those who have an external control locus believe that they cannot change their fate, and that their circumstances must be accepted.

  • Self-concept: individualist and collectivist. Individualist patients rely on themselves for survival and believe that in protecting the self, one can protect others. Collectivist patients rely on the group for survival and perceive themselves primarily as part of a group. Collectivists believe that protecting others protects the self. For example, Bogomolov recalls an Iraqi woman being asked about the type of treatment she desired, and the woman responded, “Talk to my cousin.” He was the male in the family charged with making health care decisions.

  • Communication context: direct and indirect. Patients who communicate directly view words as carriers of meaning, and the goal of communication as receiving and giving information. For patients whose communication context is indirect, words themselves convey power. For example, to say “cancer” could mean a curse to a family member, consigning the loved one to death. The implied meaning is equally as important as the stated meaning.

  • Power distance: low gradient and high gradient. Patients with a low gradient of power distance view power as decentralized—and would be more likely to challenge their health care providers, choose a different provider, or research their health care options. Patients with a high gradient on the power curve would be less assertive with a practitioner and less likely to seek a second opinion.

Bogomolov pointed out that practitioners must “take your own pulse first”—cross-culturally speaking, one must assess one’s own locus of control, self-concept, and work environment.

“Most of us work cross-culturally every day with people who look just like us, or nothing like us, if you consider belief systems as being a defining characteristic,” she said. “Difficult behavior may be mislabeled—it may be that the patient is resisting an approach that violates a core part of his or her being.

“Are you aware of the impact of your practice environment? It might be intimidating. Are you locked into the belief that if we can fix it, we should, no matter what the patient’s preference? Ask yourself, ‘What role am I being called to play with this patient?’

“Understanding worldview is one dimension of cultural competency,” Bogomolov told the crowd. “This approach can help avoid stereotyping, illuminate your own beliefs, and expand opportunities for positive outcomes.”

She concluded by sharing with members the meaning of “asha” in other cultures. “In Sanskrit asha means ‘hope’ or ‘light of hope,’” she said. “In Arabic it means ‘life’ or ‘lively’.

“I wish you all much ‘asha.’”

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May 2009
Volume 14, Issue 7