South Florida has been widely recognized for its diversity. Over the last decade, there have been significant increases among all of the prevalent minority groups. While Hispanics are the fastest growing segment of our population, the number of Haitians continues to increase and this region is now home to a growing population of Mayan Indians from Guatemala.

With the changing demographics of our population and so many cultures and subcultures now represented come some very real challenges for the health care community.

Health care providers are having to strike an often delicate balance between the science of medicine and the patient’s own values, beliefs, and practices around health care which can obviously have a significant impact on the clinical encounter. It is important for the health care provider to know what the beliefs are and be able to work with the patient to help manage the clinical experience. So, it is important for providers to be able to functioning effectively in the context of the many cultural differences.

With the many cultures and subcultures represented, there are often language barriers for patients that are limited-English proficient (LEP). Obviously, good communication between a provider and patient is critical in ensuring quality health care and patient safety. When there is poor communication, there is an increased chance for misdiagnosis and misunderstandings.

The disparities in health status and outcomes for certain racial and ethnic populations also persist, and in some cases, are widening. Of course, the causes of these disparities are multiple and complex.

Responding to the challenges, Palm Beach County Medical Society through its Cultural Competency Initiative (CCI) is committed to providing resources to strengthen the ability of health care providers to serve the diverse populations. The Medical Society’s multi-pronged approach includes the promotion of cultural competency, improving language access, and addressing problems associated with health literacy.

A best practice in cultural competency, one of the primary focus areas of the initiative will be to provide training and education for hospitals and healthcare practitioners. The essential focus of the training is on promoting cultural awareness and sensitivity and helping health care practitioners with effective ways of communicating interacting with their increasingly diverse patient base.

The trainings provide an overview of the changing demographics of our population, the importance of cultural competency, language access, and health literacy in serving this population. As cultural competency is not a skill that can “be taught”, the goal of effective trainings is simply:

  • Facilitating awareness of and encourage respect for various cultures (Cultural Competency)
  • Promoting the effective use of resources that address linguistic barriers to care (Language Access)
  • Promoting effective communication between providers and patients by providing tools for assessing and addressing (Health Literacy)

Research shows that the most effective trainings of this sort are not lecture-based. So, this training has been designed as an experiential educational and awareness experience to provide a better understanding of the cultural barriers that may challenge a health care provider’s ability to provide patient-centered, quality health care services.



When Patty Braga began performing sonograms in 1978, they were little more than a black and white picture on a screen. But to health care professionals, they were a remarkable new technology.

“It was like wow! we can see a baby’s head,” says Braga.

More than 25 years later, sonography has undergone many changes and is now a diagnostic tool that is used to produce many different images of the body. Much like x-rays show bones and MRIs show tendons and muscle, sonograms show soft tissue structures such as the liver, gall bladder, kidneys and aortas. They also provide unbelievably clear pictures of babies in utero.

Because of the increased usage of songraphy in the medical field, Palm Beach Community College added a sonography program to its curriculum in May of 2003. A diagnostic medical sonographer combines creativity and advanced technological ultrasound equipment to produce images of the body. Sonographers use high frequency sound waves to demonstrate body parts and assist physicians in the diagnosis of medical abnormalities.

The PBCC sonography program has two distinct courses of study: a two-year,72-credit associate’s degree and a 14-month, 42-credit certificate program that focuses on core sonography classes.

The associate’s degree is designed for those who have a health background from a hospital that was not part of a degree program. This path allows students to earn a 2-year degree and perhaps go on to earn additional degrees in the future. The certificate program is more for those with degrees and backgrounds in radiology or nursing that are seeking a career change. Program courses include anatomy & physiology, sonography, physics, psychology and a clinical rotation.

Braga, who is the assistant professor and program leader of the sonography program, says many students are seeing the opportunities sonography has to offer. “Nursing is such a demanding career and sonography is much less so. Many nurses with ob/gyn experience can get the sonography training and go to high-risk offices and do both nursing work and sonography work.”

PBCC decided to add sonography to its curriculum last year because local hospitals were demanding it, according to Braga. Much like with nursing, there is a critical shortage in the field of sonography also. In the past, sonography training was hospital based but due to increased costs, many of the programs were phased out. leaving a growing demand and fewer qualified workers.

“There is a huge demand for sonographers in Florida, and nationwide as well,” she says. “People are living longer and there is an influx of older people in Florida that are in need of care.”

The sonography program at PBCC is still in its infancy but has already graduated five students. Four of them had their jobs lined up before commencement and the fifth went right to work. Typically, sonographers work in hospitals or doctor’s offices but some choose the route of a traveling technician, going where their skills are needed. And due to the increase in demand for qualified sonographers, the earning potential can be limitless, Braga says.

According to the U.S. Department of Labor Employment, the field of diagnostic medical sonographers is expected to grow faster than the average for all occupations through 2012 as the population grows and ages. Hospitals are expected to remain the principle employer of sonographers, however, the number of office jobs is expected to increase. Median annual earnings of diagnostic medical sonographers was $48,660 in 2002.

“Sonography is a rewarding and interesting job that pays well. And where else can you make such good money right out of school,” Braga asks.

Because of the high level of knowledge sonographers must have of the human anatomy, this program does have limited access. This means all applicants must document completion of a two-year accredited health science program, with preference given to registered radiographers.

Prospective students are also required to attend an open house. The next open houses are scheduled from 1-2 p.m. on Friday, Dec. 10 and Friday, Jan. 28, in Room LC 122 of the Lewis Center on the Palm Beach Gardens Campus.



St. Thomas University in Miami offers three degrees in the health management field, two graduate one undergraduate. At the graduate level, students may pursue either a Master of Business Administration or a Master of Science in Management both with health management specializations. At the undergraduate level, students holding an AA or AS degree, may pursue an accelerated formatted Bachelor in Health Care Services. All three degrees are designed for the working healthcare professional. In fact, St. Thomas University’s undergraduate health management program will be featured in the second undergraduate edition of The Journal of Health Administration Education this summer in an article entitled, Designing and Implementing an Undergraduate Health Administration Program for Nontraditional Students, authored by Nancy Borkowski, DBA, CPA, FACHE.

Courses in the health management programs at St. Thomas University are fast-paced offered over 9 or 5 week formats and taught by well know South Florida healthcare community leaders, such as associate professor of health management Dr. Nancy Borkowski, who bring real world experiences into the classroom.

Prior to joining St. Thomas University in 1997, Dr. Borkowski held healthcare executive positions in physician practice management and managed care and is a past recipient of the American College of Healthcare Executive’s Southern Florida Senior Career Healthcare Executive Award.

Dr. Borkowski is board certified in health management and a Fellow of the American College of Healthcare Executives. She serves on the editorial board of the Journal of Healthcare Management and recently completed her new book, Organizational Behavior for Healthcare, which is available through Jones and Bartlett Publishers.

When asked, why write a book on the topic of organizational behavior for healthcare professionals? Dr. Borkowski relates, “Given the service-related intensity of the industry, the understanding of individuals’ behavior and group dynamics within health service organizations is a critical part of healthcare managers’ success. Managers need to understand the causes of workplace problems, such as low performance, turnover, conflict, and stress. With this understanding, managers are better able to predict and thus influence the behavior of employees to achieve organizational success through increased job satisfaction and productivity.”

Dr. Borkowski book has already received praise from experts in healthcare management as “one of the most significant advances in the field of health services administration…providing the foundation to be successful in meeting the new organizational behavior challenges of today’s complex and turbulent health care system.”

In addition to her faculty position at St. Thomas University, Dr. Borkowski continues to consult with and serve on many local and national healthcare companies’ boards. Locally, Dr. Borkowski is Past President and current Treasurer of the South Florida Healthcare Executive Forum, President-Elect of the Women Healthcare Executive Network of South Florida and serves on the American College of Healthcare Executive’s Southern Florida Regent’s Advisory Council.



Changing The Way Doctors Learn

The Medical Education Research Unit at Mount Sinai has developed a curriculum that has changed the way doctors are educated and has proven that these changes actually improve patient outcomes. It’s a true win-win for Mount Sinai, its physicians and patients, and it is revolutionizing the way medical school graduates are trained.

Residency training programs give new doctors just out of medical school their practical training. Called “residents,” these new doctors take care of patients under the supervision of experienced physicians. They also attend lectures on disease and treatment. Mount Sinai’s residency training programs are unlike any other in the country, thanks to a progressive research project that began in July 2005.

The hospital is reexamining the skills needed to be a good doctor. Medical knowledge is obviously important, but there are other essential tools for taking care of patients and their families and working effectively within the medical community. “We want to produce young physicians who are compassionate and well rounded, who understand the larger medical system and are committed to self directed learning,” said Gloria Weinberg, M.D., director of the Internal Medicine Residency Training Program at Mount Sinai.

Can these doctors communicate with their patients and colleagues? Are they listening to their patients? Do they understand their role in the hospital setting? Do they have good people skills? Are they treating all the staff and patients in a professional way? Do these doctors continue to learn throughout their careers? These are the kinds of questions being asked.

In the past, residents were evaluated by their supervising doctors and their peers. At Mount Sinai, they are evaluated by their patients, their peers, their supervisors and the nurses and staff with whom they work.

Patients enjoy being part of the process, offering feedback about their experiences and helping mold better doctors. Nurses are asked whether the residents have been professional in taking care of paperwork and writing orders. The residents themselves are asked whether they feel confident in their technical abilities and their personal skills. Dr. Weinberg says the answers are often surprising and they provide an opportunity to better mentor young doctors and identify their strengths and weaknesses.

This new approach also gives doctors in the program a chance to broaden their views on what it means to be a good physician. “The program enables the students and their teachers to change and encourages them to be more flexible,” Dr. Weinberg said.

The new and innovative educational program at Mount Sinai adapts to the students so they can spend more time concentrating on areas in which they feel deficient. The curriculum includes the most common diagnoses that the residents will encounter and reflects the reality of what residents see on a daily basis. “This is called a practice pattern-based curriculum,” said Richard Isaacson, M.D., director of the Research Unit in Medical Education. “A lot of this is common sense. Young doctors are really excited and willing to do this. They see that both their patients and their education benefit from the new curriculum. Everyone really wins.”

The Research Unit has set out to prove that this new curriculum actually improves patient outcomes. “Doctors make patient choices based on evidence-based medicine,” Dr. Isaacson said. “That means doctors use the treatments and procedures that are proven to be effective. It’s no surprise then that an evidence-based curriculum would be developed to train doctors.”

The research indicates that the changes developed at Mount Sinai have affected patient outcomes in a positive way. “This is an area of research that hasn’t been explored,” Dr. Isaacson said, “so there’s great interest in what we’re uncovering. This is research that can be adapted to fit any specialty, is flexible, a no-brainer and free for anyone to use.”

In July 2006, the Accreditation Council for Graduate Medical Education will require all accredited residency training programs to show that they are making “data-driven” improvements. They must prove, as Mount Sinai has already done, that the way they train their doctors makes for better patient care. Mount Sinai’s Residency Training Programs and its Research Unit are blazing a trail that will improve health care across the country.



The healthcare industry is in a constant state of flux. As an industry, it is bombarded by continuous regulatory changes, new technology, personnel shortages, and ongoing financial challenges. The delivery site of health services has shifted at an accelerated pace from the inpatient hospital to the outpatient arena. These tumultuous changes may sound dire, but in reality they have created significant opportunities for professionally trained healthcare managers.

These opportunities cover a diverse number of settings and present exciting career challenges for managers in this industry. The following is a very limited list of potential career opportunities for managers with the appropriate professional education, skills and the desire to succeed and contribute to the healthcare industry:

  • Ambulatory care center
  • Outpatient surgery center
  • Diagnostic imaging and other centers
  • Medical group practices
  • Long-term care (requires appropriate licensure)
  • Nursing homes
  • Adult living facilities
  • Skilled nursing centers
  • Hospitals
  • Senior management
  • Middle management
  • Managed care organizations
  • Public and government agencies
  • Military

The opportunities are endless. All it takes is the personal desire to pursue an exciting career by starting with the right professional education. Students in Barry University’s program have varied backgrounds including physicians, nurses, therapists, social workers and a wide variety of other backgrounds. They have chosen healthcare because it provides challenges and rewards not available in other careers.

The Master of Science Program Health Services Administration growth attests to the potential career opportunities existing in the marketplace. The program enrollment has tripled over the past 2 1/2 years and Barry courses are offered in 5 locations, with 2 additional sites anticipated for Summer 2007.

Our graduates work in all of the previously mentioned setting. In addition, a number of our graduates have used this degree as a stepping stone to further their education. Currently, Barry alumni are enrolled in medical school, doctoral programs, and law school, studying health law.

Remember, the need for health professionals is not regulated by the economy. People get sick and require care be provided in well managed facilities providing state-of-the-art quality care.