Right away you can see the difference: In freshly painted hallways in the lower level of a huge, new multipurpose brick building, signs to each office are written in English and Russian.

Darrell Sapp, Post-Gazette Having experienced firsthand the services now available to recent immigrants, Olga and Leonid Steinberg sit in an examination room with Dr. Andrea Fox, right, at the Squirrel Hill Health Center on Browns Hill Road. Mrs. Steinberg sits on a low exam table, easily accessible to patients of all heights. Click photo for larger image. Related article Compassionate care rescues a family in crisis

A message of cultural inclusiveness can be read in those signs, part of the mission of the new Squirrel Hill Health Center, which celebrated its grand opening Oct. 29. The center, on the campus of the Jewish Association on Aging off Browns Hill Road, offers access to comprehensive primary and preventive health care with fewer obstacles for patients -- not just how to pay for it, but also barriers of culture, language, age and disability.

In one familiar building along bus lines close to home, patients find family-care doctors, nurses, nurse practitioners, social workers and a case manager all under one roof. Next year, a pharmacy, offering discount medications, will open. Dental services are planned as well.

Susan Friedberg Kalson, the center's CEO, oversees the new health center designed to serve the medically needy and underserved population in Squirrel Hill, Greenfield, Hazelwood and Oakland. Launched through the efforts of the Jewish Healthcare Foundation, it's now an independent nonprofit agency funded primarily through a federal grant.

"The foundation saw a need that wasn't being addressed," Ms. Kalson said, adding that it found a hidden population of people with no insurance or insufficient insurance.

How did they know the patients were out there?

Ms. Kalson explained that the foundation has roots in the 1990s' merger of Montefiore Hospital with UPMC. Montefiore's clinics in Greenfield and Hazelwood were closed.

"There was a concern in the Jewish community. They had seen the need in the food pantry and saw a lot of hungry people, a lot of cultural needs not met in the general culture," she said. For example, the large Russian immigrant community was not served, and one-third of the Squirrel Hill-Greenfield-Hazelwood-Oakland population was at 200 percent of the poverty level or below (in 2006, a family of four with combined income of $40,000 or less). Federal money has been available to serve just this need since the 1960s.

In planning the center, the foundation cast a wider net beyond the Jewish community and aimed to serve people where international, physical and other cultural barriers to care existed. Other religious communities had specific needs, as did people with multiple jobs and those with no insurance.

The health-care goals of the foundation would not be met without more of an emphasis on preventive and primary care services, Ms. Kalson said.

"If they're neglecting preventive and primary care, they wind up in emergency rooms a lot sicker," she said.

Dr. Andrea Fox, the center's medical director and an internist and geriatrician, oversees a staff that includes Dr. Deborah Gilboa and Dr. Susan Dirks, family practitioners, and Dr. David Segel, who is officially retired but works Tuesday evenings to fit some working patients' schedules.

Dr. Fox explained that the center is still trying to reach its target populations. For uninsured and underinsured people, it provides care and financial help, including a sliding-scale fee structure. She estimated that 30 percent to 40 percent of their patients are uninsured; 60 percent to 70 percent have some insurance.

After a physical assessment, patients can be referred to the center's social worker for behavioral health services. "There is a lot of need," Dr. Fox said. "People have very complex lives."

Her previous work has been with the Veterans Administration system, where as a geriatric doctor, she did a lot of home visits. She wants to continue that, though she's glad to have the opportunity to build a new program with a mission.

"I like being able to see everybody. At the VA, there were people who couldn't see me. They weren't vets."

The center faces a marketing challenge to let people know it's there, Ms. Kalson said.

Buses come along Browns Hill Road -- more now that the Waterfront development is booming -- and one bus route includes the JAA campus. Access and other transportation for the elderly bring patients to the site.

For people with trouble communicating in English, there is a Russian-born medical assistant; Drs. Fox and Dirks speak Spanish, and Dr. Gilboa speaks Hebrew and American Sign Language.

To ensure that employees are open to other cultural traditions, the center screens applicants and has guidance from the Welcome Center for Immigrants & Internationals, a group that helps foreigners find housing, schools and health care.

For the patients of smaller stature -- including many elderly women, Dr. Fox said -- three exam rooms have tables that sit low to the floor to enable the patient to sit down easily before the table is raised to exam level.

The center has been treating patients of all ages. A 9-month-old baby was the first, on June 30.

"I think we're a kind of missing link in this town. Providers can refer patients to us and we can refer to them," Ms. Kalson said. "We want to see that life needs are met."

The center also has the distinction of being a showcase for the "Perfecting Patient Care" principles the foundation encourages doctors and hospitals in the region to adopt. The problem-solving principles are based on the Toyota Production System model and is promoted through the Pittsburgh Regional Healthcare Initiative, health-care providers and community leaders striving to cut medical errors, improve care and reduce its costs.

Foundation President Karen Wolk Feinstein said the PPC principles were put to work in hospitals first. The new emphasis on primary care came through the foundation's efforts in depression and diabetes care, Dr. Feinstein said.

"Primary care is the place to intervene, before a person becomes hospitalized," she said, adding that the PPC principles were first tested for primary care about three years ago at the St. Margaret's Hospital family practice office in Lawrenceville. "They started revising the care plan for diabetes. There had been problems with diabetes patients getting the best care."

Managing that program was Fran Sheedy Bost, who now runs the PPC training for PRHI, known as "PPC University," for interested health care providers. Ms. Bost trained the Squirrel Hill Health Center staff in the model of continuously improving patient care. Ms. Bost said PPC "provides education to the whole team to show them how to help patients get what they need." Employees at every level are trained to see problems in caring for patients -- from transmitting infections to long lines in waiting rooms -- and work to quickly solve those problems at the source, whatever it may be, for every individual patient.

For example, to eliminate wasted time and effort, exam rooms are fully equipped, so patients don't have to move from room to room for weight checks and blood draws. But the effort must be continuous to be effective, Ms. Bost said. Health center employees must see what the problem is, then "implement a countermeasure." If it works, it must be adopted as standard practice.

"We want the best care for every patient, every time," Dr. Feinstein said. "Health care is usually set up for the convenience of the health care team. We really wanted to set this up for the convenience of the patient.

"For example, if a patient needs a test that requires fasting, we should find a way for all these patients to get their appointments early in the day," Dr. Feinstein said.

Ms. Bost said insurance reimburses doctors for 15-minute visits. To make those minutes count, no time can be wasted looking for a blood-pressure cuff or for patient information.

"Perfecting Patient Care is how to eliminate waste, so patients and clinicians have valuable time together," she said. "We bring problem-solving tools to allow nurses or nursing assistants to design the work."

To have employees feel it is safe to suggest changes, Ms. Bost said, the CEO and medical leadership must be comfortable with the principles. "The whole system has to be transformed," she said. "There has to be a blame-free environment, where the goal is finding errors."

At the new health center, she said, everyone is trained to see problems quickly and do rapid, frequent problem-solving.

"Even when you're brand new, you will have problems," she said. "They're committed to fixing the root cause and fixing it immediately."

At the Squirrel Hill center, patients will have access to comprehensive care, including screenings for the warning signs of depression, for example. If therapy is needed, the staff will refer the patient to another professional. But the center will keep track of the patient's treatment and follow up on the patient's progress.

"The idea is it's not good enough to see a patient in the office and give them a prescription," Ms. Kalson explained. Encouraging patients to keep a continuous relationship with their caregiver improves care, Ms. Bost said.

"It's an excellent care team," Dr. Feinstein said. "They're very experienced. They're pushing the frontiers."

"Every person we hire knows we have a mission," Dr. Fox said.

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Correction/Clarification: (Published Nov. 13, 2006) In this article about the new Squirrel Hill Health Center in Nov. 8, 2006 editions, it was not noted that Hazelwood Family Health Center continues to serve people in that city neighborhood.