Globalization and international migration make a case for diverse language and linguistic demographics in the US. The challenge occurs when individuals with Limited English Proficiency (LEP) present to healthcare institutions without the ability to communicate effectively with their providers. Healthcare organizations should set standards for safe and equity-centered care to improve care delivery to LEP patients.
Addressing any communication issue can be daunting, but individuals with LEP have language and linguistic issues that can be more complicated in the healthcare setting. Neglecting to eliminate language barriers can negatively affect a patient’s safety during their hospital stay. The risk of complications from diagnostic and medication errors leads to adverse or sentinel events.
In a Joint Commission (TJC, 2015) study, a substantial 49.% of LEP patients experience physical harm while hospitalized compared to 29.5% of English-speaking patients. Therefore, there is a compelling need for equity-centered care in linguistic diversity to ensure the safety of LEP patients. Healthcare organizations should develop a quality improvement plan incorporating benchmarking, evidence-based practice, and quality improvement initiatives as recognized by an outcome evaluation agency, such as the Agency for Healthcare Research and Quality (AHRQ).
The use of English as a second language is soaring. An estimated 61.8 million US residents speak a language other than English, with approximately 322 different languages spoken, and 25.1 million are LEP (AHRQ, 2018; TJC, 2015: USCB, 2018). The concern for linguistic minority patients is that they must use English, their second language, during their hospital encounter or depend on the accuracy of medical interpreters, which poses a medical error risk. A
An unshakable fact is that miscommunication of health information for this population could result in their death. Thus, healthcare organizations are obligated to determine a patient’s English proficiency level as a safety measure when administering essential medical treatments. However, many organizations struggle to adequately reform their healthcare delivery system to address the population’s needs for more culturally congruent care relating to language and linguistic safety.
The primary goal is to increase patient access to need-specific language and linguistic services. Specifically, high-quality hospital language services are necessary to identify patients’ cultural and linguistic needs while providing enhanced interventions. The quality improvement plan should be thorough and inclusive of screening tools, certified medical interpreters, and provider access to patient language proficiency levels (Regenstein et al., 2008; Walsh, 2016).
The success of the quality improvement plan hinges on the availability of hospital linguistic and language services. The first step in implementing a program designed to decrease the burden of language and linguistic barriers is to determine how robust the current hospital language service is. The second step is to build a structure to track information comparable to the AHRQ measures related to LEP patients. A third step is to arrange for safety culture adaptation through policy development, staff education, and clinical practice guidelines reinforcements. A phased action plan is ideal for establishing an equity-centered culture for cultural and linguistic diversity and safety.
Developing organizational systems to meet the language needs meets a call to action to activate quality improvement initiatives in the nation’s hospitals. Thus, it becomes essential to address contextual, structural, and behavioral factors impeding the provision of cultural and linguistic diversity. It is also crucial to identify and stabilize causes that precipitate diagnostic and medical errors due to language barriers. In establishing a quality improvement plan, the goals and measurable outcomes should consist of:
- Ensuring the patient receives health literacy materials in their spoken language (including sign language)
- Employing certified medical interpreters who understand how to convey healthcare information to the patient accurately
- Using plain language when talking to a patient as indicated by The Plain Writing Act of 2010 (AHRQ, 2018)
- Developing policies and education materials for providers around language and linguistic support for LEP Patients
- Evaluating and assessing the cultural and linguistic diversity of the workforce
Additionally, the following AHRQ established quality indicators should constitute in the plan (Betancourt et al., 2012):
- Avoiding the use of family members as translators
- Understanding how the patients’ cultural beliefs and traditions influence their health
- Creating a safety culture that encourages reporting medical errors, monitors LEP patient safety, and addresses root causes
- Adopting a teach-back procedure to ensure patient understanding
In conclusion, avoiding misunderstandings due to language barriers in the healthcare setting is necessary to eliminate the diagnostic and medical errors that often lead to adverse or sentinel events in LEP patients. Healthcare organizations are obligated to keep patients from harm through continuous quality improvement and equity-centered initiatives geared toward cultural and linguistic safety. Improving care delivery to LEP patients through high-quality language and linguistic services aids in their protection, healthcare satisfaction, and establishing a reciprocal provider-patient relationship.
References:
Betancourt, J. R., Renfrew, M. R., Green, A. R., Lopez, L., Wasserman, M., & US Department of Health & Human Services, Agency for Healthcare Research and Quality. (2012). Improving patient safety systems for patients with limited English proficiency: A guide for hospitals (pp. 1-64, Publication No. 12-01041). Rockville, MD.
Regenstein, M., Huang, J., West, C., Mead, H., Trott, J., Stegun, M., & Agency for Healthcare Research and Quality. (2008). Hospital language services: Quality improvement and performance measures. Advances in Patient Safety: New Directions and Alternative Approaches, 2.
The Joint Commission, Division of Health Care Improvement (TJC). (2015). Overcoming the challenges of providing care to LEP patients. https://www.jointcommission.org/assets/1/23/Quick_Safety_Issue_13_May_2015_EMBARGOED_5_27_15.pdf
U.S. Census Bureau (USCB). (2018). Data. Retrieved from https://www.census.gov/data.html
US Department of Health & Human Services, Agency for Healthcare Research and Quality (AHRQ). (2018). National healthcare quality and disparity reports. https://nhqrnet.ahrq.gov/inhqrdr/
Walsh, I. K. (2015). Language barriers may put patients at risk during daily hospital care. Evidence Based Nursing, 19(2), 57-57. doi.org/0.1136/eb-2015-102157
