Standard 6

Health care organizations must assure the competence of language assistance provided to limited English proficient patients/consumers by interpreters and bilingual staff.   Family and friends should not be used to provide interpretation services (except on request by the patient/consumer)

In 1980, eighteen-year-old Willie Ramirez was taken to South Florida hospital.  With limited English skills, the teen’s mother and girlfriend told paramedics he was intoxicado (a Cuban term meaning “feeling sick due to something you ate or drank).  The paramedics and doctors took the term to mean “intoxicated” and treated Willie’s condition as an overdose.  This miscommunication resulted in a misdiagnosed intracerebellar hemorrhage.  This incident left Willie a quadriplegic and resulted in a  $71 million lawsuit. Read more about Willie’s case at http://healthaffairs.org/blog/2008/11/19/language-culture-and-medical-tragedy-the-case-of-willie-ramirez/.

(Image by A.D.A.M., Inc.) Had Willie’s intracerebellar hemorrhage been diagnosed correctly, he would have successfully walked out the hospital.   

Willie’s case illustrates how easily miscommunications may arise and their effects on patients and healthcare providers.  To avoid miscommunication, misdiagnoses, patient dissatisfaction, and improper treatment, it is important for health care providers to evaluate and ensure efficient language services. Bilingual staff who communicate with patients must be fluent in both English and the target language, including fluency in medical terms and concepts. 

Formal training and testing are two methods of ensuring bilingual staff and interpreters are equipped to communicate with patients.  According to the HHS, the National Council on Interpretation in Health Care recommends a minimum of 40 hours of formal training for working interpreters. 

Image by UC Davis

Although some patients may want to use family members as translators, providers should discourage such practices and inform the patient of free, qualified interpreter services.  Reasons patients’ family members and friends should not be used as interpreters include:

1.     Although family members and friends may feel confident speaking a language conversationally, they may not be able to accurately grasp medical terms and concepts.

2.     Family members and friends may withhold vital information from patients due to embarrassment or fear. 

3.     Some cultures disapprove of children discussing certain topics with parents such as sex and reproductive systems. 

4.     It is unfair to expect a child or a minor to take the responsibility of translating for his/her parents.

It is understandable that not every health care clinic or provider may have the resources to provide translation services. However, it is vital that health care providers find a way to do so.  Accurate and clear information to patients is critical to delivering care of services and reducing unnecessary duplication of services.

Faces of Diabetes PSA

NCQAndy: Medicare Stars and HEDIS

I follow Andy's Blog which has great information about NCQA HEDIS measures.  Here is a recent post on all the STAR measures.

NCQAndy: Medicare Stars and HEDIS: I thought I would start putting together some of the ideas I've been talking about into more concrete forms. I know when I talk about about...

Helen Dao, MHA

CLAS Standard #5

Standard 5: “Health care organizations must provide to patients/consumers in their preferred language both verbal offers and written notices informing them of their right to receive language assistance services”.

We have previously discussed the need for health care providers to provide multilingual services to patients.  It is also necessary to clearly notify (in verbal and written form) patients of these valuable services.

Due to intimidation, unawareness, or lack of time, patients may refrain from inquiring about translation services.  Therefore, it is the health care provider’s responsibility and ethical drive to actively offer patients free translation services. Health care providers should inquire and keep a record of patients’ preferred language; this can be documented and accessed in the patients’ demographic data.

According to The U.S Department of Health and Human Services, some methods of informing patients/consumers of language assistance services include:

• Posting signs in common languages at entrances and
• Using “I speak…card” to identify patients/consumers’ preferred language

Photo taken by Francisco Seoane Perez

Bilingual information and language assistance services requirement may seem unnecessary to some providers. However, from a malpractice point of view, lack of language services can have dire effects. Providing patients with the necessary information, instruction, and education in their native language is critical for health care quality improvement.   

Now, we can also look at this standard from two other points of view:

• First, language services are a government-mandated requirement.  This especially applies to those health care institutions receiving federal funding.
• Second, language services are fundamental to improving quality care.  Health care providers who have the motivation and self-initiative to provide patients clear and accurate treatment must strive for quality language services.

CLAS Standard #4

Health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation.

This week, we discuss the importance of providing language assistance and interpretive services to patients.  Regardless of the patient’s English proficiency (the ability to speak, write, or read), health care providers must ensure the patient receives linguistically appropriate services. 

Health care can be compared to building a house.  You can have all the proper supplies (the bricks, the concrete, the tools, etc.), but without a blueprint, the supplies are futile.  Communication is the blueprint to healthcare.  A patient may be given all the tools for treatment.  However, without a clear, linguistic understanding of his condition, the patient’s progress will be as steady as a house of cards.

The U.S. Department of Health and Human Services, Office of Minority Health identifies adequate language services as:

·      “The availability of a bilingual staff who can communicate directly with patients/consumers”

·       “Face-to-face interpretation by trained staff”

·       “Or contract or volunteer interpreters”

·      “Telephone interpreter services.”

The availability of a bilingual staff is crucial at a practice.  Some practices may not have the resources to hire a part-time or full-time interpreter.  However, there are other effective ways to provide interpretive services.  For example, one can hire a bilingual staff and identify those who can have dual interpretive roles at the front office, call center, or registration staff. There isn’t a quick fix to the shortage of bilingual staff or interpreters, but it is important for practices to think outside the box in order to meet their patient’s linguistic needs.

Interpreters can be onsite staff or operators at a language bank.  However, a phone operator may not always be available based on the demand and/or volume. A face-to-face interpreter is usually the best choice; we also need to examine the interpreter’s training and skills.  In addition to interpretation skills, interpreters must also be knowledgeable about medical terms and communicating medical content in a comprehensive manner.