Chapter 8: Educating Clinical Staff on Meeting Patients' Language Needs

    • June 4, 2008

"Health care professionals need to understand that effective communication is an essential component of patient safety. Therefore, patients who are not proficient in English must have their language needs met during every encounter. This is a critical part of providing high-quality, patient-centered care.”

Connie Camelo
Director of Interpreter Services
UMass Memorial Health Care

The Goal:
To promote education and awareness among clinical staff on the importance and methods of meeting patients' language needs.

Why It's Important:
Educating clinical staff on the importance of language services and giving them the tools to access services can help ensure that patients' language needs are met in your organization.

How to Make it Stick:
The language services department must emphasize the importance of its program with clinical staff to ensure its services are used properly. The following five steps on educating clinical staff emphasize the importance of implementing a strong curriculum that includes both why meeting patients' language needs is important and how they can meet those needs:

1. Take a snapshot of clinical staff awareness and use of language services.

Establish a baseline of provider attitudes about language services:

  • Are clinical providers aware of the importance of meeting patients' language needs?
  • Are clinical providers aware of the safety issues that might stem from using unqualified interpreters?
  • Do clinical providers know what language services are available in your organization? Were staff hired before services were available?
  • Do clinical providers know how to access and use language services?
  • Are they familiar with policies and guidelines on using language services? Do they know how to use the various modalities of interpretation that may be available in your organization?

Tip: Conduct a focus group, distribute a survey or talk with clinical providers to gather this information. Look at criticisms that clinical staff provide as opportunities for improvement. Educate yourself on issues related to clinical provider satisfaction, interpreter access issues or any other problems that may cause providers to shy away from using language services.

Identify departments or individuals who do not use language services in encounters in which communication is necessary. Examples of how organizations track use of language services include information from interpreter logs, telephonic interpretation invoices, audits of documentation in medical charts, field observation or shadowing of clinical providers and surveys. In addition to uncovering the reasons why clinical providers do not use language services, study those who are regular users. This can help you to identify "what works" and strategize how to convert nonusers.

2. Develop a curriculum plan to target educational deficits and encourage best practices for language services in your organization.

Create a curriculum that explains the who, what, where, when, how and why of language services. Make sure that your curriculum is in compliance with Federal Culturally and Linguistically Appropriate Services (CLAS) standards.

Tip: Many organizations commonly use unqualified interpreters. Make sure that warnings on safety issues associated with using ad hoc interpreters have a prominent place in your curriculum.

Tip: Work with someone who has a clinical background and can help "champion" language services in your organization. This person can help develop the "why use language services" part of your curriculum by identifying evidence linking communication and health outcomes, and by offering advice on how to make your curriculum relevant for a clinical audience.

Work with clinical providers to tailor your curriculum for certain clinical areas or conditions.

Tip: The better that you are able to convey the relevance of your services in specific areas of care, such as diabetes management and behavioral health, the more essential your services will become in the care process.

Tip: Understanding the different patient flow processes in your organization can enable you to provide guidance to clinical providers on the most efficient and effective ways to access language services. For example, if you know that patients admitted to a certain unit typically need an interpreter right away, you might suggest that providers on that unit use telephonic interpretation versus waiting for a face-to-face interpreter.

Determine the best teaching opportunities for delivering your curriculum, including:

  • Hospitalwide orientations for new employees
  • Organizational training sessions or annual competency testing
  • Nurse and clinical provider grand rounds
  • Rounding on patients and/or clinical providers by interpreters
  • Daily unit/clinic meetings or "huddles"
  • Department meetings
  • Clinical in-services
  • In-services created by the language services department
  • Educational campaigns
  • Safety fairs.

Remember that hearing it once may not be enough. Use a multipronged approach to educate clinical staff, including a mix of training initiatives, to reinforce your curriculum and ensure that you reach the majority of clinical staff in your organization. Additionally, try to include a hands-on approach to training clinical providers on how to use various interpretation modalities, such as telephonic interpretation. Role playing may also be effective in teaching providers how to access and use language services. Consider working with clinical providers, such as nurse educators, to integrate information on language services into their clinical curriculums.

Adapt the intensity of your teaching methods to the level of education and awareness about language services in your target audience. Some clinical providers currently not using language services may need to be targeted with special educational messages or daily interpreter rounding to encourage them to use the program. Other low-use clinical providers may benefit from a refresher course to remind them how to use your services when needed.

Identify the individuals who will deliver the educational curriculum on language services to clinical staff. Scripting messages can ensure that your staff convey the right messages about your program to clinical staff. Consider having your clinical champion deliver the curriculum to clinical staff to facilitate acceptance.

Develop organizational policies requiring training of clinical staff on the use of language services.

Tip: When developing organizational policies about language services training, consider how you will address training for residents, students and contracted clinical staff.

3. Create tools that promote awareness and encourage utilization of language services among clinical staff.

Create triggers that notify or remind clinical providers of a patient's language needs. Examples of language reminders include "I speak" cards, a note or electronic reminder in the patient's chart, a sticker at the top of the chart, a sign outside the door or by the patient's bed and listing the language by the patient's name on the unit white board.

Create triggers that notify or remind clinical providers of how to access language services. Develop readily available instructions on using language services to make it easier for clinical providers to use. For example, phones for telephonic interpretation should be easily accessible, in good working order and should have instructions for use attached.

Designate a location for language service resources for clinical providers, such as:

  • Translated documents
  • Other written materials used for communicating with patients, such as visual translation cards and universal symbol signage
  • Explanation of policies, procedures and guidelines pertaining to language services.

Tip: You may choose to post documents on your intranet or department Web site, distribute a small pocket guide to clinical providers and/or store a set of documents in a file folder at each unit.

4. Evaluate the performance of your initiatives for the education of the clinical staff.

Develop a mechanism for measuring the effectiveness of your education and awareness efforts. Possible mechanisms may include pre- and post-surveys to check on information retention or measure change in use of language services. Consider sorting out by location the information you receive to monitor educational gaps among certain clinical provider groups, departments or facilities within your organization. This can be helpful in targeting future education efforts.

Talk with clinical staff to elicit and address feedback, questions and concerns about language services in your organization.

Evaluate the visibility and usability of tools to promote the use of language services.

  • Where are notifications or reminders about the patient's preferred language located?
  • Do clinical providers know where to find the instructions or phone numbers for reaching an interpreter?
  • Do clinical providers know the location of the phone or other equipment needed to obtain an interpreter?
  • Are the instructions for reaching an interpreter clear? Are there too many steps?
  • Do clinical providers know who to contact in the event that equipment is in need of repair?
  • Is the process for accessing translated materials clear?

5. Develop strategies to improve clinical staff education and awareness about language services in your organization.

Involve clinical staff who are "champions," or regular users of language services, in your educational efforts. Clinical providers can promote the clinical importance of language services to their colleagues with their example. You may also want to include quality improvement, risk management, compliance officers, patient relations or legal services in your educational efforts.

Use the influence of senior leaders to focus organizational policy and resources on language services education.

Acknowledge and recognize clinical providers for meeting their patients' language needs. For example, you can acknowledge clinical providers for using language services for the first time, or recognize clinical providers who consistently meet their patients' language needs by featuring them in a newsletter or through staff recognition programs.

Follow up with clinical providers, clinical units and clinics that are not meeting their patients' language needs. Work with clinical leaders to determine how to address the clinical providers and clinical areas and departments that consistently do not use language services or don't use them appropriately. You may choose to have a language services staff member approach individuals on a case-by-case basis or contact the administrator of that department or clinic to allow them to address clinical providers.

Use campaigns, research projects and quality improvement projects to raise awareness about the success of language services.

Create a memorable learning moment by using success stories and learned experiences in clinical care. Feature these stories and the clinical provider or unit behind the story, in internal newsletters or presentations to clinical staff.

Use educational efforts as an opportunity to elicit and address performance issues in language services operations and delivery.

Related websites

  • PowerPoint: Language Barriers in Health Care