Hospital leaders across America are changing their procedures in order to increase the quality of care they provide to their patients. While quality for all patients needs to improve, research shows that patients of different ethnicities may receive different levels of care. This can be attributed to many factors, including patient-provider communication. Although U.S. hospitals are required to provide language services to patients who speak limited English, there are currently no guidelines regarding the most effective ways to communicate with these patients.
In order to improve quality of care and reduce racial and ethnic care disparities, more hospitals are recognizing that the quality of language services they provide directly links to the quality of medical care their patients receive.
Many studies and projects have provided information about the characteristics of a high-quality language services program in a health care system. What remains a challenge, however, is the development of an appropriate set of administrative and organizational mechanisms to embed language services into the very fabric of health care delivery. Speaking Together: National Language Services Network aims to address this challenge by recognizing that in order to more effectively use the limited resources of hospital-based language services, institutions need to better understand how to move linguistic competence into the mainstream of service delivery and quality improvement activities.
Background In 1999, Congress requested that the Institutes of Medicine (IOM) conduct a study to examine the extent of health care disparities among racial and ethnic minorities in America. The study, released in 2003 and titled "Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care," determined that gaps in the quality of health care for minorities exist even when factors such as income and insurance status are comparable to Caucasians. One of these gaps lies in the quality of patient-provider communication.
More than 46 million people, or approximately 17 percent of the U.S. population, speak a language other than English in their homes, a number that is expected to increase in the coming decades. For this growing portion of the population, poor communication can result in serious consequences when it comes to accessing health care. People with limited English proficiency (LEP) are less likely to have a regular source of primary care and are less likely to receive preventive services than people whose primary language is English. For example, in a national survey of insured nonelderly adults, Spanish-speaking Hispanic patients showed significantly lower use for physician or mental health visits, influenza vaccinations, and mammograms compared to non-Hispanic white patients.
Communication barriers due to LEP can also adversely affect the quality of care delivered to patients. Such barriers impair discussions of symptoms and alternative treatment regimens, resulting in misdiagnoses or poor treatment decisions. Communication barriers also impede the understanding and compliance of treatment plans and therapies among patients with LEP. For example, studies have shown that patients who need an interpreter but do not receive one are less likely to understand the instructions for taking medications, receive information on medication side effects and experience satisfaction with their care. One survey found that in the absence of an interpreter, Spanish-speaking LEP patients report significant difficulty in being able to fully explain their symptoms and trust the medical recommendations of an English-speaking-only provider.
Moreover, barriers due to LEP slow the efficiency of health care delivery. In a study of health care utilization in an emergency department (ED) setting, patients with LEP demonstrated a higher rate of resource utilization and increased ED visit times compared to those proficient in English.
Medical interpreters, when assessed and trained, can help in bridging this critical communication gap between provider and LEP patient. For this reason, the IOM lists supporting the use of interpreter services as a chief strategy for fighting disparities in health care and recommends that professional interpretation services be "the standard where language discordance poses a barrier to care." Unfortunately, providers in communities with rapid rates of growth among non-English-speaking patient populations often do not have the knowledge or tools to enable them to design, develop and grow sufficient language service capacity in response to the needs of their linguistically diverse patient populations.