To ensure access to linguistic services at every point of contact, health care organizations must address multiple unique encounters that span the patient and family health care experience. Each point of contact may be specialized and requires its own level of linguistic competency. Faced with increasing language service demand, and in the absence of adequate numbers of onsite qualified health care interpreters, health care organizations are turning to their own diverse workforce for practical solutions. To promote access to linguistic services, Kaiser Permanente developed the Qualified Bilingual Staff (QBS) model to identify, qualify, educate/enhance, mobilize and monitor an internal workforce as a key strategy to promote culturally competent care, improve health outcomes and reduce health care disparities.
Kaiser Permanente established the QBS model to expand the ways it provides culturally and linguistically appropriate care services and training to its staff and providers serving LEP members. Specifically, the QBS model aims to:
- Identify workforce capacity;
- Qualify levels of linguistic competency;
- Enhance linguistic capabilities;
- Mobilize QBS within the care system; and
- Monitor the services provided to ensure continuous quality improvement and patient safety.
Three levels of staff training for the model include:
- Bilingual staff—language liaison
- Bilingual staff—language facilitator; and
- Designated interpreter.
The QBS model is complete with an internally developed training curriculum, resources and materials. It is open to all members of the Kaiser Permanente workforce who seek to enhance their linguistic competency. Currently, the model targets the plan’s threshold languages including Spanish, Chinese (Mandarin and Cantonese dialects), Vietnamese, Tagalog, Russian, Hmong, Punjabi and American Sign Language. The QBS model enhances bilingual communication within the staff’s scope of practice or clinical specialty. QBS staff and clinicians can serve in dual roles where one role services a functional need, the other a linguistic need.
The model also promotes CLAS standards by embedding the standards as a core-element learning objective in each level of the curriculum. It provides a systematic approach to bridge health practice with health training by institutionalizing a skill enhancement process that internal workforce staff can use.
The development of the QBS Model required the participation of national, regional and local staff, project leads, executives, business managers, union leaders and community advocates. The QBS model introduced a fundamental change in organizational culture by investing in its internal expertise to meet the needs of linguistically diverse populations. The model was initiated in 2003 and has gained momentum as it is replicated within the organization in different regions. The model complies with the CLAS standards and federal and state mandates such as Title VI of the Civil Rights Act of 1964.
The QBS model has been successfully implemented in Kaiser’s Northern California, mid-Atlantic states, Georgia and Southern California regions. Kaiser Permanente regions have been exceptionally successful in the implementation of the QBS model. The model has been recognized both internally (recipient of Kaiser Permanente’s prestigious internal R.J. Erickson Award) as well as externally (recognition by patient rights leaders, advocates and community organizations). In 2006, the QBS model Program received the NCQA Recognizing Innovation in Multicultural Health Care Award.
In the Northern California region (covering 3.2 million members), particular achievements include:
- Implementation of the QBS model in 2003;
- Training of 75 level-one trainers and 50 level-two trainers;
- Implementation in 51 medical offices throughout Northern California;
- Completion of 6,173 assessments as of April 30, 2006;
- Assessment and training of 3,060 QBS staff with approximately 1,517 in level one and 1,543 in level two;
- Provision of more than 388 QBS level-one training and 119 level-two training sessions since the program’s inception in 2003;
- Increased cultural and linguistic capacity for Spanish, Chinese, Vietnamese, Russian, American Sign Language, Tagalog, Hmong, and Punjabi speaking staff; and
- Collaboration with four main labor unions.
In the mid-Atlantic states region, which includes Washington, D.C., Virginia and Maryland (covering 500,000 members), accomplishments include:
- Implementation of the QBS program in 2004;
- Training of eight certified facilitators;
- Implementation in 22 facilities;
- Training of 102 QBS staff with approximately 15 in level one and 87 in level two; and
- Increased cultural and linguistic capacity for Spanish-, Chinese- and Vietnamese-speaking staff.
Lessons Learned and Next Steps
Kaiser Permanente plans to add additional languages into the QBS model depending on patient demand. The model continues to flourish in an environment of strong organizational commitment and continues to gain momentum in regions that recognize potential program benefits. The model will continue to succeed as a viable and cost-effective solution to meet the needs of Kaiser Permanente’s diverse multilingual and multicultural population and reduce the need to outsource services while maintaining the health plan’s standards. Leadership at the various Kaiser Permanente regions throughout the country, coupled with collaboration and agreements with partnering labor unions, reinforce the effort to develop the linguistic competency of internal staff. Regional and labor union partnerships also provide monetary rewards as recognition for the provision of QBS services.
A fully developed curriculum and related program support material allow the model to be replicated across the organization. Policies and procedures are in place to govern and monitor the standards for ongoing assessments and training. These guide delivery and expansion of the QBS model.
- 1. What Categories of Race/Ethnicity to Use?
- 2. Chapter 5: Direct REL Data Collection Methods
- 3. Section 5: Case Studies
- 3.1. Harvard Pilgrim Health Care: Pilot Test of IVR Outreach Calls as a Mechanism for Collecting REL Data
- 3.2. WellPoint, Inc.: Georgia Telemedicine Diabetes Education Project (GPTH): Using Proxy Methodologies to Locate High Opportunity Areas
- 3.3. Molina Healthcare's TeleSalud Program: Providing Direct Access to Language Services
- 3.4. Kaiser Permanente: Qualified Bilingual Staff Model
- 3.5. Kaiser Permanente: Health Care Interpreter Certificate Program
- 3.6. The National Health Plan Collaborative to Reduce Disparities and Improve Quality
- 4. Indirect REL Data Collection Methods
- 5. Chapter 5: Promising Practices in Interpreter Training and Competency Assessments