Lost in Translation: Communicating with Non-English Patients

Medical information can be challenging for an outsider to understand at times. The challenge is even greater for those who do not speak English or have limited proficiency in English. Despite federal regulations requiring language access services and evidence showing the impact of language barriers on the quality of patients’ healthcare. It is apparent that not all hospitals provide interpreters or translations for their non-English patients.

The Numbers

  • In 2013, about 21 percent of the U.S. population, nearly 62 million residents, spoke a language besides English at home, according to the U.S. Census Bureau.
  • About nine percent, more than 25 million Americans, speak English “less than very well.” This group is considered to have Limited English Proficiency (“LEP”).
  • Nearly one-third of U.S. hospitals fail to offer interpreters.
  • About one-fourth of U.S. hospitals in areas with a high or moderate need for language services do not offer interpreters.

The Problems

Healthcare services are significantly impacted due to non-English patients not receiving the correct information. In turn, this leads to longer hospitalizations, misdiagnosis and increasing medical errors. Research reveals that language barriers leave LEP patients at a greater risk of line infections, surgical infections, falls, pressure ulcers and surgical delays. Because of difficulties in understanding instructions about managing their condition or taking medications. LEP patients also have a greater chance of readmitting into the hospital for certain chronic conditions.

By using unqualified interpreters, such as a relative or friend are the most frequent cause of serious harmful events reported to the Joint Commission’s Sentinel Event Database. The use of professional interpreters, whether in person, via telephone or through video, increases patient satisfaction, improves adherence to care instructions, improves health outcomes, reduces bad events and limits malpractice risk.

The Requirements

  • Title VI of the Civil Rights Act of 1964 requires that any program or activity (including hospitals) that receives federal funds, which includes Medicare and meaningful use, must take reasonable steps to ensure meaningful access to their activities by LEP persons. Hospitals can use telephone translators, bilingual staff, professional on-site translators or video translators.
  • Section 1557 of the Affordable Care Act (ACA) requires notices of non-discrimination be provided in 16 different languages and mandates the use of only qualified interpreters in healthcare scenarios.
  • Individual states have their own requirements.

The Solutions

The development and implementation of a suitable language services program at a hospital is multi-step and involves multiple departments. The process generally requires a needs assessment and buy-in from administration/management. Also, written policies, staff training, the gathering of data and periodic assessments. Additional steps may require the use of medical interpreters through a third party versus hired staff.

Guidance from the Office of Civil Rights suggests a four-factor assessment to determine what language access services to offer. While the Office of Minority Health recommends four Language Access Services standards as part of its Culturally and Linguistically Appropriate Services in Health Care standards. Besides identifying the languages spoken by patients and current offerings for communicating with patients who do not speak English or LEP patients. An assessment must catalog the hospital’s technological capabilities. For example, if telephone interpreting is to be provided, adequate telephone jacks and headsets need to be accessible to staff.

To identify the volume of interpreting encounters and document translations, recording data entry is the best solution. This includes the number of face-to-face versus telephonic-interpreted encounters. Each encounter should document the duration of any interpretation, the language used, topics discussed, etc. Also, useful to gather are patient satisfaction surveys.

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