THE IMPACT OF LANGUAGE & CULTURAL BARRIERS ON PATIENT SAFETY & HEALTH EQUITY

by Anita Sulaiman, Founding Consultant & Trainer IBEX | Inter-Cultural Business Excellence If you have ever been in a situation where you do not speak the language of the land and cannot understand or make yourself understood, you know what it is like to face a language barrier. Imagine needing medical attention in that environment. In any given setting, the inability to effectively communicate can be very limiting and stressful. In a healthcare setting – where even in the happiest of circumstances like the birth of a newborn, people are feeling anxious and vulnerable – that stress is amplified and that limitation has significant repercussions on patient safety, health outcomes, and health equity. A DIVERSE LANDSCAPE MEANS DIVERSE NEEDS One out of five, or over 60 million people in the United States, speak a language other than English at home[1]. Forty-two percent of this group is Limited English Proficient (LEP)[2], meaning they speak English less than “very well.” This segment of the U.S. population is at risk for adverse events because of impediments associated with their language ability. In Washington State, approximately 660,000 people are LEP[3]. Whatever the patient care setting, as this country becomes increasingly diverse, health systems are encountering more and more LEP patients and families from various different cultures. Language and cultural barriers present critical challenges to both providers and patients in ensuring meaningful access[4] to quality care. Recipients of government funding are mandated by a number of laws to provide language access to healthcare services. The reality is that many struggle to fulfill this obligation. Our healthcare system, in its current state, is not equipped to operate in an environment where a large section of the constituency requires language assistance. LEP PATIENTS FACE BARRIERS TO ACCESS FROM STEP ONE Unless you are a person with limited English proficiency, it is easy to forget how much of a barrier language and culture can pose. Simply scheduling an appointment can be an ordeal if you do not speak English. As part of a cultural competency audit I was conducting as a consultant on several hospitals in different states, I had to make telephone calls to these hospitals as if I was an LEP patient. On one, where I presented myself as a Chinese-speaker, this was what ensued: “Patient” (in Mandarin): Hello. Good morning. I’d like to see a doctor please. My head is hurting very badly. Hospital employee...

Read More

TAILORING A COMMUNICATION AND RESOLUTION PROGRAM TO YOUR MEDICAL SYSTEM

Organization: Confluence Health Project Name/ Title: CRP Point of Contact: Randal Moseley, MD, FACP, FHM, Medical Director of Quality | randal.moseley@confluencehealth.org About Confluence Health Confluence Health is an integrated healthcare delivery system located in North Central Washington. We serve a population of about 250,000 dispersed over 12,000 square miles. Our resources include two hospitals, 13 clinic locations, over 270 physicians covering more than 40 medical specialties and primary care, and 150 advanced practice clinicians.   Starting the Journey: CRP Foundations Communication and Resolution Programs (CRPs) consist of a bundle of strategies to improve response to patient harm events, learn from them, and execute needed changes to prevent similar events in the future. In our quest for a best practice way to handle patient harm events in our system, we found CRP strategies to be culturally very compatible with Confluence Health quality philosophy. To implement CRP strategies into our system, we began by educating leadership and key operational personnel in CRP principles and methods, and now have top executive support to adopt CRP as the foundation for the majority of our incident response and quality improvement activity within our facilities. From what we’ve learned, the CRP journey requires: Making a commitment to transparency with patients Employing rigorous event analysis using just culture and human factors principles Supporting the emotional needs of the patient and care team affected by the event Proactively seeking appropriate financial and non-financial resolution for patients Continuously assessing the impact of the program   From Vision to Action: Essential Building Blocks Our core action team leading this work is called the Culture of Safety Committee, with representation from incident management, quality improvement, and members of the senior leadership team. We have used the “key steps” list from the Collaborative for Accountability and Improvement for our roadmap, and these are the lessons and tools we’ve employed: 1. Facilitating the Initial Response: It is important to have an engaged workforce that is not hesitant to report patient harm events quickly. To gain the confidence of employees, it is critical to operate with just culture principles and a human factors perspective when approaching error events. While this foundation is critical to the success of CRP implementation, this cultural environment is impossible to create quickly. At Confluence, we had a fortunate accidental segue into CRP needs – we had been working on a “speak up” program from the beginning of our organization in 2013....

Read More

BREAKING THE ICE ON END-OF-LIFE CARE

by Emily Wittenhagen Organization: WSMA Project Name/ Title: Honoring Choices Pacific Northwest Point of Contact: Jessica Martinson, jessica@wsma.org I was happy recently to sit down for a talk with Jessica Martinson, ‎the Director of Clinical Education and Professional Development at the Washington State Medical Association, known to many in our state as WSMA (pronounced wizma). ABOUT THE WASHINGTON STATE MEDICAL ASSOCIATION WSMA represents over 10,000 physicians, resident physicians, medical students and physician-assistants throughout Washington State, the only professional organization in the state that represents the interests and priorities of all physicians, regardless of specialty or practice type. WSMA’s mission is to provide strong physician leadership and advocacy to shape the future of medicine and advance quality care in Washington State. DESCRIBE THE PATIENT SAFETY CONCERN YOU OR YOUR ORGANIZATION WAS AIMING TO EFFECT Jessica has worked since 2014 on the Honoring Choices® Pacific Northwest initiative. Co-sponsored by WSMA and the Washington State Hospital Association, this collaborative effort between physicians and hospitals will ensure that health care providers are prepared to discuss and honor patients’ end-of-life wishes. Honoring Choices PNW is one of the biggest rollouts of an advanced care planning program in the country and works in partnership with Respecting Choices, an internationally recognized evidence-based model of advance care planning (ACP). The first cohort on the project is made up of 32 teams from 23 healthcare organizations, representing every major healthcare system in the state, as well as rural and critical access hospitals and medical groups. DESCRIBE THE CHALLENGES YOUR TEAM OR ORGANIZATION FACE. HOW DID YOU OVERCAME THESE BARRIERS? CHALLENGE #1: LACK OF URGENCY To begin with, the Honoring Choices PNW team is focused on First Steps® conversations with healthy adults. While advance care planning is not the “biggest fire burning” for adults when they are happily enjoying good health, this is precisely the right time to get the conversation going. Instead, the reality is that many people don’t think to have these conversations until it’s too late, if they have them at all. Sometimes the conversations happen after a serious diagnosis. But all too often we see the worst-case scenario: a person has a medical emergency and they cannot speak for themselves, leaving their families to guess what kind of care their loved one may want. SOLUTION: BUILDING URGENCY “To address that,” Jessica says, “we have to move the conversation upstream.” As the saying goes, “It’s always too early until it’s...

Read More