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Workshop D-2: Developing assessment tools for language assistance services in hospitalsThe Joint Commission on Accreditation of Healthcare OrganizationsResearch has shown that limited understanding of information provided in English to non-English-speaking patients can influence the quality of health care provided, as measured by both patient satisfaction and health outcomes (Youdelman, 2002, and Weech-Maldonado et. al, 2003). Providers’ limited sensitivity to the dynamic effects of culture can have a similar effect. The Joint Commission, in cooperation with The California Endowment, is interested in raising the awareness of health care organizations to the need to deliver culturally and linguistically appropriate services, recognizing that the delivery of these services is more than simply a patient’s right, but is, in fact, a key factor in the safety and quality of patient care (Schyve, 2002). A 30-month project funded by The California Endowment, Hospitals, Language, and Culture: A Snapshot of the Nation will gather baseline data on a sample of hospitals to learn how they address the cultural and linguistic needs of their patients, identify best practices, and inform policy. The Joint Commission plans to collect on-site data at approximately 60 hospitals across the nation and survey a representative sample of hospitals. Advisors, who are experts in cultural competency and healthcare; a national technical advisory panel; and analytic consultants support the project. The results of the study will serve as a foundation for setting realistic expectations for hospitals to meet the cultural and linguistic needs of the populations they serve. This session will be an opportunity for the presenters and participants to learn from and exchange ideas with one another on designing research and collecting data. The presenters will share their experiences and the challenges of designing Hospitals, Language, and Culture, and share preliminary results from a literature review. In particular, the presenters will share the research plan, discuss the process of developing a sampling plan and effective methodologies, and describe how the project team settled on six primary areas of focus for the research. Research information, a bibliography and other materials from the project will be distributed. Amy Wilson, M.P.P., C.P.H.Q., is an Associate Project Director in the Division of Standards and Survey Methods and is currently the Principal Investigator for the Joint Commission study Hospitals, Language, and Culture: A Snapshot of the Nation. Ms. Wilson earned her Master of Public Policy in Health Policy and a Graduate Certificate in Health Administration and Policy from the University of Chicago. Her studies explored poverty, health inequalities, and health status. She is a Certified Professional in Healthcare Quality (CPHQ) and is responsible for the development and maintenance of Joint Commission standards and survey processes. Ms. Wilson has been a leader in the Joint Commission’s initiatives related to cultural and linguistic issues in health care. She conducted an assessment of Joint Commission Surveyors’ opinions and observations related to culturally and linguistically appropriate health care services and developed a two-part surveyor training program to address issues of language and culture that may be identified during Joint Commission surveys. She represents the Joint Commission on a number of National Advisory Committees on subjects related to the provision of culturally and linguistically appropriate services and has presented on behalf of the Joint Commission at a number of national conferences. Ms. Honeycutt, a Senior Research Associate in the Division of Standards and Survey Methods at the Joint Commission on Accreditation of Healthcare Organizations, manages the activities of Hospitals, Language and Culture: A Snapshot of the Nation. She began working on issues of equity and cultural diversity at Education Development Center for the Women’s Equity Resource Center and on an adult ESL curriculum for the Lead Poisoning Prevention Project. Prior to joining the Joint Commission, Ms. Honeycutt served as Associate Director of Corporate and Foundation Relations at Bentley College, where she led development for diversity initiatives and foundation cultivation. She earned a Master of Public Policy from the University of Chicago, where she was a McCormick Tribune Fellow, and completed graduate studies at the University of Massachusetts, Boston. She serves on the Junior Board of the Heartland Alliance for Human Needs and Human Rights, and writes multicultural fiction.
Challenges and Lessons: A Survey of Local Hospitals’ Language Access ServicesIn Alameda County, California, local government officials and community organizations partnered together to conduct a survey on the availability of language assistance services for limited-English speaking patients at local hospitals. The survey results revealed that that most hospitals in Alameda County have language access policies in place and have contracts with companies that provide interpreter services over the phone. However, many health care providers are not being trained on how to access an interpreter when a patient is in need of language assistance. In addition, translated written materials are still needed, including critical documents and signage. The Alameda County Board of Supervisors and community organizations identified several hospitals that have promising practices in providing language access for their patients. These promising practices are being highlighted as models for other hospitals in the area. The “best practices” report describes practical models and solutions that can be pursued, even during financially strained times. The report was released to the public at a press conference with the Alameda County Board of Supervisors and local leaders from community organizations. The collaborative approach to surveying hospitals in Alameda County was met with success on several levels.
The challenges in conducting the survey and lessons learned from these challenges included:
Lara Bice has served as health policy analyst for Alameda County Supervisor Keith Carson since 1997. Supervisor Carson was elected in 1992 to represent the residents of District 5, which includes the cities of Berkeley and Oakland, California. As Supervisor Carson’s Deputy Chief of Staff, she directs and implements District 5’s health policy agenda, which focuses on specific issues impacting community health and health care access issues for low-income and minority populations in Alameda County. Luella J. Penserga has more than 10 years of experience in public health, coalition-building, and the health issues of immigrant communities. She is currently a project director at the Alameda Health Consortium, an association of 8 member community health centers in Alameda County, California. She directs the W.K. Kellogg-funded Community Voices Project, a collaborative project of Asian Health Services and La Clinica de La Raza, two community health centers located in Oakland, California.
Summary of Funders’ Collaborative Fund for Racial Justice InnovationLinguistic access to health care is now a pressing issue in communities throughout the United States but it is particularly pronounced in Los Angeles County, the most diverse and populous county in the country, home to nearly a third of California’s residents and having the second largest public health system in the nation. In Los Angeles County alone, more than 100 languages are spoken. Fifty-four percent of County residents speak a language other than English at home, while almost 30 percent speak English less than “very well.” Given the rollbacks in service that are considered an inevitable consequence of enormous budgetary deficits facing the county, the degree to which we can successfully implement the County’s Cultural and Linguistic Competency Standards (“C&L Standards”) can serve as a national model for improving cultural and linguistic access. There are many difficulties faced by both LEP patients and our health care system in meeting the growing demands for linguistically appropriate services. Without skilled language assistance, LEP patients often have to rely on untrained interpreters (including friends, family members, children and ad hoc interpreters), can be discouraged from seeking health care services, or can receive inferior and/or delayed health services. The situation is exacerbated by a lack of awareness of language access requirements by consumers and health care providers, and the absence of enforcement of legal requirements. Further, the benefits associated with patient-centered interpreter and translation services for LEP individuals are often not fully recognized. The Project proposed by the Los Angeles Language Access Collaborative (“Collaborative”), comprised of the National Health Law Program, PALS for Health, Asian Pacific American Legal Center, Armenian Relief Society, and Coalition for Community Health, will confront these issues by demonstrating through our collaboration with providers that cultural and linguistic standards can be successfully implemented despite financial obstacles and resource limitations and by sharing best practices and models used by other medical facilities. The Collaborative hopes to work with the Los Angeles County Department of Health Services to develop and implement a demonstration plan to successfully implement the Los Angeles County Department of Health’s C&L Standards at a county facility and educate the community at large about the results of this effort. The project will begin by developing a site assessment tool to conduct a baseline evaluation of current capacity and the hospital's language access program. The assessment tool will also include criteria, including such factors as the LEP patient and partner feedback, the diversity of the facility’s service area population, the resources of the facility, and its commitment to providing C&L services, to assist in the selection of the appropriate facility to engage in the development of an effective language access plan. The assessment tool can be used, in consultation with the Los Angeles Department of Health, to identify the facility that will most benefit from the collaborative's knowledge base and offer of technical assistance. The project’s goal is to increase the availability of culturally and linguistically appropriate services for the LEP population in L.A. County. It will identify ongoing problems stemming from structural exclusions that preclude LEP patients from securing needed health care, and will determine ways to improve LEP patients’ access to health care providers. The project partners will work with public officials, hospital administrators and relevant staff in the facility to evaluate current cultural and linguistic access policies and provide technical assistance to improve LEP patient access to their services. Documenting and publicizing this initiative and involving local community groups will increase the visibility of language access issues to other providers and the community at large. To accomplish these goals, the following strategies will be used:
Doreena Wong is a staff attorney at the National Health Law Program ("NHeLP"), which is a national public interest law firm working to increase and improve access to quality health care on behalf of limited income people by providing legal analysis and representation, information, education, and policy advocacy. She provides support to the Health Consumer Alliance, a partnership of consumer assistance programs operated by community-based legal services organizations whose purpose is to help low-income people obtain essential health care. She places a special focus on increasing the provision of culturally and linguistically appropriate health care services for immigrants and limited-English proficient populations. She has participated on the Office of Minority Health's National Advisory Committee for the Development of Culturally and Linguistically Appropriate Services in Health Care, California's Task Force on Culturally and Linguistically Competent Physicians and Dentists. She is currently a member of the Advisory Committee of the California Health Care/Safety Net Institute’s Model Language Access Policies and Procedures Project and the Policy and Research Committee of the National Council on Interpreting in Health Care. Phone: (310) 204-6010; E-mail: wong@healthlaw.org
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National Conference is presented by State University of New York Downstate Medical Center, Resources for Cross Cultural Health Care, Arthur Ashe Institute for Urban Health, US Department of Health and Human Services, Joint Commission on Accreditation of Healthcare Organizations |
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| As with the rest of Diversity Rx, this section
is a work in progress and we welcome information on other efforts, programs,
and reports that will expand upon the information offered here. Please
let us know if you have other examples to include here. |
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Diversity Rx is sponsored by: |
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