Quality health care demands clear communication. Communication problems are at the heart of many sentinel health care events—including unexpected deaths and catastrophic injuries—as well as the consequential legal liability and financial loss for health care providers (The Joint Commission, 2007b). Patients with limited English proficiency (LEP), low literacy, and those who are hearing impaired or have cognitive disabilities pose special communication challenges. Health care organizations and individuals need to develop a capacity to communicate effectively with diverse audiences. Linguistic competency is quickly becoming essential to maintaining quality of care standards and practices.

Fortunately, most health care organizations already have the seeds for developing cultural and linguistic competencies to care for today’s diverse patients. These include human resources with diverse language backgrounds and quality improvement technologies; the formal structures and staff dedicated to assure that quality of care standards (either self- or industry-imposed) are met.

The recommendations in this tool offer broad national and global perspectives on language diversity and practical action steps that have emerged from our work with Hablamos Juntos demonstrations and focused research on translated materials. These recommendations and action steps are intended to build on existing core competencies by focusing a special lens on the communication needs of LEP patients. They suggest ways in which hospital and health plan administrators, physicians and other health care providers, and other government, insurance and industry professionals can develop linguistic competencies at the individual, organization and industry level. 

Step 1. Embrace the Need for Change.
Accept the need for increased linguistic competency in your organization and beyond.

Step 2. Consider Your Own Population and Your Current Risks.
Become aware of the diversity of language needs and understand the consequences of poor communication.

Step 3. Assess the Availability and Quality of Your Non-English Written Materials.
Rate the strengths and weaknesses of your current stock of non-English health materials.

Step 4. Focus on Improving Your Translation Capabilities.
Learn more about the translation process and adopt standards and best practices.

Step 5 Encourage Investments in Communication Improvement.
Advocate for communication-related strategic investments by health providers, language   professionals (interpreters/translators) and researchers.

The recommendations and practical steps in this tool are a work in progress, guided by our years of focused work to develop practical tools that address language barriers and the expertise of linguists, language researchers and practicing translators. They are not evidence-based guidelines. Rather, they represent a social-ecological approach to creating response capacity for a growing population unable to communicate in English. This approach assumes health communication takes place in many environmental subsystems within and outside of health organizations, and that cultural and linguistic competencies can take many forms and need to be developed at various levels within health care organizations as well as within the local, state or national health care industry.

We hope you find these recommendations useful in developing new competencies within your organization and that your work in this arena will help orient health care industry attention to the nation’s diverse and multilingual society. Be sure to read the entire Hablamos Juntos More Than Words Toolkit Series for more guidance, tools and strategies to improve the quality of non-English materials.