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eUpdate |
| Vol. 2 No. 1 | October
2004 |
Hablamos Juntos eUpdate is a periodic electronic newsletter that focuses on current developments in improving patient-provider communication for individuals with limited English proficiency (LEP). This is achieved by highlighting activities of the Hablamos Juntos program and our grantees, sharing information on recent advancements and current discussion on language services. |
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| This Issue’s Articles |
In September, the National Program Office hosted a mid-implementation phase grantee meeting in Washington D.C. A year ago, grantees set out to achieve seven program requirements in order to create affordable ways to provide language services. This recent meeting confirmed that the ten grantees are producing a variety of products and programs that will be replicable in other health settings. They are on track to reach these benchmarks as they approach the midpoint of the grant.
Language Services - Increase the availability and quality of interpretation services for Latino patients who speak little English. To reach this goal, demonstration sites created 37 testing centers and administered 674 tests to assess language and interpreter skills of local interpreters and bilingual workers. Each candidate tested received individualized recommendations for improvement based on the test results. From these tests we learned that most interpreters are women (82%); more than half (66%) worked less than 20 hours per week as interpreters and 52% had zero hours of training. Grantees are beginning to establish training programs, in an effort to increase the qualifications of interpreters.. In September, five sites started new college-level programs to train health interpreters. Two more grantees are looking to start programs spring 2005. These programs were started through partnerships with local community colleges and universities. At the organization level, grantees have also been working to increase organizational awareness and support for addressing language barriers throughout their organizations. Grantees reported a variety of changes in staff attitudes and practices, and new initiatives to increase the ability of their organizations to serve limited English populations. One grantee is using Quality Improvement Processes to identify and address problems related to patient safety, patient satisfaction, clinical outcomes and employee fear caused by caring for patients with language barriers. Others reported early data gathering efforts to quantify the financial impact of increasing interpreter services. Still others reported use of technology like PDAs, notebooks and video conferencing equipment to create more efficient ways of providing language services. More than Words - Developing Useful Informational Materials in Spanish Developing useful Spanish materials is a significant challenge for all health providers. Grantees conducted a gap analysis to prioritize the focus for the development of new materials. The best materials were collected and analyzed for quality with the hope that they could be replicated by others. All of the 83 documents collected contained errors; misspellings, incorrect vocabulary, inappropriate sentence structure and poor grammar. Many of these were produced by commercial translation firms. More than Words was developed to build capacity within grantees sites to produce useful materials in Spanish. Our work is guided by what we have learned from studying the errors found in translated documents. Many errors are the result of a blind faithfulness to the English text. Where faithfulness to the English text is essential at the semantic or information level, it works against good writing if applied at other levels of the text. Overall there is high disregard for the integrity of the Spanish language. Vocabulary problems are another source of error related to challenges posed by health terminology, which are often inappropriately translated with words that are similar in form but different in meaning (false cognates) and the creation of new terms for concepts that do not exist in Spanish. The result is Spanish text using the English language structure, producing material that is difficult for Spanish readers to read and comprehend. One example is the use of acronyms, popular in health care and commonly used in English. Translated document often reproduce acronyms which are rarely used in Spanish. To produce useful materials grantees are working with the NPO to review translations-in-process and are developing policies and guidelines for the production of Spanish materials. Methods for evaluating translated text will also be tested and developed in the coming year. Signs That Work - Develop easy-to-understand ways for patients to find their way around health care facilities The NPO launched Signs That Work, a project to develop a set of tested symbols that can be used in health care facilities for wayfinding. Demonstration sites will support the testing of proposed symbols by surveying limited English speakers of many different languages to measure comprehension of the symbols. Four rounds of surveys are planned. Pilot sites to test the symbols applied in a signage program are currently being recruited. A set of 20-30 symbols for health care and how they can be used in a signage system will be produced by September 2005. More on program requirements... Audio from the meeting will be available on our website soon. |
One of the objectives of Hablamos Juntos is to develop comprehensive methods for patients with limited English ability to navigate health care facilities. Hablamos Juntos National Program Office has partnered with the Society for Environmental and Graphic Design (SEGD), JRC Designs and a team of independent graphic designers to create and test symbols for health care. Signs That Work was launched in May with funding provided by the Pioneer program of the Robert Wood Johnson Foundation. The project will create a set of tested symbols that designers and health care administrators can use to create friendly facilities which can adequately accommodate those with limited English ability. Guidelines and standards for using the new system in health facilities will also be developed. Symbol testing and evaluation of the new system are important in determining whether the Signs That Work program is successful. Hablamos Juntos demonstration sites will first test symbols by recruiting limited English speakers from a variety of diverse languages communities across ten states. Once the top twenty to thirty most comprehensible symbols have been identified, the chosen symbols will then be installed and tested in pilot facilities to determine whether this form of signage is more effective than word base signage. Four health facilities, meeting project criteria, are needed to support this evaluation. Through a Request for Application (RFA), Hablamos Juntos seeks to identify inpatient or outpatient health facilities willing to serve as pilot sites for this project. Participation would be voluntary and no compensation will be provided.
Several teams have assembled to help with this project. Team members include distinguished designers who specialize in hospital signage systems and those who have created notable symbols systems for the Olympic Games, Americans with Disabilities Act, federal and parks signage systems as well as internationally known projects such as the subway system in Mexico City. |
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The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recently established a panel of national experts to research and analyze ways to address cultural and linguistic issues that impact the quality and safety of patient care. Members of the panel who serve as leaders in a variety of public and private organizations will bring a diverse range of expertise on such topics as interpreter services, preventive and community health, research on health care disparities and policies and practices that could reduce those disparities. This panel will culminate with site visits at approximately 60 hospitals in 2005 to explore what hospitals are doing to address the cultural and linguistic needs of patients. The Joint Commission will use information from the study to inform health care practitioners and policymakers about the state of culturally and linguistically appropriate services in hospitals. JCAHO is not-for-profit organization the sets health care standards and is a nationwide accrediting body. The mission of the commission is to "continuously improve the safety and quality of care provided to the public through the provision of health care accreditation and related services that support performance improvement in health care organizations." |
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Grantees were required to come up with their own signature project that incorporated Hablamos Juntos, but was independently designed for their health care system. Here, one such project is highlighted. |
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Recent state law in Rhode Island mandates that hospitals provide qualified interpreters at no additional cost to the patient as a condition of continued licensure. The Neighborhood Health Plan of Rhode Island and its health provider partners responded to the legislation with a program that has been able to simultaneously provide interpreter services for patients and generate revenue for hospitals towards improving language services in the future. With the beginning of the Hablamos Juntos implementation grant, NHPRI implemented a reimbursement system for interpreter services, paying its partnering health care providers for newly hired interpreters. The partner sites can bill NHPRI each time a dedicated or dual role interpreter, qualified and approved by the health plan is used as a medical interpreter in a clinical setting. The reimbursement rate is $28.50 per hour for each clinical encounter; however hospitals generally do not spend that much per hour to use an interpreter. The revenue generated is helping establish start up money to incorporate interpreter services at each demonstration site and to offset the cost of language services for non-NHPRI members. A key element in the reimbursement program is the Health Care Common Procedure Coding System which allows all "clinical" interpreter services to be billable at designated areas within partner sites. Each dedicated or dual role staff that successfully demonstrates language proficiency in English and Spanish and completes the required training gets a provider code assigned to them through NHPRI. Using the code, partner sites can bill NHPRI for the services provided. The reimbursement function serves as a tracking tool through the claims department at NHPRI to measure and analyze expected outcomes such as decreased emergency room utilization, use of interpreters, and an increase in primary care utilization. Based on hospital usage statistics in 2002, NHPRI estimates it can save over $500,000 by avoiding these costs through language services. In addition, the project increases data collection, knowledge, and experience on the quality and cost benefit of providing interpreter services within health care. By the end of the project, Su Salud will have the data, information, and the expertise to present the case to extend reimbursement of language services in Medicaid to the state of Rhode Island. |
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Who We Are |
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Hablamos Juntos (Spanish for "We Speak Together") is a unique project designed to forge connections between health care providers and the rapidly growing Latino health market. As a national program of the Robert Wood Johnson Foundation, Hablamos Juntos is investing $10 million in ten demonstration sites around the country. These sites, ranging from health plans and large hospital systems to small nonprofit community organizations, will work to improve communication between health care providers and patients and eliminate language barriers that can lead to medical errors and compromise the quality of care. |
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National Program Office |
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Feel free to contact any Hablamos Juntos with questions or suggestions |
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Hablamos Juntos University of Southern California School of Policy, Planning & Development 650 Childs Way, Lewis Hall, Room 102 Los Angeles, CA 90089-0626 |