June 2006

Hablamos Juntos’ initial phase supported ten demonstration efforts to develop replicable and affordable solutions to improve communication between providers and limited English-proficient Latino patients. As a result, we’ve come to learn several lessons. The demonstrations shined a light on the significant challenges providers face in meeting the communication needs of LEP patients, and the severe limits of current approaches. We learned that health care dollars spent on language services fall short of their intended goals in the absence of supportive infrastructure in host environments. The communication needs of patients go beyond the patient-provider encounter; there is need for developmental investments throughout the organization to support more strategic use of interpreters.

At the industry level, investments are needed to develop an interpreter workforce, including the establishment of medical interpreter training and performance standards. Today, every health care organization is on their own, without industry or nationally recognized standards to assess and hire interpreters. We’ve also come to understand language barriers in the context of broader communication challenges, those requiring systems-based approaches guided by how patients experience health care. Interpreters are essential, but alone they become a Band-Aid intermittently meeting the health information and communication needs of patients with limited English. More important, meeting the communication needs of patients must be integrated into the fabric of an organization, where the focus is on understanding and responding to patients with limited English–with interpreters enabling, not replacing direct communication. Several of our demonstration CEOs came to appreciate that the cultivation of language services is a journey; one requiring multiple and consistent efforts over time in order for practical solutions to get encoded into the DNA of their organizations.

Health disparities are a reality affecting many disadvantaged groups, including those with language barriers. Today, 50 million people in the United States speak a language other than English at home, half of whom are considered to be limited English proficient (LEP). Language barriers have been linked to poor, abbreviated, or erroneous communication and poor decision-making on the part of both providers and patients(1). Attention to communication and language access is essential to improve a patient’s health care experience. Yet, many initiatives aiming to increase access and reduce inequalities in heath care are missing the opportunity to explicitly include language access in program design.

Universal Health Coverage Recommendations Miss Opportunity To Address LEP Patients
For example, the Citizen’s Health Care Working Group was created by Congress to develop recommendations for national investments leading to universal access to quality affordable health care coverage for all Americans. These recommendations, while still under review, only briefly address communication issues (see recommendation five and six), and fail to address language entirely, even though the group considered issues pertaining to health disparities and minorities.  Although Federal guidelines mandate meaningful access to health programs for persons with limited English proficiency, few national resources are available to assist health organizations to meet the language needs of their patients. The public has until Aug. 31, 2006 to comment on the interim recommendations. To provide your input and feedback please click here.

Materials In Languages Other Than English, Important to Childhood Obesity Prevention
To reach minority groups it is vital to look at how we can improve communication, paying special attention to those who can’t speak English well. Important initiatives, like the Institute of Medicine’s Committee on Progress in Preventing Childhood Obesity, serve as a reminder of the need for non-English materials and strategies to impact ethnic minorities. This committee recently announced the public release of a summary of their symposium entitled: Progress in Preventing Childhood Obesity: Focus on Industry which was held on Dec. 1, 2005 in Irvine, Calif., in collaboration with The California Endowment and sponsored by The Robert Wood Johnson Foundation. The summary highlights the major themes that emerged from the symposium where the issue of obesity was said to be of great importance for the health of all: “[E]thnic minorities are at the greatest risk for obesity including African American, Hispanic, American Indians, and Asian/Pacific Islander children and youth, especially those living in low-income communities”.

National Sister Study as a Model
Programs like the National Sister Study,however, serve as a model approach. The study’s primary objective is to learn how the environment and genes affect the chances of getting breast cancer, yet addresses communication and language barriers. The study targets Hispanic women, who suffer from breast cancer more than any other type of cancer. The National Sister Study recently announced the implementation of new language materials offering new culture- and language-specific recruitment materials for Latinas and other racial/ethnic groups. The new materials include a Spanish-language bulletin and a DVD with Spanish subtitles that were previously available only in English. Click here for more about this project.

Another great example is a recently published guide from The National Institute on Aging (NIA) to help older Hispanic patients communicate with providers., Part of the National Institutes of Health, the NIA has published a Spanish-language guide to help consumers choose a doctor, prepare for an appointment, work with an interpreter, discuss sensitive health issues and find additional health information in Spanish. To access the guide click here.

Hablamos Juntos and the Robert Wood Johnson Foundation recently received a Special Mention Award for Best Environmental Graphic Design from the Society of Environmental and Graphic Design (SEGD) for symbol usage in health care.This award comes after two years of work, which included a six-member Design Team, technical experts in symbols and wayfinding testing as well as sound advice from a Technical and Project Advisory committee. The collaboration focused on developing a set of easily understood graphic symbols that ultimately could be used universally in health care environments to aid visitors unable to read in English.

Two New Resources For Language Services

A friendly reminder to our readers that the Journal of General Internal Medicine’s (JGIM) June issue includes a call for papers for its upcoming special issue focusing on the topic of language barriers in health care. JGIM is encouraging submissions from educators, researchers, clinicians, and policy makers who wish to address important issues related to language barriers and health care. For further information, click here.

Hablamos Juntos II – Language Policy and Practice in Health Care funded by the Robert Wood Johnson Foundation to disseminate lessons learned from ten demonstration sites around the country and to set standards and create practical tools for developing useful health materials in languages other than English.

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