January 2007

Hablamos Juntos, an initiative of the Robert Wood Johnson Foundation helped to bring national attention to language barriers in health care by investing in ten diverse organizations (hospitals, health plans, universities, etc.) from around the country. As a result of this funding, most demonstrations developed or expanded their interpreter services and worked to create organizational environments supportive of language services. Due to the lack of national standards for health interpreters and tools to assess language or interpreting proficiency, demonstration sites had to create the internal capacity to assess, hire, and train interpreters. In regions where language barriers were new or emerging, the learning curve proved steep, requiring extraordinary expenditures to grow a resource of qualified interpreters.

Over the past year, the last of the Hablamos Juntos Demonstration Sites completed their work. With continued support from RWJF, the National Program Office launched Phase II – Language Policy and Practice in Health Care. During this next phase, we plan to disseminate the lessons learned from the demonstration phase and continue development of practical tools to improve access to quality health care for patients with limited English proficiency (LEP).

Our demonstrations left us with a deeper understanding of the challenges that patients and their health care providers face in overcoming language barriers. Their work helped to underscore a prevailing naiveté about the level of investment (in both time and money) required of health organizations to meet the language needs of their LEP patients. At the same time leading scholars focused attention on what little research has been done on proposed solutions to language barriers and the importance of investing in methodologically and disciplined study to support sound policymaking choices .

By the end, we saw emerging promising practices showing that organizations can work effectively to assure safe and quality care for their LEP populations. These include using systemic approaches, employing practical steps and known techniques, such as performance improvement and rapid change cycle methods. Most importantly, we learned that by focusing on the communication challenges of LEP patients, health care organizations can do more to improve communication and ultimately enhance the delivery of safe quality care for all patients.

In 2006 we’ve also seen leading health organizations undertake a wide range of other language access initiatives to improve patient-provider communication. We reported on some of these efforts in our previous eUpdates:

• President Bush's initiative to spur the growth of language development programs beginning in grade schools and to increase the number of Americans who speak languages other than English.
• American Medical Association's conferences and awareness campaigns launched to help physicians identify resources to improve communication with their LEP patients.
• Agency for Healthcare Research and Quality 2005 report on the widening of the disparity in quality care for Hispanics, where language barriers were cited as a contributor to those healthcare disparities.
• Joint Commission on Accreditation of Healthcare Organizations implemented a new standard which requires hospitals to collect information on language and communications needs of patients, in order to identify and address language barriers to health care.
• National Council on Interpreting in Health Care disseminated consensus focus groups results of practice standards for health care interpreters.

Through the work of the demonstrations, we have made many new friends and established a strong network and following of organizations and individuals who strive for excellence in meeting the health care needs of patients with language barriers. Looking to 2007, we are highly anticipating our next phase of work where we will share practical solutions and approaches that emerged from this historic initiative.

From our rich experience in working with 10 demonstration sites from around the country, we have learned many lessons about increasing language access through interpreter services, translated materials and signage and the importance of developing organizational environments supportive of language services. As we move towards the heart of our Dissemination Phase, we plan to share more information through our Resource Library that will include among other things an Organizational Readiness Guide.

The Organizational Readiness Guide will focus on the importance of making investments to create organizations committed to meeting the communication needs of patients. These investments begins with an organization’s leadership growing, at the highest and lowest levels within their organization, a passion for nothing less than optimal care for all patients. It includes using known techniques such as performance improvement and being willing to embark on a journey to develop improved capacity to communicate with all patients effectively. We will share lessons learned about organizational structures that were developed, how leaders within these health care organizations became engaged and worked diligently to continuously develop proactive organizations supportive of language services.

We will also focus on how departments like Human Resources and Quality Improvement can play an active and supportive role in helping to grow an organization’s capacity to respond to language needs of their patients. Increasing awareness among employees about the effects of language barriers on patient safety and quality of care, focusing on improving the organization’s ability to respond to patients across language barriers, developing facility-specific practical solutions, offering training for employees working with interpreters, and developing incentives for improving language skills are examples of strategies used by our demonstrations. Other strategies included conducting community and organization level assessments of resources and needs, developing benchmarks to assess progress for certain initiatives and making other systemic changes to create supportive environments where language services can thrive.

This guide will focus on concepts important to an effective approach and developing solutions to language barriers that go beyond hiring and using interpreters.

• Organizational Readiness: This is the key to developing a climate for a systems approach to overcoming language barriers, reducing resistance to change and encouraging active participation to increase response capacity within existing processes of care. For instance, leveraging interpreters instead of relying on them as the only solution. The patient’s experience is used as a guiding basis for development.
• Leadership and Commitment: These elements should be found throughout the organization and are essential to promote safe quality patient care. Research findings and changes in community demographics influence changes in patient-provider communication broadly and the needed to improve language access specifically.
• Assessment: Learning about your strengths, weakness and the community you serve is important. Assessments provide information with which you can set priorities and track progress toward defined goals. Gathering information about your local patient population, their language needs and local resources available is a useful tool in capacity planning.
• Access Points: Exploring the many junctures where LEP patients routinely face barriers to health care delivery is a practical first step to learning what health care organizations can do to improve communication and reduce barriers. Examining how employees are responding to patients with language barriers offer many opportunities for developing practical and systematic solutions.
• Human Resources: Organizational structures and common vision are essential to align values supportive of providing patient-provider communication and to creating organizations committed to safe quality patient care. Increasing awareness and developing a workforce with the skills necessary to work across language and cultural barriers are some examples of efforts that support a comprehensive systemic strategy.

Introduction To Health Care Interpreting Curriculum
Connecting Worlds, a statewide collaboration funded by The California Endowment, developed curriculum for teaching an introduction to health care interpreting. The curriculum includes an introduction to the theory, concepts, and skills associated with health care interpreting to teach an appreciation for the complexities of the roles and responsibilities of interpreters in the health care setting and the skills required to carry out those functions. A variety of teaching methods and materials, including lectures, videos, large group discussions, small group activities, role-plays, research and homework are recommended. The participant’s manual and workbook include simulated interpreting sessions and scenarios on challenging situations and to learn medical terminology (specifically anatomy and physiology and HIV/AIDS terminology). The Trainer Manual is only available for those taking a "train-the-trainer" session from one of the Connecting Worlds grantee organizations.

Participant Manual | Participant Workbook

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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