Currently a work in progress, The Organizational Readiness Guide will provide information and resources intended to reduce language barriers in health care organizations. Over the next few months, the information gathered from ten demonstration sites funded to develop affordable solutions and the lessons learned across these sites will become available.
We encourage you to explore the Organizational Readiness Guide to find solutions that can be applied in your setting. Keep in mind, every setting is different and will require unique solutions. But regardless of the setting, our demonstrations showed us that access to safe, quality health care for all patients, especially those with limited English abilities, can improve. Information, ingenuity and commitment will be the anchors for your journey to find and create appropriate solutions for your health care organization.
To begin, we have provided an overview of concepts important to understanding our approach and solutions. In the weeks ahead, the Organizational Readiness Guide will contain further descriptions of these concepts and practical solutions that may apply in your settings. Don’t forget to visit other sections of the website to learn about how Interpreters, Non-English Materials (materials in languages other than English) and Universal Health Symbols play a role in improving language access.
The journey to increased language access begins with leadership and a commitment to developing a health care organization responsive to the communication needs of patients. Organizational Readiness is the key to developing a climate for a systems approach to overcome language barriers by building response capacity within existing processes of care; leveraging interpreters, not relying on them as the only solution. Leadership and Commitment are essential. Research findings and changes in community demographics create influences, the business case, for improving patient communication broadly and language access specifically. Learning about your strengths, weakness and the community you serve is an important planning tool. Assessments discusses ways in which you can gather information about your patient population and your current language resources. Access Points explores the many junctures where LEP patients face barriers to the health care delivery system and what health care organizations can do to improve communication. Organizational structures and aligned values throughout the health care organization are necessary for vision and commitment to manifest. Attention to Human Resources to raise awareness and develop a workforce with the skills to work across language and cultural barriers is a central strategy.
This "How to" guide provides background discussion for how these concepts apply to language access with tools and practical solutions for implementation. Some of these sections are currently under development. Please check back often.
The Hablamos Juntos experience indicates that improving meaningful language access for LEP patients requires a systems approach that integrates language services into existing care processes. This approach can be patient-centered, taking into consideration each juncture where the patient interacts with health care staff. The information exchange that occurs can be examined from the patient’s perspective for ways in which language capacity within the health care organization can be developed.
Improving language access is a journey. It is about changing habits, rethinking priorities and looking for ways to use the patient’s experience as a guiding basis for development. It takes active commitment from the entire health care organization (beginning with its leaders) and systematic development of structures and practices to improve communication with all patients. The experiences of our grantees indicate that the following four building blocks are critical to building organizational readiness and beginning the journey.
A directive from the executive leadership of the health care organization, although essential, is simply not enough. Our grantees found that leaders needed to make improved language access a priority and to find tangible ways to focus attention on changes to improve the patient experience. By setting achievable objectives and using practical tools, health care organizations can improve the quality of care for patients with limited English by improving communication with all patients.
Once a health care organization is engaged and committed to this journey, durable structures can be developed and implemented to systematically increase language access. Structures such as coordination and control mechanisms, formalized objectives and centralization of responsibilities are important to raising the attention needed to improve patient-provider communication. In addition, data systems can play an important role by helping you to understand your patient population profile and your current language access resources. Data systems may also enable or support care delivery and communication in multiple languages. Principals that prepare their institutions appropriately may control costs by maximizing the use of their current resources.
We understand that describing the above commitments and structures is much easier than incorporating them into the day-to-day operations of a health care organization. However, there are a number of compelling reasons and benefits for making this kind of broad, system-level commitment and for developing organizational structures that increase language access. These driving forces and benefits are discussed in The Business Case.
To help health care organizations invest in language services, it is important to assess local population needs and to discover resources that exist to meet those needs. Assessments provide information with which you can set priorities and track progress toward defined goals. Community or population assessments are important to understand the base of patients likely to be served by a health care organization. Internal organizational assessments help identify resources and opportunities for increasing language access. Both are planning and evaluation tools that can help health care organizations form a more comprehensive view of language service needs and develop strategies to meet these needs.
Access Points are routine stops along the health care visit where an LEP patient must interact and communicate with members of the health care team. This includes personnel who answer the phone, help make an appointment or in some way play a role in the patient visit. Language barriers block patients from moving smoothly through the visit and present challenges for health care staff. The consequences for LEP patients are clear; these barriers can lead to delayed or foregone care. Less evident is the effect on health care staff. Too often, mostly due to neglect, health care staff is left to create solutions on their own. One demonstration site found that these conditions left staff feeling helpless, worried and scared that their inability to communicate would result in preventable pain and suffering, or worse, for LEP patients.
The experiences of Hablamos Juntos grantees indicate that meaningful language access for LEP patients involves the combination of many types of resources, services, tools and technologies at access points. Outside of interpreter services, Hablamos Juntos grantees provided language access at system entry points by using a variety of approaches simultaneously.
The systems approach suggested here travels the road to a patient-centered health care organization. Organizational structures and management priorities focus on aligning the workforce to improve patient communication broadly and language access specifically. Human resource policies and practices support building awareness of communication issues and focus on building employee competencies to work across language barriers. Developing foreign language capabilities include formalized testing of language proficiency and interpreting and invest in developing interpreter expertise broadly. Recruitment strategies are employed to increase foreign language skills among employees and management practices are developed to take advantage of a wide range of competencies while ensuring safe and quality care to patients.