The Joint Commission (TJC) shows that, when compared to English-proficient patients, limited English proficient LEP patients have:
- Longer hospital stays when professional interpreters were not used at admissions and/or discharge.
- Greater risk of surgical infections, falls, and pressure ulcers.
- Greater risk of surgical delays due to difficulty understanding instructions, including how to prepare for a procedure.
- Greater chance of readmissions for certain chronic conditions due to difficulty understanding how to manage their conditions and take their medications, as well as which symptoms should prompt a return to care or when to follow up.
These issues, along with other more day-to-day challenges, can be successfully addressed with an overall approach that leverages cultural intelligence to enhance patient satisfaction, engagement, and outcomes, especially for LEP patients.
Developing Cultural Intelligence
Cultural intelligence (CQ), the ability to relate and work effectively across cultures, involves understanding the cultural backgrounds of patients and how these backgrounds affect their healthcare beliefs, behaviors, and communication styles. This includes cultural beliefs and traditions that affect care delivery, such as expression of pain, respecting authority, gender roles, and class biases.
Training and Education
Regular cultural competence training leads to measurable benefits to patient care. A critical appraisal of seven published research articles evaluating the effectiveness of cultural competence training for healthcare providers on improving patient satisfaction revealed that cultural competence training interventions significantly increased the cultural competence level of healthcare providers, with five studies demonstrating that cultural competence training was significantly associated with increased patient satisfaction. [i]
MasterWord delivers CQ training to healthcare professionals in digestible sessions that include Section 1557 updates and principles of Trauma-Informed Care (TIC).
The Health and Human Services (HHS) Office of Minority Health also offers online training modules through Think Cultural Health.
Final Rule for Section 1557
With the US Department of Health and Human Services recent publication of the Final Rule for Section 1557, there has been a strengthening of protections against discrimination and enhancing language access to care for LEP patients. These protections align with the principles of patient-centered care and encourage an overall approach that leverages cultural intelligence to enhance patient satisfaction, engagement, and outcomes, especially for LEP patients.
Implementing Effective Communication Strategies
Effective communication is crucial for LEP patients who often face barriers due to language differences.
Maximizing Interpreted Interactions
Whether you’re engaging an interpreter remotely over video or audio platform, or in person, working effectively with interpreters is key for successful LEP patient care. HHS recommends the following for effectively working with interpreters:
Before the Visit:
- Use a trained and certified interpreter, especially in clinical settings.
- Treat the interpreter as a respected healthcare professional.
- Allow extra time for communication.
- Minimize distractions and provide a summary to the interpreter.
During the Visit:
- Introduce yourself and others directly to the patient, not the interpreter.
- Use first-person speech and maintain eye contact with the patient.
- Monitor nonverbal communication.
- Speak clearly and avoid jargon.
- Use sentence-by-sentence interpretation.
- Allow the interpreter to ask clarifying questions.
- Avoid interrupting the interpreter unless necessary.
Near the End of the Visit:
- Use the “teach back” method to confirm patient understanding.
- Allow time for patient questions and clarifications.
Interpreters can be a expert source of cultural information and can provide valuable feedback to providers. Read some of their insights in the blog Medical Interpreters Share Stories of Culturally Savvy Healthcare Providers.
Providing Multilingual Materials
Section 1557 requires that materials be available in the top 15 languages served. This includes forms, educational materials, and consent forms, ensuring that LEP patients have the same resources as English-speaking patients.
Leveraging Technology
Telehealth platforms and remote interpreting services can bridge communication gaps when in-person interpreters are unavailable. AI technologies, while helpful, should be reviewed by professional translators for critical information – a requirement outlined in the Section 1557 Final Rule.
Fostering an Inclusive and Supportive Environment
Creating an inclusive environment where LEP patients feel respected and valued is essential for engaging patients and improving satisfaction.
Cultural Competence Policies
Developing and implementing policies that promote cultural competence within a healthcare organization is crucial. This includes hiring bilingual staff, providing ongoing cultural competence training, and assessing the language skills of bilingual staff to ensure they can effectively communicate with patients.
Patient Feedback
Regularly seeking feedback from LEP patients through surveys and direct interactions helps in understanding their experiences and improving care practices. A designated compliance officer, as highlighted by Section 1557, can facilitate this process.
Family Involvement in Patient Care
Involving family members in the care process, respecting cultural norms and preferences, enhances patient support and adherence to treatment plans.
Consider the following case study shared by Sarah McClymonds, a certified healthcare interpreter who managed the language services program for a city hospital for 5 years.
Case Study: Culturally Sensitive Care in Palliative Settings
Dr. John Doe, a Caucasian physician from the U.S., exemplifies culturally sensitive care in his interactions with Hispanic LEP patients in a palliative care setting. Recognizing the importance of family decision-making, he built trust through personal, unhurried interactions with patients and their families.
Key Practices:
- Personal Interactions: Dr. Doe engaged with each family member individually, understanding their dynamics and the patient’s personality.
- Collaborative Approach: He involved interpreters and healthcare team members in discussions, addressing communication challenges and incorporating cultural perspectives.
- Cultural Understanding: Dr. Doe’s respect for interpreters and his role as the chair of the hospital ethics committee ensured culturally sensitive and ethical patient care.
Dr. Doe’s Story: In the city hospital where Dr. Doe worked, he faced the challenge of providing culturally sensitive palliative care to Hispanic LEP patients and their families. Understanding that family decision-making was crucial in these settings, he made it a point to connect with each family member individually, taking the time to understand their relationships and the patient’s personality. He would sit on the edge of the bed with the patient, ask for personal stories, and avoid rushing through explanations. His careful, considerate approach earned the trust of the patients and their families.
Dr. Doe also scheduled regular meetings with the palliative care team, chaplaincy, and language services. These roundtable discussions allowed interpreters to share the challenges they faced with certain medical terms, like “comfort care” and “hospice,” which required additional explanation. By involving interpreters in these discussions, Dr. Doe ensured that cultural perspectives were integrated into patient care. His dedication to culturally sensitive care was further evident in his role as the chair of the hospital ethics committee, where he included representatives from the language services team to contribute insights on cultural and communication perspectives.
By developing cultural intelligence, implementing effective communication strategies, and fostering an inclusive environment, healthcare providers can deliver patient-centered care that meets regulatory standards and enhances patient outcomes. These strategies are especially critical for LEP patients, who benefit significantly from culturally and linguistically appropriate care.
Incorporating these practices not only improves patient satisfaction and engagement but also ensures that healthcare delivery is equitable and respectful of all patients, regardless of their linguistic or cultural backgrounds.
Would you like more information on MasterWord’s CQ training for health professionals?
To discuss how MasterWord can help support your organization with comprehensive language access services and cultural competency training, email us at [email protected].
By breaking down language barriers, MasterWord helps healthcare facilities maximize the benefits of PCC, leading to better patient outcomes, higher patient satisfaction, and more efficient use of resources.
[i] Govere L, Govere EM. How Effective is Cultural Competence Training of Healthcare Providers on Improving Patient Satisfaction of Minority Groups? A Systematic Review of Literature. Worldviews Evid Based Nurs. 2016 Dec;13(6):402-410. doi: 10.1111/wvn.12176. Epub 2016 Oct 25. PMID: 27779817.