Better Communication Better Care

7/27/2019 Better Communication Better Care

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Better communication, BetterCare: Where to start?

Jelena Pasalic,BS

TB & Refugee Health ProgramJanae Duncan, BS

Center for Multicultural Health


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Overview of the issues:

Today, over 11% of the U.S. population(31 million people) is foreign born.

One child in five is an immigrant or animmigrants child.

47 million U.S.residents over the age of

four speak a language other thanEnglish at home (18% of thepopulation).


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1/3 of the foreign born population of theU.S. arrived in the decade between

1990-2000 New arrivals show a great diversity of

culture and languages.

More than 380 languages are nowspoken in the U.S.


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Common Foreign Languages in

the U.S. Spanish

Chinese

French

German

Tagalog Vietnamese


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Common Foreign Languages in

the U.S. (continue) Korean

Russian

Arabic and

Japanese


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Studies show that patients

speaking limited English: Receive less than optimal health care

Receive less preventive care

They are at increased risk of experiencingmedical errors

Have fewer physician visits

They are less likely to return for follow-upvisits

They are less satisfied with their health care


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What Can Organizations Do?

Increase access to care

Improve quality of care, health

outcomes, and health status

Increase patient satisfaction

Enhance or ensure appropriateresource utilization


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Increase Access to Care

Providing linguistically and culturallyappropriate trained medical interpreters

at the time of service.(Title VI of the Civil Rights Act of 1964)

Increase racial and ethnic diversity

among professionals.


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Quality of Care

The provision of linguistically andculturally appropriate trained medical

interpreters can improve quality of care. Many LEP patients receive poor

medical diagnosis and inappropriate

services, as a result of the failure ofmedical staff to speak/provide medicalinterpreter.


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Patient Satisfaction

Appropriate language assistanceservice (LAS) implementation can

improve patient satisfaction. LEP patients have higher satisfaction

with their health care providers when

quality language services wereavailable to them.


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Resource Utilization

The implementation of LAS can enhanceappropriate resource utilization.

Physicians have performed more frequentand more expensive testing when a bilingualphysician or professional interpreter was notavailable.

The lack of interpretation services hasresulted in more frequent hospitaladmissions.

The duration of patient visit has increased

when LAS were not in place.


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Title VI of the Civil Right Act of

1964Title VI of the Civil Right Act of 1964 states: No

person in the United States shall, on groundof race, color, or national origin, be excludedfrom participation in, be denied the benefitsof, or be subjected to discrimination underany program or activity receiving Federalfinancial assistance.

To avoid discrimination based on nationalorigin, Title VI and its implementingregulations require recipients of Federalfinancial assistance to take reasonable steps

to provide meaningful access to LEP persons.


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Title VI of the Civil Right Act of

1964The purpose of this Act is to improve the

health of racial and ethnic minority

populations through the development ofeffective health policies and programsthat help to eliminate disparities in

health.


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Who must comply with Title VI

requirements?All public and private entities receivingDepartment of Health and Human Servicesfederal financial assistance are coveredentities.

State, county and local health and welfareagencies

Hospitals and nursing homes Managed care organizations

Head Start programs

Contractors/vendors


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Who Can You Use As An

Interpreter? Trained bi-lingual staff

On-staff interpreters

Contract interpreters

Telephone interpreters


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Who Should Not Serve as a

Health Interpreter: Patients family and friends

Children under 18 y.o.

Other patients and visitors

Volunteers


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Professional Interpreters!

What can they do for me? Reduce liability, help ensure appropriate

utilization, increase client compliance

and satisfaction with services Provide a quality service

- accuracy and completeness

- trained to handle difficult situations

- code of ethics


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Professional Interpreters!

What can they do for me?Assure effective communication by

facilitating the communication between

both the client and provider. Effective use of time during the clinical

encounter.

Improved outcomes for the client.


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Bridging the Gap

Bridging the Gap is a 40-hourbasic/intermediate training course for

medical interpreters. The training was originally developed by

the Cross Cultural Health Care Program

(CCHCP) in 1995 in Seattle,Washington.


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Goal of the Bridging the Gap

Understand the work and role ofmedical interpreters

Professional criteria to deal with anydifficult situation

Concrete skills dealing with

interpretation, culture/cultural sensitivity,advocacy


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Bridging the Gap

Basic interpreting skills(role, ethics,conduit and clarifier interpreting,

intervening, managing the flow of thesession).

Information on health care (introduction

to the health care system, how doctorsthink, anatomy, basic medicalprocedures).


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Bridging the Gap

continued Culture in interpreting (self-awareness,

basic characteristics of specific cultures,

traditional health care in specificcommunities, culture-brokering).

Communication skills for advocacy(listening skills, communication styles,

appropriate advocacy). Professional development


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Interpretation Services

Where to start? Disseminate information to front line staff who

may need to utilize interpreter services indaily interactions.

Build awareness regarding laws, guidancesand why an interpreter should be used.

Identify the considerations for choosing an

interpreting option (provider, interpreter andLEP).

Recognize key factors in successful vs.unsuccessful interpretative encounters.

Identify your questions

C l l A f W ki i h l


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Cultural Aspects of Working with people

from different cultures Lifelong experience

Be familiar with the normative cultural valuesof your clients

Avoid stereotyping

Work with Trained Language Interpreters Try to assign same-sex health care

providers/Interpreters

Be familiar with folk illnesses

Work with family and community leaders Consider the priorities for the patient

Learn about the beliefs and practices of the

patient populations you serve


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Tips for providers working with

untrained Interpreters: Make introduction among all participants.

Make appropriate positioning.

Speak directly to the client and use first person.

Speak at a moderate pace and at normal volume,pause often

Avoid using technical vocabulary, symbolic speech.

Consecutive interpreting.

Ask the interpreter to be Conduit/Interpreteverything what is said, exactly what is said: addnothing, omit nothing and change nothing.

Document the use of an interpreter by name, in the

client chart


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What if an interpreter is not

available?

Who yagonna call?


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Use Telephone Interpretation

Services When

You receive a call

You make a call

You are face-to-face


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Telephone Interpretation Companies

Language LineServices

1-800-752-6096

Propio LanguageServices LLC

1-888-804-2044

Institute for CulturalCompetency

1-800-654-6231

Pentskiff

(801)484-4089


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How does it work?

Dial toll free #

State name of your company, billing

code and language needed You are connected with an interpreter

It is that simple!


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How much does it cost?

Public

@ $4.00 per minute

charged to creditcard

Contract

@ $1.00 per minute

with a minimum of20 minutes a month-Possibility of a jointcontract


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What does a it include?

24/7 service 365 days a year

Billing code

Training kit

Rapid toll free access

Billing options

Volume discounts

Detailed summary reports


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Telephone Interpretation

is an Option for

Fast

Reliable

Professional

Language Access Services


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Interpretation and Translation


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How do I choose a

translation agency?

Have a clear idea of what you want fromthe agency and choose one that meets

your needs

Communicate in order to better

COMMUNICATE


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What can I expect from a

translation agency?

Credibility

Quality translating

High quality customer service

Good business practices


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Take time up front to ask questions

When you contact a prospectivelanguage agency, you will want to ask

about a wide range of issues in order togauge the likely quality of services

See handout


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General Translation

Recommendations

Translate meaning and NOT word forword

At least TWO translators per document Evaluate English version for readability,

figures of speech, acronyms and

technical terms Establish a method to ensure quality


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Translation Process

Pre-translation

Review existing materials

Develop a project timeline

Select a translator


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Translation Process

Translation

Assign subject matter experts to work

with the translators Staff and translators meet to review

document and discuss terminology

First translator prepares a draft Second translator proofreads draft and

makes edits


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Translation Process

Translation continued

Two translators discuss issues and negotiate

changes Throughout the process translators should

consult staff with questions

Assemble native speakers or focus groups toevaluate the accuracy and culturalappropriateness of translated materials


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Sources and Resources

The California EndowmentHow to Choose and Use a Language Agency: A

Guide for Health and Social Service ProvidersWho Wish to Contract With Language Agencies

[email protected]

California State Personnel Board

Recommendations and Resources for theTranslation of Written Documents, April 2003

Center for Multicultural Health Technical Assistancehttp://www.health.utah.gov/cmh/udoh/Request.pdf

I it th t h lth
mailto:[email protected]:[email protected]


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Is it necessary that health care

providers offer linguistically

competent care, and if so, why?Such care is indeed necessary

because providing quality and safe

health care in our pluralistic societycannot be done without erasinglanguage barriers. In other words:

This is who we are and these are the

patients we serve.

Language Access in Health Care Statement of Principles: Explanatory Guide,NHeLP October 2006

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