Resources for boosting patient communication

Effective communication is critical to the successful delivery of healthcare services. The Joint Commission supports a number of efforts to improve communication between healthcare professionals and patients.

It's been estimated that there are more than 300 languages spoken in the United States and more than 90 million Americans have low health literacy, meaning they don't have the capacity to adequately understand and use health information. The Joint Commission recommends an approach to communicating health information that encompasses language needs, individual understanding, and cultural and other barriers. The Joint Commission's efforts to promote effective communication include:

• Joint Commission accreditation standards.

The Joint Commission standards set performance expectations for activities that affect the safety and quality of patient care. These standards include several requirements that promote effective communication between patients and their caregivers, cultural competence, and patient-centered communication. As reflected in The Joint Commission standards, these issues should be addressed at the organizational-level and embedded within all of the functions of the organization. The patient-centered communication standards for hospitals are published in the Comprehensive Accreditation Manual for Hospitals (CAMH): The Official Handbook. The standards address issues such as qualifications for language interpreters and translators, identifying and addressing patient communication needs, collecting patient race and ethnicity data, patient access to a support individual, and non-discrimination in care.

• "Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care: A Roadmap for Hospitals."

Published in August 2010, this monograph was developed to inspire hospitals to integrate concepts from the communication, cultural competence, and patient- and family-centered care fields into their organizations. The "Roadmap for Hospitals" ( provides recommendations to help hospitals address unique patient needs, meet the patient-centered communication standards for hospitals, and comply with existing Joint Commission requirements. Example practices, information on laws and regulations, and links to supplemental information, model policies, and educational tools are also included.

• R3 Report.

Published for Joint Commission-accredited organizations and interested healthcare professionals, "R3 Report" provides the rationale and references that The Joint Commission employs in the development of new requirements. While the standards manuals also provide a rationale, the rationale provided in "R3 Report" goes into more depth. The references provide the evidence that supports the requirement. Issue 1 ( of the "R3 Report," published in February 2011, is focused on the patient-centered communication standards.

• Improving Patient-Provider Communication: Joint Commission Standards and Federal Laws.

With this video (, The Joint Commission and the U.S. Department of Health & Human Services (HHS) Office for Civil Rights have worked together to support language access in healthcare organizations. The video highlights what is required by Joint Commission standards as well as federal civil rights laws with respect to patients who are deaf/hard of hearing or limited English proficient. Accompanying the video is a list of resources and tools that healthcare organizations can use to build effective language access programs.

• Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: Meeting the Needs of Lesbian, Gay, Bisexual, and Transgender (LGBT) Patients and Families.

Lesbian, gay, bisexual, and transgender people (LGBT) and their families reside in every county in the United States and include members of every racial, ethnic, religious, mental and physical ability/disability, age, and socioeconomic group. The 8.8 million lesbian, gay, and bisexual people now estimated to be living in the United States experience disparities not only in the prevalence of certain physical and mental health conditions, but also in healthcare due to lack of awareness and insensitivity to their unique needs. These issues include the denial of visitation access, restrictions on medical decision making for LGBT family members, a distrust of the healthcare system and hesitation to disclose their sexual orientation or gender identity to medical professionals. With funding from The California Endowment, the Joint Commission convened a panel of stakeholders on Sept. 13, 2010, to identify practices and articulate implementation processes to help promote effective communication and patient- and family-centered care for LGBT patients and families. For more information, please contact

• "One Size Does Not Fit All: Meeting the Health Care Needs of Diverse Populations."

Published in April 2008, this report ( healthcare organizations to assess their capacity to meet patients' unique cultural and language needs. Based on successful practices being used in hospitals, the report underscores the need to move away from a "one-size-fits-all" approach that negatively affects the quality and safety of care for diverse patients. The report includes a self-assessment tool that can help healthcare organizations tailor their initiatives to meet the needs of diverse populations. The report is the result of a multi-year research study, "Hospitals, Language, and Culture: A Snapshot of the Nation," supported by funding from The California Endowment.

• "Exploring Cultural and Linguistic Services in the Nation's Hospitals: A Report of Finding."

Issued in March 2007, this report ( targeted strategies for addressing language and cultural issues that increasingly pose challenges to hospitals seeking to deliver safe, effective care to diverse American populations. The recommendations in the report are the result of the "Hospitals, Language, and Culture: A Snapshot of the Nation" study, which explored how 60 hospitals across the country are providing health care to culturally and linguistically diverse patient populations. Few studies have systematically explored the provision of culturally and linguistically appropriate health care in a large number of hospitals. With funding from The California Endowment, this project is closing the gap.

• "What Did the Doctor Say?: Improving Health Literacy to Protect Patient Safety."

Published in February 2007, this white paper ( is the result of the Health Literacy and Patient Safety Roundtable, part of The Joint Commission's Public Policy Initiative. This roundtable met in May and September 2005 and was charged with framing the issues related to low health literacy and its impact on patient safety. The white paper describes interventions to improve the ability of patients to understand complex medication information and provides recommendations for a broad range of healthcare stakeholders and policymakers to mitigate the risks to patients with low health literacy or low English proficiency.

• Speak Up™ program.

In March 2002, The Joint Commission launched a national campaign to urge patients to take a role in preventing healthcare errors by becoming active, involved, and informed participants on the healthcare team. The program features brochures and posters on a variety of patient safety topics. All brochures are available in an easy-to-read format and in Spanish. Speak Up™ is intended to involve the public in their health care, raise their knowledge about healthcare issues, and enable them to make good decisions about their health. A Speak Up™ coloring book is also available for children.

In March 2011, The Joint Commission released the first in a series of animated Speak Up™ videos. These entertaining 60-second videos are intended as public service announcements and air on The Joint Commission's YouTube channel (, on The Joint Commission web site (, and in other venues. The cast of characters in the videos encounter everyday situations where they have to read instructions, inspect labels, and "speak up" and ask their doctors and caregivers questions.

Free downloadable files of all Speak Up™ brochures, posters and videos (including Spanish language versions) ( are available on The Joint Commission web site. Transcripts of the videos are also available.

•"You: The Smart Patient: An Insider's Handbook For Getting The Best Treatment."

Published in 2006 by Free Press, a division of Simon and Schuster, and sold at bookstores nationwide, this book uses humor and illustrations to provide concrete guidance to patients in navigating the healthcare system. It also urges patients to get involved in their healthcare and showcases the importance of Joint Commission accreditation. The book was written by best-selling authors Michael F. Roizen, MD, and Mehmet C. Oz, MD, in collaboration with Joint Commission Resources, The Joint Commission's not-for-profit affiliate.