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TJC: Time is now to examine communication with LEP patients
New Joint Commission standards link with requirements of U.S. law
Now is the time for health care facilities to evaluate communication practices between patients and providers at the point of care to make sure they comply with new Joint Commission standards, says Amy Wilson-Stronks, MPP, project director in the Division of Standards and Survey Methods.
To aid staff in their efforts, The Joint Commission and the U.S. Department of Health and Human Services Office for Civil Rights released a video in Nov. 2009, titled, "Improving Patient-Provider Communication.
"The video was produced to encourage health care organizations to determine the best methods for meeting communication needs. With 28 million people in the United States experiencing hearing loss and 47 million people speaking a language other than English, language access is a matter of national importance, according to The Joint Commission.
"When we did our Hospitals, Language, and Culture research study and visited 60 hospitals across the country, we talked with administrators, as well as clinical staff. It became very apparent to us that many hospital administrators and clinicians are not aware there are laws and regulations that support the provision of language access service, both for people who aredeaf or hard of hearing and those with limited English proficiency," says Wilson-Stronks.
The study helped to shape the proposed standards, which were sent out for public comment in June and July of 2009. Following the field review, the standards considered to be the most vital were selected for implementation. An implementation guide was developed as the standards were finalized. The guide recommends that the practices identified in the larger set of standards released in the summer of 2009 be followed; however, only the smaller set will be part of the accreditation process, according to Wilson- Stronks.
"I don't think we put forward anything that is unreasonable. I think we put forward things that many hospitals in some way, shape, or form are already doing, whether or not they are doing them well," says Wilson-Stronks.
What were some of the areas that hospitals needed to improve upon? When the researchers made site visits, they would follow a hypothetical patient through the system of care. Often, when clinicians were asked how they would communicate with that patient, there was a lack of consistency with hospital policy, available services, and the action of the clinicians, says Wilson-Stronks.
While all hospitals visited had access to the telephone interpreter services, clinicians relied on gestures, sign language, and the use of pictures with non-English speaking patients, she adds.
The questions asked by the researchers had to do with informing the hypothetical patient that he had acute appendicitis and would need to be transferred to surgery. In many cases, the clinicians were not aware that there were telephone services, and in some cases, interpreters or designated bilingual staff trained as interpreters available, says Wilson-Stronks.
She added that some people interviewed didn't see a problem with relying on a family member, but that is not a recommended method for providing language access, because the clinician will not know what is communicated to the patient.
There should be more emphasis on good practices vs. poor practices, says Wilson-Stronks.
Assessment of policies a must
Hospitals also need to have in place systems that are working, she adds. While contracts with telephone interpreter services were common, not all clinicians knew the access code for their use -- or that there were special phones that were kept locked up, making them difficult to access. Also, there was some resistance among clinicians to using a telephone interpreter, because they weren't familiar with the system and felt awkward using it.
During the study, researchers learned from the administration what policies, practices, and resources were available and then went out on the floor to talk to clinicians. According to Wilson-Stronks, the hospitals that did best had administrators that thought about their approach and made an effort to understand the need and utilization of language services by patients. In some cases, hospitals found it more cost-effective to hire an interpreter, because the need for that particular language was so great, it was best to have someone on staff.
Currently hospitals should be collecting data on race and ethnicity, as well as language and communication needs, says Wilson-Stronks.
"My recommendation to organizations is to look to resources that are currently available to help assess current needs in terms of language services, language needs, and communication needs within their community and to determine how they are meeting those needs," she adds.
The Office for Civil Rights has a guide for developing a plan for meeting the needs of limited English proficiency patients and the link is available on The Joint Commission web site.
"It is a good way to make sure you are putting something in place that is comprehensive and complies with the law," says Wilson-Stronks.
Also, on The Joint Commission web site, there is access to the "Health, Research, and Educational Trust Disparities Toolkit," which walks an organization's staff through the steps of assessing systems, training staff, and using data to determine if there are health care disparities.
Communication is important for patient safety, accurate assessment, and accurate diagnosis, says Wilson-Stronks. Good communication also minimizes readmissions, because when patients are given discharge instructions in a language they understand and in a manner they understand, they are less likely to return to the health care institution, she adds.
For more information about new communication standards issued by The Joint Commission, contact:
The Joint Commission, One Renaissance Blvd., Oakbrook Terrace, IL 60181. Telephone: (630) 792-5000. Web site: www.jointcommission.org.
[For access to video on communication and information on evaluation resources on The Joint Commission web site, go to Patient Safety, Hospitals, Language, and Culture. The Quick links accesses evaluation toolkit.]