Volume 38 Number 1 | February 2024
Patient Safety Corner
Georgia Vega, MBA, MLS(ASCP)CM, ASCLS Patient Safety Committee Chair
Approximately 68 million people in the United States speak languages other than English at home, with the top five being Spanish (61.6 percent), Chinese (5.2 percent), Tagalog (2.6 percent), Vietnamese (2.3 percent), and Arabic (1.9 percent). About 8.3 percent of the U.S. population speaks English less than “very well,” indicating limited English proficiency.1 In response to this diversity, Executive Order 13985 was issued in 2021, directing federal agencies to address historic failures in investing justly and equally in underserved communities. Title VI of the Civil Rights Act of 1964 requires recipients of federal financial assistance to make their programs accessible to individuals with limited English proficiency.
Beyond meeting governmental requirements, communicating with patients in their native language has proven beneficial to patient safety and quality, reducing hospital stays, infections, surgical complications, and readmission risks.2,3 In the laboratory, language barriers can impact appointments, patient identification, and specimen collection. Implementing a language access plan is crucial for equitable and high-quality patient care, enhancing safety in the laboratory setting by outlining services for non-English speakers or those with limited English proficiency.
“[C]ommunicating with patients in their native language has proven beneficial to patient safety and quality, reducing hospital stays, infections, surgical complications, and readmission risks”
In 2023, the Centers for Medicare & Medicaid Services (CMS) released a comprehensive guide aimed at helping organizations develop a language access plan.4 This plan encompasses essential components, including a needs assessment to understand the patient population, delivery of language services, informative notices for patients, staff training, and ongoing program evaluation for continual improvement. The following is a breakdown of each component.
- Needs Assessment: This section outlines how the laboratory will assess the language assistance needs of the communities it serves. Internal data sources, such as call center information or electronic health records, can be used to determine the patient population. If internal data is unavailable, the U.S. Census Bureau can be used. Once there is a better understanding of the patient population, assess the points of contact and levels of interactions needed for a successful patient encounter. For the laboratory, this could be at the specimen collection site or the point of care with outreach programs. Further data can be collected via a customer satisfaction survey of applicants and beneficiaries with limited English proficiency to obtain insight into their experience accessing the laboratory’s services.
- Language Services: This section details how the laboratory will provide interpretation services and translated materials. Interpretation services refer to verbal communications and may include ensuring easy access to dedicated staff interpreters, contracted interpreters, qualified bilingual staff, or remote interpreters. It is highly discouraged to utilize bilingual family members as they may need help understanding medical terminology which can lead to poor outcomes. Translation refers to written communication that will be used during the patient encounter. In the laboratory, this could include materials such as patient instructions and patient preparation requirements.
- Notices: This section outlines strategies for posting notices about the availability of language services. It ensures that persons with limited English proficiency can meaningfully access program services. “I speak” cards help identify what language an individual speaks and to identify what language an interpreter will need to speak to communicate effectively with that individual. The electronic medical record may reference a preferred language field before any patient encounter. Additionally, patient notices and taglines can inform patients in their language that an interpreter will be provided at no cost. The Department of Health and Human Services Office for Civil Rights offers sample notices and taglines in various languages for public use.
- Training: The training component is vital for everyone interacting with patients. Many organizations have training in communication and language services as part of the onboarding process for new hires. Within the laboratory, it is essential to ensure that any patient-facing staff are trained in the importance of utilizing available translation services, accessing them, and regularly evaluating their usage. The HHS Office of Minority Health’s Think Cultural Health program developed The Guide to Providing Effective Communication and Language Assistance Services (the Guide). The U.S. Department of Justice created a video, Providing Meaningful Access for Limited English Proficient Individuals. These are helpful resources for developing and training staff who care for patients with limited English proficiency. Training should be documented in applicable policies and procedures to ensure the staff’s adherence and quick reference.
- Evaluation and Monitoring: To ensure ongoing effectiveness, the plan incorporates evaluation and monitoring procedures within the laboratory. These procedures outline how the plan will be monitored and how the consistent assessment of the needs of the patient population will be addressed. The Department of Justice provides the Language Access Services Assessment and Planning Tool, which can be adapted to evaluate and assess the services provided by the laboratory.
Recognizing the linguistic diversity among the U.S. population and addressing language barriers in healthcare is crucial for promoting equity, patient safety, and overall quality of care. Implementing a comprehensive language access plan, as outlined in the CMS Guide, is not only a regulatory necessity but also a strategic initiative to enhance communication with patients with limited English proficiency.
- United States Census Bureau. American Community Survey. October 8, 2021. https://www.census.gov/library/visualizations/interactive/people-that-speak-english-less-than-very-well.html
- Engaging patients in decision-making and behavior change to promote prevention. Krist, A. et al. February 3, 2020. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996004/
- Improving Patient Safety Systems for Patients with Limited English Proficiency. A Guide for Hospitals. Agency for Healthcare Research and Quality. https://www.ahrq.gov/sites/default/files/publications/files/lepguide.pdf
- Center for Medicare & Medicaid Services (CMS). August 2023. Guide to Developing a Language Access Plan. https://edit.cms.gov/media/91851
Georgia Vega is Vice President/Associate Administrator for Lab Services at Harris Health System in Houston, Texas.