Not speaking the same language could cost you
Rehab facilities required to offer translation services
(Editor’s note: The next two stories about translation services and diversity issues facing rehabilitation facilities are a follow-up to a special report in the September issue of Rehab Continuum Report.)
Title VI of the federal Civil Rights Act of 1964 requires health care organizations receiving federal funds to ensure that patients with limited English proficiency (LEP) have access to language assistance.
The law states that providers could provide oral language assistance using a variety of methods. (See "What's required under Title VI of 1964 Civil Rights Act," in this issue.)
Studies have also examined patient satisfaction among non-English-speaking patients and have found that language difficulties are a problem.1,2
While it’s important to have a culturally diverse staff, rehab facilities still should consider using interpretation contracting services so professional interpreters can be available at any time they are needed, says Bonnie Breit, OTR, MHSA, administrative director of rehabilitation services for four hospitals in the Crozer-Keystone Health System in Upland, PA.
"We’ve created a systemwide interpretation process so staff can access an interpreter any time in the day or night," Breit says. "We not only train staff about foreign languages and cultures, but we also provide interpretation for deaf patients, and we avoid stereotyping cultures, while showing how cultural differences may affect how a person perceives things."
Rehab facilities should look at interpretation services as yet another way to build a good reputation and to satisfy customers, suggests Cindy Roat, MPH, quality assurance specialist with Pacific Interpreters in Portland, OR.
"Non-English-speaking people are living here, working here, and now are a paying clientele to be served," Roat says. "So if you’re a business, you’d be silly not to try to accommodate Spanish speakers or others because they’re consumers."
Besides possibly being in violation of the law, using family members to interpret for an LEP patient could result in malpractice, says Bill Martin, executive director of Phoenix Language Services of Huntington Valley, PA.
Martin offers this example: "We had an incident where a woman was scheduled for a D&C [dilation and curettage], and the hospital had used the patient’s husband to interpret," he says. "It turned out that she wasn’t experiencing vaginal bleeding; it was rectal bleeding."
Some studies have found that non-English-speaking patients are more likely to be compliant with medical instructions, more likely to seek preventive services, and more likely to have positive outcomes when they are provided interpreters.3-7
"There’s a growing body of research about the importance of interpreter services," Roat says.
Roat has personally reviewed some informal, unpublished studies comparing a hospital that provided interpreter services to one that did not. "If you looked at the patients from the same language group with the same diagnosis, you would see that those who were provided interpreters had a hospital stay that was an average of one day shorter and a lower readmission rate than the patients at the hospital that did not provide interpreter services," she says.
"Overall, there are direct and indirect costs to not having an interpreter," Roat adds.
References
- Carrasquillo O, Orav EJ, Brennan TA, et al. Impact of language barriers on patient satisfaction in an emergency department. J Gen Intern Med 1999; 14:82-87.
- Morales LS, Cunningham WE, Brown JA, et al. Are Latinos less satisfied with communication by health care providers? J Gen Intern Med 1999; 14:409-417.
- Seijo R, Gomez J, Freidenberg J. Language as a communication barrier in medical care for Hispanic patients. Hispanic Journal of Behavioral Sciences 1991; 13:363-375.
- Manson A. Language concordance as a determinant of patient compliance and emergency room use in patients with asthma. Medical Care 1988; 26:1119-1128.
- Naish J, Brown J, Denton B. Intercultural consultations: Investigation of factors that deter non-English speaking women from attending their general practitioners for cervical screening. BMJ 1994; 309:1126-1128.
- Enguidanos ER, Rosen P. Language as a factor affecting follow-up compliance from the emergency department. J Emerg Med 1997; 15:9-12.
- Woloshin S, Schwartz LM, Katz SJ, et al. Is language a barrier to the use of preventive services? J Gen Intern Med 1997; 12:472-477.
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