Patient safety 'fluency' requires more than language interpreters

Today marks the end of the National Patient Safety Foundation's annual "Patient Safety Awareness Week." It's a good time to review your policies and procedures around medication safety, infection control and commication effectiveness.

But it's also a timely reminder to explore your actions around a growing patient safety issue that is still overlooked by many healthcare organizations: cultural diversity and language barriers. 

The potential for patient safety errors--due to miscommunication, misinterpretation, or poor communication--is huge. Communication breakdowns are responsible for about 3,000 unexpected deaths, catastrophic injuries and other sentinel events each year, according to the Joint Commission. And those are just the events that healthcare organizations self-report to the accreditor. The actual number is probably much higher.

When language barriers are incorporated into the mix, "limited-English proficient" or "LEP" patients face a higher rate of patient safety-related errors. Recent Joint Commission findings reveal that LEP patients incur a greater percentage of adverse events (52 percent) when compared with English-speaking patients (36 percent). 

Aside from misunderstandings or misinterpretations, LEP patients may be less satisfied with medical encounters, have different rates of diagnostic testing and receive less explanation and follow-up, the Pennsylvania Patient Safety Authority recently found

As part of a new regulation focusing on this issue, the Joint Commission in January launched a year‑long pilot requiring healthcare organizations to provide all patients--regardless of their language--with patient-centered communication. Organizations that fail to comply by January 2012 may jeopardize their accreditation. 

These regulations will require proof of interpreter training and fluency competence for interpreters in various spoken languages, along with competence in American Sign Language for deaf and hard-of-hearing patients. 

But a bigger problem remains: few hospitals are taking all the necessary steps to fully comply. Some of those organizations still don't see the link between language services, patient rights and patient safety. Others simply don't provide staff with the resources they need to communicate effectively with all patients.

Each hospital and healthcare facility serves different populations--and the solutions that they are looking for will reflect that. They can beef up the availability of written plans in the patients' languages or make sure that they hire only interpreters trained to deal with health-related issues or hire bilingual staff. 

Healthcare leaders may assume their organizations are compliant because they employ bilingual staff, contract with face-to-face interpreters and provide interpreting services via telephone or video. But they may still be falling short in meeting the Joint Commission’s new standards. For example, are their interpreters specially medical interpreters who are specifically trained and qualified to work with patients? 

With patient safety week drawing to a close, it's time for everyone to take a step back to reassess their 'language' of patient safety and how fluently everyone speaks it. - Jan

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