From Ad-Hoc to Best Practices in Healthcare Interpreting Conference July 9, 2009 Wendy Jameson, Director, California Health Care Safety Net Institute The California Health Care Safety Net Institute: Partnering with Public Hospital Systems to Advance Language Access

Progress Since Last Healthcare Interpreting Conference…  Spread of innovation & best practices from a few hospitals (public hosps, Kaiser, & handful of private and academic hosps) to many more  SNI, Kaiser and HCIN playing a critical role in spreading excellent healthcare interpreting practices  CHA & CAPH collaborated in advancing policy, e.g., MCal Reimbursement

California Health Care Safety Net Institute  Quality Improvement Partner of the California Association of Public Hospitals and Health Systems  2009 marks 10-year anniversary of spreading innovative practices to assure equal access to excellent health care  4 Goals:  Improve Quality of Care Delivered at California Public Hospital Systems  Promote Efficient and Organized Public Hospital System Delivery Models  Eliminate Health Care Disparities  Widely Promote Innovative Practices and Delivery Models Emerging in Public Hospital Systems

California’s Public Hospital Systems  19 pub hosp systems in 15 counties (16 county, 3 UC)  Over 200 outpatient primary care and specialty clinics  Located in counties where 81% of Californians live  6% of CA hospitals, yet provide nearly 45% of all hospital care to the uninsured

California’s public hospitals serve all, regardless of ability to pay or insurance status  2.5 million patients, 2/3 on Medi-Cal or uninsured  Ethnically diverse:  Nearly 50% Latino  12.5% African American  6.5% Asian  A total of 71% non-white  Over 50% LEP  Multiple, complex conditions; chronic illness; some have extensive psycho-social needs

Looking Back…  SNI/CHA Hospital Forum on Language Access With a few exceptions, most hospitals in CA had:  Little awareness of legal, regulatory mandates, and quality issues  Few staff interpreters, reliance on untrained bilingual staff, volunteers and family/friends, limited access to telephonic contract services  Erratic and haphazard practices, vague and ill-defined standards …public hosps were ahead of most CA hospitals overall, but most still had a long way to go.

Staff Interpreters at CA Public Hospitals

Total Number of Qualified Healthcare Interpretations Per Mo. in CA Public Hospitals 28,089 36,701 54,859

Remote Healthcare Interpreting in CA Public Hospital Systems

Why Such Progress?  SNI cultural and linguistic competence programs  Synergy between SNI program opportunities and expansion of remote interpreting technology (VMI/HCIN)  Commitment on the part of public hospital language access champions & leadership: “Interpretation services are vital to your institution’s mission. Interpreter services improve patient care and productivity, and remove institutional barriers to care.” -- Ken Cohen, Director, Health Care Services, San Joaquin County  Foundation support: The California Endowment, The California HealthCare Foundation, Kaiser Permanente  CA public hospital systems created “cultural shift”

SNI Efforts to Advance Language Access  Published Straight Talk: Model Hospital Policies & Procedures on Language Access  Launched Advancing Public Hospitals Along the Language Access Continuum  Co-conducted (w/UCSF Center for Health Professions) LEADing Organizational Change: Advancing Quality Through Culturally Responsive Care  Supported public hospitals’ efforts to innovate and spread language service delivery (e.g., HCIN, VMI)

Evaluation of language access progress in CA pub hosps  Conducted by HRET (Romana Hasnain-Wynia & Julie Yonek), funded by TCE in 2008  Findings:  CA pub hosps had made significant system-level improvements in language access  Key changes included:  Policies and procedures  Commitment articulated in mission statements  Exec sponsorship and specific managerial position  Staff training “…participation in SNI improvement initiatives was a major facilitator for language access advances.”

Looking Ahead  Public hospitals continue to be seen as centers of innovation  SNI’s REAL Data Initiative  Capturing accurate, consistent Race/Ethnicity/Language (REAL) data is the foundation for creating equitable health care in --- quality, safety and access  Yet most hospitals struggle with capturing and using meaningful, accurate patient demographic data  SNI is concluding secondary research and interviews with nine public hospitals, one health plan, and several best practice facilities on barriers and facilitators to improved REAL data collection and use -- happy to share findings