Recognizing the Importance of Language Need in Healthcare: The US Experience Elizabeth A. Jacobs, MD MPP John H. Stroger, Jr. Hospital of Cook County Welsh Language in Healthcare Conference Cardiff, Wales March 26th, 2010

Why Would I be Informative? Wales –Small Population –Homogeneous –National Health Care –Emphasis on Primary Care –Welsh Language predominant “other” language” US –Large Population –Heterogeneous –Mostly Private System –Emphasis on Specialty Care –303 languages spoken at home

We Have the Same Problems

Although, Not Exactly Welsh Language Need –20% speak Welsh –Code-switching –Especially when communication important US Language Barriers –20% speak English “less than well” –Linguistic access services are essential

Why Aren’t Language Needs Met? Lack of data Lack of planning Lack of awareness Attitudes Cost Lack of access to language resources G. Roberts and Colleagues. Report of a Study of Welsh Language Awareness in Healthcare Provision in Wales. 2004

Data: Garbage In Garbage Out Need to ask (the right way) Need to record Need to use

Planning: “One More Thing?!” Data Dedication Diligence

Awareness? "If English was good enough for Jesus, it’s good enough for Texas schoolchildren”

Attitude?

Awareness Attitude Data Stories Solutions

Why Should We Pay for This? We pay already It is cheap “Do no harm”

How Do We Do It? Bilingual providers Professional interpreters –Face-to-face –Telephonic –Video Dual-role interpreters Ad hoc interpreters

Your Stories?

How Do You Do It? Bilingual providers Professional interpreters –Face-to-face –Telephonic –Video Dual-role interpreters Ad hoc interpreters

But Are They Qualified?

Making it Happen

4 Critical Questions Who is my audience? What do they need to know? What is my ask? Who are my allies?

1. Who is My Audience? 1. Administrators 2. Clinicians

Power of Positive Intentions No one made the decision that all patients should communicate in English, regardless of language need They just don’t know: –The consequences –How to provide the appropriate services

2. What do They Need to Know? What happens when patients don’t have access to care in Welsh How do they provide care in Welsh

Providing Insight

Top 3 Tools 1.Stories 2.Stories 3.Stories

Providing Solutions Be the source Think about what you want them to do Then make and present a realistic plan as to how they can do it

3. What is My Ask? What do I want? What data do I have to support it? How will I support it?

4. Who Are My Allies? Doctors Patients Staff Administrators Board members Politicians

“I wanted to ask them about my illness. I couldn’t because there was no one to help me [communicate].”