1. Many Hospitals. One Voice. Caring for a Changing Community: How Northeast Ohio Hospitals are Serving a Diverse Population September 2006 Issue Brief available at: www.chanet.org www.chanet.org

2. Many Hospitals. One Voice. The Melting Pot: Language Diversity

3. Many Hospitals. One Voice. The Melting Pot: Language Diversity (cont’d)

4. Many Hospitals. One Voice. The Melting Pot: Language Diversity (cont’d)

5. Many Hospitals. One Voice. The Melting Pot: Racial Diversity U.S.OhioAshtabulaCuyahogaGeaugaLakeLorainMedina White alone75%84%95%66%97%94%86%97% Black or African American alone 12% 3%29%1%3%7%1% American Indian and Alaska Native alone 1%<1% 1%<1% Asian alone4%1%<1%2%1% Some other race alone 6%1%<1%2%<1%2%3%<1% Two or more races2%1%2%1% 2%1%

6. Many Hospitals. One Voice. Key Laws, Guidelines and Standards Title VI of the Civil Rights Act of 1964 –LEP Guidance Standards for Culturally and Linguistically Appropriate Services (CLAS) Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Standards

7. Many Hospitals. One Voice. Title VI of the Civil Rights Act of 1964 “No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance.” Title VI consistently interpreted by the courts and the agencies charged with its enforcement to require the provision of language access services.

8. Many Hospitals. One Voice. Title VI of the Civil Rights Act of 1964 (cont’d) LEP Guidance 1.The number or proportion of LEP persons eligible to be served or likely to be encountered by the program or grantee 2.The frequency with which LEP individuals come in contact with the program, activity or service 3.The nature and importance of the recipient’s program, activity, or service 4.The resources available to the grantee/recipient and costs

9. Many Hospitals. One Voice. Standards for Culturally and Linguistically Appropriate Services (CLAS) Issued by the U.S. Department of Health and Human Services’ Office of Minority Health The 14 CLAS standards can be organized into three main themes: –Culturally competent care –Language access services and –Organizational support for cultural competence. Four of the 14 standards are based on Title VI, while the remaining standards are not based on Title VI

10. Many Hospitals. One Voice. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Standards New standard for 2006 requires JCAHO-accredited hospitals to document patients’ language and communication needs. JCAHO standards related to language access are not specific in terms of how patients’ language and communication needs should be met. A three-year project is evaluating language and culture services at 60 hospitals based on survey responses and site visits. –Study results may inform future JCAHO standards related to meeting patients’ linguistic and cultural needs.

11. Many Hospitals. One Voice. Multiple Strategies for Ensuring Linguistically and Culturally Appropriate Care Language services –In-person interpretation FTE staff, trained in interpretation Dual-role staff, trained in interpretation Contracts with agencies –Telephone interpretation –Videoconference interpretation Cultural competency training

12. Many Hospitals. One Voice. Benefits of Providing Linguistically and Culturally Appropriate Care Increased patient satisfaction Potential for decreased costs –Decrease the length of time required for treatment in ER –Fewer readmissions Guard against miscommunication –Protect patients from medical errors and hospitals from lawsuits Garner patient loyalty that holds potential for increased market share

13. Many Hospitals. One Voice. Evaluating Interpreter Competency and Sharing the Cost of Language Services National Standards of Practice for Interpreters in Health Care –Voluntary standards for medical interpreting professionals in the U.S. –Currently no national certification for interpreters working in healthcare settings Hospitals almost exclusively absorb cost of providing interpretive services –States have the option of reimbursing healthcare providers for language services provided to Medicaid and State Children’s Health Insurance Program recipients

14. Many Hospitals. One Voice. What Our Hospital Is Doing