1. Health, Language and Culture

2. Imagine the experience of our culturally diverse patients.
Language and cultural barriers
A very different healthcare system to navigate.
Consider this:
The phrase “What brought you here today?”
Show your empathy for what people from other cultures must experience… so challenging… anxieties of patient ON TP OF anxieties of being in a VERY unfamiliar culture/language.
Show empathy here for how difficult it must be for patients from different cultures who may not speak English fully.
Don’t make suggestions…. Just show empathy here, because their plight is yet another reason why we feel compelled to pursue a GREAT patient experience.
Copyright 2005; Wendy Leebov 2

3. Improving Communication with our Patients Interpreter Services provided by trained medical Interpreters helps improve patient outcomes, quality and satisfaction.
It’s the Law
Federal Laws preventing discrimination include language.
Massachusetts Law mandates that we provide face to face
Interpreter Services in the Emergency Department and
Acute Psyche encounters in our most common spoken languages.
Patients who are deaf and or hard of hearing are entitled to a Sign Language, or Sign Language and Certified Deaf Interpreter under the American Disabilities Act.

4. It all starts with registration.
We are mandated to ask patients what language they prefer to discuss health concerns and what language prefer to read healthcare materials.
This information prepopulates RN Assessment
With new EHR will likely have more options.
RN should document how they met language barrier.

5. High Cost of Language Barriers in Health Care
A National Health Law Program study analyzing 35 claims filed in four state between January 2005 and May 2009 for one liability insurer found the insurer paid $2.3 million in damages or settlement and $2.8 million in legal fees for case where the provider failed to offer a professional interpreter.
Among the cases studied, five patients died and others suffered permanent damages, such as leg amputations and organ damage.

6. Interpreter Roles
Advocate
Cultural Broker
Clarifier
Conduit

7. Working with Professional Medical Interpreters
Interpreters are part of the care team for the patient. In addition to interpretation services, they can help providers understand cultural differences.
Hold a pre or post conference with the interpreter for briefing or feedback. Very important for telephonic interpretation.
Make sure the patient understands that interpreter services are free of charge.
Document in the Medical Record
Use of Interpreter
Refusal of Interpreter Services

8. Family Members as Interpreters

9. Can I interpret?
At Mount Auburn Hospital only medically trained interpreters interpret.
Trained medical interpreters do not add, omit, distort, or change the register of the message.
Many providers are fluent in other languages and choose to speak to their patients in those languages.
Growing attention nationally. Some organizations have tested providers language skills. Reports cite a 30%-60% pass rate.

10. Can a patient refuse interpreter services?
Yes. If a patient wishes to refuse interpreter services:
Make sure the patient knows the services are free of charge
Have the patient sign a Refusal Form . You must utilize an interpreter to have the form signed. (This form is located on the portal)
Note, even if the patient refuses an interpreter the clinician may choose to have an interpreter. Call x5750 or pg for assistance.

11. American Sign Language Video Relay Other: Flash Cards Amplifier
Interpreter Department x5750 or pg 6681
Spoken Language
In Person
Telephonic
American Sign Language
Video Relay
Other:
Flash Cards
Amplifier

12. Monday - Friday 7a-5p Spoken Languages American Sign Language I
N T E R P R E T E R S E R
V I C
#6681
Spoken
Languages
Monday - Friday 7a-5p
Staff Languages page:
Spanish: #6681,
Portuguese: #6852
Armenian/Russian: #6692
All other languages
Use Phone
Evenings and Nights:
5p-10p
Spanish page #6681
Other Languages use phone
10p-7a
Spanish page #6681 AGENCY WILL RESPOND.
Other Languages use phone
Weekends and Holidays:
7a to 10p
Spanish page #6681
Other Languages use phone
American Sign Language
Immediately start using American Sign Language via Video Remote Relay AND page #6681 to request face to face interpreter.
For other accommodations for our Deaf patients see Interpreter Services on Portal.

13. Interpreter Services The Telephone Language Line is available to all clinicians 24/7.
Call
At prompt enter account #
At prompt enter pin #
Follow instructions to select language
Write Interpreter ID number in patient’s medical record.
** Customer Service is available for help.

14. When you need to call a non-English speaking patient.
Call the telephonic interpreter from ANY phone
-Account #
-Pin #
2. Interpreter calls patient
3. Talk to patient through interpreter
4. Document that the interpreter was utilized for the conversation.

15. When a non-English speaking patient calls you.
Get the patient’s language and phone number if possible. Put the patient on hold.
Conference call the telephonic interpreter from
-Account #
-Pin # XXXX (each areas has their own specific PIN)
3. Tell the Interpreter you are going to connect a patient. Connect the call.
4. Talk to patient through interpreter
4. Document that the interpreter was utilized for the conversation.

16. American Sign Language
Legal obligation
Limited resources
Call x5750 as early as possible to arrange
Video Relay Interpretation may be alternative
Document steps taken to arrange interpreter.

18. Translation services arranged thru Interpreter Services
Joint Commission requires we use certified translators
Interpreters may translate one time, patient specific short documents.
DO NOT USE TRANSLATION PROGRAMS SUCH AS Google Translator.

19. Sample or Most Common Error
Phrase Translated
Sample or Most Common Error
% Correct
Your wife is stable
Your wife cannot fall over
53.8
Your husband had a cardiac arrest
Your husband's heart was imprisoned
Your wife needs to be ventilated
Your wife needs to be aired
26.9
We will need your consent for operation
We need your consent for operating (such as machinery)
61.5
Did he have a high fever at home?
Your home temperature was high.
65.4

21. Cultural Quiz-What do you think. University of Toronto www
Cultural Quiz-What do you think? University of Toronto
People have more of a “culture” than their American neighbors if they were born in a foreign country and continue to honor family traditions.
Everything considered to be “common sense” is determined by culture.
Communication styles are rooted in culture and impact clinical interactions.
To improve cross-cultural interactions, the first step recommended by experts is to understand the cultural values and beliefs of others.
False
True
True
False

22. Hospital
American
Caregiver
Biomedical
Patient
In every patient encounter there are at least 5 cultures involved.

23. Health Disparities
Health Inequity

24. Institute of Medicine 2002
Even among the better-controlled studies, the vase majority indicated that minorities are less likely than whites to receive needed services.
Although myriad sources contribute to these disparities, some evidence suggests that bias, prejudice and stereotyping on the part of healthcare providers may contribute to differences in care.
Racial differences in patients’ attitudes, such as their preferences for treatment do not vary greatly and can not fully explain racial and ethnic disparities in healthcare.

25. IOM Report-Solutions
Report highlighted no one cause of disparities and therefore no one solution.
Culturally and Linguistically Appropriate Services (CLAS) Standards
Interpretation Guidelines
New JACHO guidelines Communication
Cultural Competency Education

26. Cultural Competence
Cultural Humility
Empathy
Respect
Curiosity

27. From good to GREAT: From Common Knowledge to Common Practice
Make points:
“So, you might have been thinking all along today that you know all of this…that there isn’t really anything new. And that’s true.
To go from good to GREAT, we need to change what is COMMON KNOWLEDGE into our COMMON PRACTICE. That’s our challenge…..to take the best of what we know and put it into effect every day with every person.
Transition: Now let’s look at what next and how we’ll follow up to APPLY the skills we’ve refreshed today.”
What is “common” is related to Culture.
Copyright 2005; Wendy Leebov 27

28. People from different cultures will describe the same object differently.
“I think this would look great in my Living Room.”
It is a Decoration
“Let’s bring this back from our trip to India.”
It is a Souvenir
“I use this everyday when I pray.”
It is a Place of Prayer

29. People from different cultures will describe the same word differently.
Status
A well decorated
war hero.
Status
An expensive
pampered pet.
Status
A wise elder.

30. Cultural Passport Think about the answers to these questions:
What words or phrases describe your cultural views of health and illness?
If you loved ones were receiving in-patient treatment for serious illness, what should providers understand about your cultural view of medical care?
What aspects of your cultural background do you feel could strengthen your interactions with and care for patients and their families?

31. “It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.”
Sir William Osler, MD

32. Explanatory Models Communication tools used to elicit increased understanding when those communicating have diverse cultural perspectives.
The Explanatory Model-Kleinman
What do you think caused your problem?
Why do you think it started when it did?
What do you think your sickness does to you?
How serve is your sickness? Do you think it will last a long time, or be better soon in your opinion?
What kind of treatment do you think you should receive?
What are the most important results you hope to get from this treatment?
The LEARN Model-Berlin, Fowles
Listen with sympathy and understanding to the patient’s perception of the problem
Explain your perceptions of the problem
Acknowledge and discuss the differences and similarities
Recommend treatment
Negotiate agreement

33. Thank You