1. Effective Communication and Patient Safety Team Membership Interpreter Services Interpreter Services Patient Relations Patient Relations Quality & Patient Safety Quality & Patient Safety Hospital Units Hospital Units Outpatient Clinics Outpatient Clinics Emergency Department Emergency Department Confidential: For Quality Improvement Purposes Only

2. Project Aim Statement To promote safe, high quality care for Limited English-proficient (LEP) and non-English speaking patients by providing qualified medical interpreters for all clinical interactions across Loyola. Confidential: For Quality Improvement Purposes Only

3. 35 Languages Encountered at Loyola in 2007 Albanian * Amharic * Arabic * Bosnian * Bulgarian * Cantonese * Czech * Dari * Farsi * French * German * Greek * Gujarati * Hindi * French * German * Greek * Gujarati * Hindi * Italian * Japanese * Korean * Lithuanian * Malayalam * Mandarin * Mongolian * Polish * Portuguese * Romanian * Russian * Serbian * Slovak * Spanish * Tagalog * Turkish * Ukrainian * Urdu * Vietnamese * ASL * Urdu * Vietnamese * ASL Confidential: For Quality Improvement Purposes Only

4. Opportunity For Improvement Prior to the creation of Interpreter Services, the approach to communicating with LEP patients was based on the use of: bilingual staff members family and companions of LEP patients Anecdotal feedback from physicians, patients and staff reveals a need for a formal interpreter service department for LEP and non-English speaking patients. Confidential: For Quality Improvement Purposes Only

5. Evidenced Based Need Hospitalized patients who speak little English are less likely to have documentation of informed consent prior to invasive procedures (28% vs. 53% of the general patient population) Hospitalized patients who speak little English are less likely to have documentation of informed consent prior to invasive procedures (28% vs. 53% of the general patient population) Hispanics who speak little English are less likely to receive all recommended health care services (35% vs. 57% of the general patient population) Hispanics who speak little English are less likely to receive all recommended health care services (35% vs. 57% of the general patient population) One in five “ad hoc” staff interpreters at a large health care organization do not have competent bilingual skills (2% failed competency assessment; 21% had only a limited fluency in both languages) One in five “ad hoc” staff interpreters at a large health care organization do not have competent bilingual skills (2% failed competency assessment; 21% had only a limited fluency in both languages) Professional interpreter services can increase access to health care for LEP patients Professional interpreter services can increase access to health care for LEP patients The Journal of General Internal Medicine, (Vol. 16, July 2001) Confidential: For Quality Improvement Purposes Only

6. The Role of Medical Interpreters To support the delivery of safe care To support the delivery of safe care To ensure understanding and reduce patient anxiety To ensure understanding and reduce patient anxiety To meet: To meet: Joint Commission Standards Joint Commission Standards CMS Standards CMS Standards OCR Guidance for compliance with Title VI, Civil Rights Act of 1964 OCR Guidance for compliance with Title VI, Civil Rights Act of 1964 Illinois Language Assistance Services Act Illinois Language Assistance Services Act Confidential: For Quality Improvement Purposes Only

7. Goals for the Program To provide a qualified medical interpreter to LEP patients for 100% of all patient encounters To provide a qualified medical interpreter to LEP patients for 100% of all patient encounters To improve LEP patient satisfaction with language services. To improve LEP patient satisfaction with language services. 6th Force of Magnetism Quality of Care Nurses provide qualified interpreters to LEP patients. Confidential: For Quality Improvement Purposes Only

8. In 2003, we first introduced the use of agency medical interpreters at Loyola In 2003, we first introduced the use of agency medical interpreters at Loyola Volumes continued to grow as demand for qualified medical interpreters increased Volumes continued to grow as demand for qualified medical interpreters increased Patient Relations staff coordinated all pre-scheduled requests with our agency providers Patient Relations staff coordinated all pre-scheduled requests with our agency providers In 2007, the department of Interpreter Services was created. We now employ a manager and eight staff interpreters providing service seven days a week In 2007, the department of Interpreter Services was created. We now employ a manager and eight staff interpreters providing service seven days a week Creation of an Interpreter Services Department 2007 Confidential: For Quality Improvement Purposes Only

9. Solutions Implemented Developed a business plan for Interpreter Services Developed a business plan for Interpreter Services Received buy-in from Senior Leadership Received buy-in from Senior Leadership Hired personnel Hired personnel Created an Interpreter Card for staff use on their ID”s. Created an Interpreter Card for staff use on their ID”s. Two-day blitz of Maywood campus informing staff of new process Two-day blitz of Maywood campus informing staff of new process Presentations at leadership meetings, staff meetings, department meetings Presentations at leadership meetings, staff meetings, department meetings Developed business cards with 3 languages (Polish, Spanish and English) to encourage patient use of interpreter services. Developed business cards with 3 languages (Polish, Spanish and English) to encourage patient use of interpreter services. Posted information on Loyola intranet on how to obtain interpreter services (Clinical Resources Tab) Posted information on Loyola intranet on how to obtain interpreter services (Clinical Resources Tab) Purchased walkie-talkies to improve communication between interpreters and dispatcher. Purchased walkie-talkies to improve communication between interpreters and dispatcher. Purchased a TTY phone for use with hearing-impaired patients Purchased a TTY phone for use with hearing-impaired patients Purchased dual handset phones for each inpatient unit Purchased dual handset phones for each inpatient unit Confidential: For Quality Improvement Purposes Only

10. Definition: Number of limited English-proficient patients requesting interpreter services. Data Source: Original data extracted from patient relations database. Analysis: Prior to department creation (January 2007), requests for interpreter services by LEP patients in 2005-2006 numbered 350. Requests for interpreter services increased by 68% by May 2007 and 96% by December 2007. Interpreter Services Program Growth Confidential: For Quality Improvement Purposes Only

11. Interpreter Services Patient Satisfaction Survey Survey developed by medical students for their Honors in Bioethics Course. Survey developed by medical students for their Honors in Bioethics Course. Aim was to evaluate patient satisfaction of LEP or non-English speaking patients and communication with physicians in 5 categories. Aim was to evaluate patient satisfaction of LEP or non-English speaking patients and communication with physicians in 5 categories. Surveys administered to 37 patients in May 2008 by Interpreter Services Surveys administered to 37 patients in May 2008 by Interpreter Services 78% respondents female 78% respondents female 22% respondents male 22% respondents male 95% respondent’s primary language: Spanish 95% respondent’s primary language: Spanish 5% respondents language: Russian and Serbian 5% respondents language: Russian and Serbian Confidential: For Quality Improvement Purposes Only

12. Data Source: Original data extracted from Interpreter Services Patient Satisfaction Survey, May 2008 by Medical Students. Analysis: Opportunities for Improvement identified with delays for interpreter services. Action plans to be developed after thorough analysis of data. Confidential and Privileged: For Quality Improvement Purposes Only

13. Patients prefer using the Loyola Interpreter significantly more than phone interpreters, bilingual staff members or family members Confidential: For Quality Improvement Purposes Only

14. Next Steps Expand on-site Spanish medical interpreter coverage to 16 hours a day. Expand on-site Spanish medical interpreter coverage to 16 hours a day. Add a Polish medical interpreter to our staff. Add a Polish medical interpreter to our staff. Provide in-services on cultural competency. Provide in-services on cultural competency. Review all interpreter requests that were not met for opportunity for improvement. Review all interpreter requests that were not met for opportunity for improvement. Confidential: For Quality Improvement Purposes Only