2. Exceptional Care. Remarkable Services. Extraordinary Grady. IMIA International Conference on Medical Interpreting “Pioneering Healthy Alliances” Boston, Massachusetts Oct. 5 – 7, 2007 COMMUNICATION - KEY TO PATIENT SAFETY

3. Exceptional Care. Remarkable Services. Extraordinary Grady. P resented by: Sandra Sanchez, M.S., Director, Multi-Cultural Affairs Grady Health System, Atlanta and Linda Joyce, M.S., Language Access Consultant Interpreter

4. Exceptional Care. Remarkable Services. Extraordinary Grady. Objectives of the Presentation Understand patient safety issues Recognize the relevance of language and culture in patient safety Discuss some of the strategies that have worked Show how collaborating will lead to better health outcomes for all, including culturally and linguistically diverse patients

5. Exceptional Care. Remarkable Services. Extraordinary Grady. Patient Safety Definitions Adverse Event/ Occurrence: Any unintended harm to the patient by an act of commission or omission rather than by the underlying disease or condition of the patient. Near Miss/Close call: A potential injury that did not happen to the patient. Sentinel Event: An unanticipated death or major loss of function, not related to the natural course of the patient’s illness or underlying condition.

6. Exceptional Care. Remarkable Services. Extraordinary Grady. Why the focus on patient safety? Joint Commission, Dec., 2006

7. Exceptional Care. Remarkable Services. Extraordinary Grady. Is it safe to go to the hospital? An average of 195,000 people in the USA died due to potentially preventable, in-hospital medical errors in each of the years 2000, 2001 and 2002, according to a 2004 study of 37 million patient records HealthGrades Patient Safety in American Hospital Study

8. Exceptional Care. Remarkable Services. Extraordinary Grady. Joint Commission - Dec. 2006

9. Exceptional Care. Remarkable Services. Extraordinary Grady. 2007 National Patient Safety Goals Patient Identification Improve communication Medication Safety Reconcile Medications Patient involvement Focused risk assessment

10. Exceptional Care. Remarkable Services. Extraordinary Grady. “Effective Communication” U. S. Department of Health and Human Services initiative to strengthen language access Along with the Office of Civil Rights, collaborating with hospital associations in nine states Assessment includes looking at the needs of small, rural hospitals

11. Exceptional Care. Remarkable Services. Extraordinary Grady. WHO (World Health Organization) Patient Safety Solutions Patient identification Communication Assuring medication accuracy Look-alike, sound-alike medication names

12. Exceptional Care. Remarkable Services. Extraordinary Grady. We are part of a mosaic: There are more than 6 categories for race and about 2.5% of the population identified themselves as having 2 or more races About 12% of the US population is foreign born About 18% of the US population speak a language other than English at home (Approx. 47 million) About 8.1% of the population 5 Years and Over Speak English Less Than “Very Well” (Approx. 21 million) US Census Bureau Federal and Accreditation Mandates

13. Exceptional Care. Remarkable Services. Extraordinary Grady. Language and culture 101 Basic considerations to improve patient safety Primary/preferred Language Cultural Background Health Literacy Levels

14. Exceptional Care. Remarkable Services. Extraordinary Grady. Cases to consider 10 month old baby with iron-deficiency anemia 3-year old child with abdominal pain Girl falling from bicycle “Intoxicado” Hysterectomy Hmong child with epilepsy

15. Exceptional Care. Remarkable Services. Extraordinary Grady. Your real time examples Experiences that you have had in your health care setting where communication has been, or could have been the cause of incidents Experiences where cultural considerations have led, or could have led to incidents

16. Exceptional Care. Remarkable Services. Extraordinary Grady. “Language proficiency and adverse events in U.S. hospitals: a pilot study” Adverse events involving some physical harm Almost half (49.1%) of LEP patients vs. Almost a third (29.5%) of patients who speak English Patients with moderate temporary harm to death: 46.8% of the LEP vs. 24.4% of English speaking patients Communication errors: 52.4% of the LEPs vs. 35.9% of the English speaking patients Joint Commission - Chandra Divi, Richard G. Koss, Stephen P. Schmaltz and Jerod M. Loeb

17. Exceptional Care. Remarkable Services. Extraordinary Grady. Adverse event type characteristics for English speaking and LEP patients Adverse event characteristicEnglish speaking N (%)Limited English proficient N (%) P-value Communication299 (35.9)130 (52.4)<0.001 Inaccurate/incomplete information132 (15.9)39 (15.5)0.44 Questionable advice/interpretation29 (3.5)28 (11.2)0.002 Questionable consent process10 (1.2)7 (2.8)0.33 Questionable disclosure process7 (0.8)8 (3.2)0.042 Questionable documentation171 (20.6)59 (23.5)0.77 Questionable assessment of patient needs53 (6.4)37 (14.7)<0.001 Patient management 467 (56.1)133 (53.0)0.12 Questionable delegation14 (1.7)10 (4.0)0.69 Questionable tracking and follow-up182 (21.9)61 (24.3)0.30 Questionable use of resources257 (30.9)60 (23.9)0.18 Clinical performance 154 (18.5)36 (14.3)0.47 Correct diagnosis questionable intervention152 (18.3)32 (12.8)0.77 Joint Commission – C.Divi et al.

18. Exceptional Care. Remarkable Services. Extraordinary Grady. Hospitals, Language and Culture: A Snapshot of the Nation Quality controlled translations Qualified interpreters and cultural brokers Education on cultural competency Avoid stereotyping Discuss impact of language and culture on patient safety Expand Joint Commission Nat’l Safety Goals Better data and research effect of language and culture in adverse events Joint commission - Wilson-Stokes

19. Exceptional Care. Remarkable Services. Extraordinary Grady. CLAS, OCR and The Joint Commission Effective and understandable communication Written information in patient’s language Interpretation and translation services Staff competence (Qualified interpreters and translators) Cultural, linguistic and learning needs Records of communication with patients Patient involvement Hospitals provide services in accordance to laws and regulations Patients with comparable needs receive same standard of care

20. Exceptional Care. Remarkable Services. Extraordinary Grady. Grady Health System Department of Multicultural Affairs Language Interpretive Services (LIS) Qualified professional interpreters and translators Continuous education sessions for interpreters Language Proficiency Assessments Multicultural Programs Outreach and education Community Partnerships Cultural Competency Training International Medical Center (IMC) Primary care – Patient centered (one-stop shop) Bilingual and culturally sensitive staff and providers Education in waiting room

21. Exceptional Care. Remarkable Services. Extraordinary Grady. Interdepartmental Collaboration at Grady Health System Patient Safety Risk Management Customer service / Patient Advocacy Training and Development Nurse Residency Program Facilities Management Public Relations Human Resources

22. Exceptional Care. Remarkable Services. Extraordinary Grady. The Goal: Patient-centered care Assessing language and cultural needs Listening to the patient Asking the patient what they are doing to address their health issues Involving the patient and families at all transitions Using “teach-back” or “show-back” techniques

23. Exceptional Care. Remarkable Services. Extraordinary Grady. What can we do together? What can health care systems do to include language and culture in its patient safety plan? What can language service departments do? What can interpreters do? What can providers and patients do?

24. Exceptional Care. Remarkable Services. Extraordinary Grady. Conclusions Language and culture have to be considered to achieve all the National Patient Safety Goals for 2007. Organizational collaboration is key to preventing communication errors. To reduce the risks to patient safety related to language and cultural barriers, always: Use qualified medical interpreters Collect data on preferred language Document use of medical interpreters Confirm understanding with “teach back” or “show back” approach Learn about practices and customs of the patient population in the service area Attend cultural competency trainings when possible

25. Exceptional Care. Remarkable Services. Extraordinary Grady. References www.jointcommission.org Hospitals, Language and Culture: A Snapshot of the Nation What did the doctor say? Improving Health Literacy to Protect Patient Safety National Patient Safety Goals www.LEP.gov www.omhrc.gov National Standards for Culturally and Linguistically Appropriate Services www.census.gov www.hhs.gov/ocr www.publimed.org

26. Exceptional Care. Remarkable Services. Extraordinary Grady. Thank You!