1. Useful Information for WU Offices From presentation to CAC 06/28/11

2. In 1999: 15,100 encounters in 20 languages Demographics: WUMC Campus In 2010: 42,621 encounters in 83 languages © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.

3. Language Diversity at WUMC 2010. Bolded languages are new to the Medical Center Campus since 2007. Underlined languages are increasing rapidly as “Bridge Tongues”. Albanian, Af-mai-mai, American Sign Language, Amharic, Armenian, Arabic, Azerbaijani, Bassa, Bangla, Birundi, Bosnian, Bulgarian, Burmese, Cambodian, Cantonese, Congolese French, Chin, Chitano, Creole, Croatian, Dari, Dzongkha,Estonian, Ewe, Malaryam, Ethiopian, Farsi, French, German, Gujarati, Greek, Hakka, Hebrew, Hindi, Hmong, Hungarian, Hunsa, Japanese, Karen, Karreni, Kazak, Khmer, Khrahn, Kinyarwandan, Kirundi, Korean, Krio, Kunama, Kurdish, Italian, Laotian, Latvian, Liberian English, Kinyarmalinga, Mandarin, Mandinga, Mongolian, Nepali, Oromo, Pashto, Polish, Portuguese, Punjabi, Romanian, Russian, Saho, Serbian, Shanghaisese, Somali, Spanish, Swahili, Tagalog, Taiwanese, Tamil, Telagu, Thai, Tigrinya, Tiv, Urdu, Uzbek, Vietnamese, Wolof, Zapotec

4. The Clear Trends in St. Louis  Rapid escalations of arrivals in relatively small total numbers with dialect level languages  Highly vulnerable, high risk, high trauma cases  37% of refugee families include an individual who requires health care intervention within 72 hours of arrival © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.

5. A Comparison Review of Adverse Outcomes Broken Down by English Language Proficiency International Journal for Quality in Health Care February, 2007 Patients who speak limited English –more likely to suffer sentinel event 49% (vs. 29%) of adverse events resulted in physical harm –more likely to be harmed to a greater degree from a sentinel event 47% (vs.24%) had a harm level ranging from “moderate to death” than patients without communication barriers. © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.

6. Regulatory Expectations  Laws (Title VI, ADA)  Joint Commission  CLAS Standards  BJH Policy © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.

7. New JC Standard (since 1/1/2011) Effective Patient-Provider Communication  NEW Standard PC.02.01.0X The hospital effectively communicates with patients when providing care, treatment, and services.  Elements of Performance 1. The hospital identifies the patient’s oral and written communication needs, including the patient’s preferred language for discussing health care. Note: Examples of communication needs include the need for personal devices such as hearing aids or glasses, language interpreters, communication boards, and translated or plain language materials. 2. The hospital communicates with the patient during the provision of care, treatment, and services in a manner that meets the patient’s oral and written communication needs. © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.

8. What is expected of a hospital in this high acuity/extreme language diversity environment?  Recognition of impact of LEP on patient services and patient health  Knowledge of relevant regulatory and accreditation expectations  A good faith effort to meet the needs of every vulnerable patient  Documentation of success and failure © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.

9. A Walk with the Joint Commission Minimum Expectations of Hospital Based Interpreter/Translation Services  Interpreter should be qualified and unbiased  Interpreters should be used at any point where LEP or communication barriers would produce a lesser quality of care than that delivered to an individual without such barriers.  Changing expectations and standards are increasing emphasis on documented evidence of patient’s understanding Teach back vs. “Do you understand?” © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.

10. How did/will the Joint Commission measure this?  (did) review relevant policies and procedures and ask questions of key staff/administrators  (will) use Tracer Methodology  Designed to look at processes, systems and structures from the perspective of the care recipient  Emphasis is on operational systems that are critical to safety and quality  The medical record provides a map to proceed through the organization’s performance © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.

11. What does this mean?  Congruence between what we say we do and what we actually do is assessed following the patient’s journey through our health care environments and systems  Consistency between care environments and among care providers is evaluated © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.

12. Nuts and Bolts: Using Interpreters and Translators Know your resources: BJH interpreters schedule 80+ cases daily and do additional 15 cases unscheduled BJH has 36 individuals who interpret for the medical center campus and can access other languages by phone Coverage is 24/7/365 Live dispatch now answering the phone 8am – 8:30 PM © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.

13. Barnes-Jewish Hospital Interpreter Services also covering SLCH and WU Obtain interpreter/translator services (including American Sign Language) at: © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.

14. What is wrong with family members as interpreters ?  They may or may not be bilingual  They may or may not have had formal training as interpreter or translator © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.

15. What else is wrong with family members as interpreters ?  It reduces patient autonomy  The family member is likely to have personal bias regarding the content under discussion. That can lead to innocent errors… or not so innocent errors.  It violates JC standards and BJH policy © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.

16. And one final thing wrong with family members as interpreters… It won’t hold up in court unless all other options were documented as exhausted. © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.

17. According to BJH policy, when is an interpreter required?  Diagnostic testing and procedures  Obtaining informed consent  Discussion of test results & options  Discharge planning  Patient/ family education  Any other language dependent activities © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.

18. New Standards (Since 1/1/2011) Right to Effective Communication  Standard RI.01.01.03The hospital respects the patient’s right to receive information in a manner he or she understands.  Elements of Performance 2. The hospital provides language interpreting and translation services. NEW Note: Language interpreting options may include hospital employed language interpreters, contract interpreting services, or trained bilingual staff, and may be provided in person or via telephone or video. The hospital determines which translated documents and languages are needed based on its patient population. 3. The hospital provides information to the patient who has vision, speech, hearing, or cognitive impairments in a manner that meets the patient’s needs. © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.

19. STOP THE LINE

20. What can you do?  If you speak another language and you are not trained as an interpreter, do not agree to interpret in those crucial situations  If you observe an untrained person trying to interpret (family or staff), you can STOP THE LINE © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.

21. STOP THE LINE  Is BJH policy  Is the right thing to do  Everyone has the authority to STOP THE LINE  Supports team work  Is all about patient safety

22. STOP THE LINE POLICY  Outlines steps to take if you feel patient safety is jeopardized  Is minimally disruptive  When used in good faith, administrative support is assured  Is considered a staff responsibility  Supports the person who “stops the line”  Failure to appropriately respond when someone “stops the line” may result in disciplinary action

23. How to “STOP THE LINE”  State: “Could we please “stop the line” because I have an important question & want to make sure we are delivering safe care to this patient.”  If the response is inadequate, address the person by name and say: “Please stop - we need to review the procedure (whatever it is) to be sure we are delivering safe care.”  If there is still no response, immediately contact the appropriate supervisor

24. Take Home Points  Interpretation of crucial medical information is a learned skill that goes beyond knowing the language; specialized training is required  Significant safety risks are associated with improper use of untrained staff or family members for interpretation of crucial information  You have the authority to “stop the line” if you feel interpretation is not being done appropriately © 2011 BJH Center for Diversity and Cultural Competence. All Rights Reserved.