More than 60 million people - about one in five legal U.S. residents - speak a language other than English at home, and it's not all Spanish, with more than 176 different languages and dialects spoken across the country. Not having the right support in place to overcome language barriers when there is a medical emergency can be the difference between life and death.
It's difficult enough to explain to the doctor what really hurts and get a resolution that gets you well, even if you do speak the language. Having to rely on a bi-lingual family member and their well-intended but often conflicting biases to translate or worse, bluffing your way through with broken English, can lead to poor medical care or worse.
That's the reasoning behind the new Joint Commission accreditation standards set to take effect in January 2011 which substantially increase the commitment hospitals must make to multiculturalism and support for numerous languages, not just Spanish.
The Joint Commission, with funding from The Commonwealth Fund, began the initiative in August 2008 to advance the issues of effective communication, cultural competence, and patient- and family-centered care in hospitals. The Patient-Centered Communication standards were approved in December 2009 and released in January 2010 (see: A Roadmap for Hospitals). Compliance will be evaluated beginning in January 1, 2011, with compliance included in the accreditation decision as soon as January 2012.
Right now, few hospitals are in full compliance with the new standards. "Most are not even close," according to Jonathan Hirsch, Director of Guest Services at Holy Name Medical Center in Teaneck, N.J., which already meets the new standards but is in the definite minority. Hirsch speaks often about the importance of language compliance for hospitals and other medical facilities. "That's why The Joint Commission is increasing the standards to finally move the needle on all hospitals becoming compliant which not only improves the quality of patient care, but trims costs for the hospitals, too."
At a time when the country is hyper-focused on equitable, affordable health care, Hirsch says language compliance is one of the critical areas to address. Holy Name, a mid-sized hospital, average's more than 5,000 interpretations per year (42 languages on a regular basis), and Hirsch credits the interpretations with dramatically cutting the amount of time patients spend in the hospital and reducing the number of patients who need to be readmitted. Both substantially lower costs. "But, most importantly, it has improved care and helped save lives," Hirsch said.
The language-related sections of the new Joint Commission standards include: developing a system of identifying the patient's preferred language; ensuring the competency of individuals who provide language services; developing a method of delivering language services; and translating materials and signage into other languages.
Some hospitals have a team of interpreters who serve a limited number of languages - again, often just Spanish - and some also use local freelance interpreters. Most facilities use a combination of on-site and over-the-phone interpreters, but full compliance with all languages under heavy traffic is unusual.
"I've seen hospitals brag about being able to interpret for 90 percent of patients who do not speak English. I always ask what they do with the other 10 percent. Charades?" Hirsch said.
Hospitals are reviewed for compliance with Joint Commission standards on an ongoing basis, with unscheduled accreditation surveys taking place approximately every three years. Hospitals that fall short of these standards risk losing access to Medicare and Medicaid funds, as well as incur additional costs in resolving issues identified to reestablish compliance.
Louis Provenzano is President and Chief Operating Officer of Language Line Services, the world's leading provider of language-based services.