Almost one person in five in the U.S.speaks a language other than English at home, and half of them have limited English proficiency (LEP).  Federal laws and standards require language assistance, including bilingual staff and interpreter services, be provided by health care organizations receiving federal funds.However, this need is not being adequately or uniformly met at all points of contact in the treatment for an episode of care, primarily due to low funding levels, a dearth of capable interpreters, a language disconnect when making referrals to specialists, and the unavailability of forms and education materials written in the languages needed. 

We’ve long since acknowledged that eliminating language barriers in the delivery of health care is a priority, but the changes fostered by health care reform are about to place an unintended spotlight on the issue, especially for health care organizations serving urban communities.  Though I wouldn’t call it a tidal wave, anywhere from one-half to two-thirds of the new Medi-Cal and Exchange-eligible beneficiaries in California will speak English as a second language with limited proficiency or not at all.  Hopefully, the medical homes being designed to manage the primary care, preventive care, health education and care coordination for these consumers will also be adequately resourced to provide the language assistance they need.  This service is integral to the production of enhanced clinical outcomes and improved population health.

What concerns me more, though, is the communication that happens between a hospitalized patient and his/her treating physician when they don’t speak the same language, especially considering the steady rise in inpatient acuity levels juxtaposed with the drive to lower lengths of stay.  The fact is that sicker patients are being sent home sooner with a greater reliance on increasingly complex post-discharge instructions to complete their recovery. 

This fact struck me recently when I was present at a discharge meeting between a family member and her physician.  In fact, everyone in attendance spoke English very well, and we family members hold six advanced education degrees between us.  Even so, we had to work hard at making sure we understood the complex discharge instructions.  We listened attentively and asked many questions, some needing to be rephrased to ensure we understood what was being said.  I don’t have to imagine how difficult that communication would have been or what we would have gotten wrong if we had to communicate through an interpreter, as I and my family members are proficient in speaking other languages and have had the opportunity to translate for others.  There were certain translation-defying language and cultural nuances in our communication with the doctor that were key to understanding what our family member needed in the way of observation, attention and care once she got home.  Her recovery and risk for readmission to the hospital were tied to our understanding of and adherence to the instructions in this communication between us and her doctor. 

This experience left me wondering how the language differences and cultural diversity in our communities will impact our drive to boost clinical outcomes, improve the quality of care we provide, and deliver on our population health enhancement goals.

Your thoughts?