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Section 1557 is the Nondiscrimination in Health Programs and Activities Act, a rule by the Health and Human Services Department, requiring the provision of a qualified interpreter versus a competent one. The act expressly bars the use of an untrained or ad hoc interpreter barring extreme circumstances.
This resource, provided by the U.S. Department of Health and Human Services, offers a summary of Section 1557, translated resources and factsheets for hospitals.
Compiled by the San Francisco General Hospital, University of California, National Health Law Program and Center for Genetics and Society, this resource provides a detailed description of the federal regulations surrounding language access in health care, existing state laws and recent legal developments in addressing language barriers. The resource also includes an analysis of key initiatives for hospitals to improve health care for LEP patients.
The act requires services provided with the funding from the federal government to be delivered without regard to race, color, or national origin. Specific to language services, “the Executive Order requires Federal agencies to examine the services they provide, identify any need for services to those with limited English proficiency (LEP), and develop and implement a system to provide those services so LEP persons can have meaningful access to them.”
The ADA is one of the most comprehensive pieces of civil rights legislation prohibiting discrimination. The act guarantees people with disabilities have the same opportunities as everyone else to participate in the mainstream of American life, e.g., enjoy employment opportunities, purchase goods and services and participate in state and local government programs and services.
The Hill-Burton Act, enacted by Congress in 1946, encouraged the construction and modernization of public and nonprofit community hospitals and health centers. In return for receiving these funds, recipients agreed to comply with a “community service obligation” which included a rule of non-discrimination in the delivery of services. The Office of Civil Rights has consistently interpreted this as an obligation to provide language assistance to those in need of such services.
In 2007, the National Association of Community Health Centers (NACHC) surveyed a sample of its member health centers to gain insight about how they serve patients with limited English proficiency. Here are their results.
The first step to a successful language access plan is identifying patient demographics, particularly their preferred language for receiving healthcare information. By understanding the area’s top languages other than English, hospitals can better prepare and provide language services for LEP patients. This resource provides helpful information surrounding the LEP population in the U.S.
The Agency for Healthcare Research & Quality (AHRQ) developed a guide for hospitals to better identify, report, monitor and prevent medical errors in patients with LEP. This resource provides helpful insight for hospitals to better understand LEP patient safety and cultural diversity among patients.
The University of California, Cook County Hospital and Rush Medical College compiled an analysis of literature surrounding the use of qualified medical interpreters to treat LEP patients. The review reports positive benefits of professional interpreters on communication (errors and comprehension), utilization, clinical outcomes and satisfaction with care, further illustrating the importance of using a qualified interpreter.
The National Institute of Minority Health and Health Disparities and the University of California San Francisco analyzed 30-day readmissions, length of stay (LOS) and estimated hospital expenditures of nearly 2000 LEP patients. Researchers found a significant decrease in observed 30-day readmission rates for the LEP group that was provided with a medical interpreter.
The Department of Family Medicine and Community Health & the University of Massachusetts Medical School analyzed the use of interpreters, length of stay and 30 day readmissions of over 3000 LEP patients admitted to a tertiary care hospital over a three-year period. Researchers concluded the length of hospital stay for LEP patients was significantly longer when professional interpreters were not used at admission or discharge.
The University of California Berkeley School of Public Health and the National Health Law Program conducted an investigation to identify malpractice claims where language barriers may have impacted patient outcome. The study includes details of several cases.
An article, published by Health Affairs, demonstrates the tragic outcome that can occur from a communication error in healthcare when a language barrier is present and a medical interpreter is not used to facilitate communication. The story illustrates the detrimental effect that a false cognate had on patient outcome when the word “intoxicado” was mistaken to mean “intoxicated”.
Researchers at University of California, in conjunction with the National Institute of Minority Health and Health Disparities, analyzed the use of telephonic interpretation to facilitate communication with over 150 Spanish and Chinese speaking patients. The study concluded that LEP patients with access to an interpreter were more likely to meet criteria for adequately informed consent and experience a higher level of clinical care than patients without language access.
The U.S. Department of Health and Human Services established the National CLAS Standards as a guide for hospitals to advance health equity, improve quality, and eliminate health care disparities.
Developed by the U.S. Department of Health and Human Services, the Blueprint is an implementation guide designed to help hospitals improve and maintain culturally and linguistically appropriate services for patients.
The Joint Commission created the Roadmap for Hospitals in an effort to help providers address patient needs, meet the patient-centered communication standards, and comply with related Joint Commission requirements. Example practices, information on laws and regulations, and links to supplemental information, model policies, and educational tools are also included.
The Health Research and Educational Trust (HRET), the research and educational affiliate of the American Hospital Association, in collaboration with the National Health Law Program, conducted a national survey of hospitals in the United States to gather information about the need and use of language services in hospitals. This report describes current practices, common barriers and helpful tools to best provide language services to patients with LEP.
The Centers for Medicare & Medicaid Services (CMS) developed the Quality Assurance Guidelines manual to standardize the survey data collection process of the HCAHPS survey and simplify the administration process for hospitals.
Effective for October 1, 2019 discharges and forward, the HCAHPS 29-item mail materials, telephone and IVR scripts are available for hospitals to download. The PDF versions of the survey instruments are available in English, Spanish, Russian, Chinese, Vietnamese, Portuguese and German.
Denver Health Medical Center conducted a study to develop a comprehensive communication strategy for providers to improve patient safety. Analysis of nearly 500 communication events after the implementation of the communication strategy revealed decreased time to treatment, increased nurse satisfaction with communication, and higher rates of resolution of patient issues post-intervention.
The International Medical Interpreters Association (IMIA) hosted a presentation outlining the work of behavioral health interpreters. Due to the complexities of behavioral health diagnosis and treatment, interpreters pursuing the field are held to particularly high standards. This piece demonstrates the importance of using a qualified medical interpreter that is extensively trained in healthcare terminology and provides tips for providers when working with an interpreter in a behavioral health setting.
The International Medical Interpreters Association (IMIA) was the first organization to write and publish an ethical code of conduct for medical interpreters. The code of ethics requires interpreters to maintain patient confidentiality, render the message accurately and in its entirety and refrain from interjecting any personal bias. It also requires interpreters to clarify any cultural misunderstandings that may arise.
San Francisco State University examined the use of interpreters in psychotherapy with refugees. Fifteen therapists and fifteen interpreters were interviewed at fourteen refugee mental health treatment centers in the United States. The findings demonstrate the impact of the nature of the work at hand on the interpreter’s emotional well-being as well as the extensive training that is required to interpret such encounters. The resource additionally offers tips for providers concerning the hiring, training and support of interpreting staff.
The Registry of Interpreters for the Deaf (RID) defines the role of the Certified Deaf Interpreter, the certification process and knowledge requirements. The page demonstrates the extensive training, performance and ongoing education required to become a CDI.
Researchers at the University of Western Australia and Sir Charles Gairdner Hospital conducted an extensive review of literature on patient-provider communication. The review concluded that doctors with better communication and interpersonal skills are able to detect problems more quickly, improve patient outcome, and boost patient engagement in care plans.