Promoting Health Equity Through Language Access

Equity and equality. To many, these two words are practically interchangeable. But understanding the difference is crucial – especially when it comes to promoting health equity through your language access plan.

As Caroline Belden, a writer for The Inclusion Solution, explains: “Equality is leaving the door open for anyone who has the means to approach it; equity is ensuring there is a pathway to that door for those who need it.”

This distinction, while subtle, should not be understated. Equality means resources are distributed evenly across a group of people, while equity is focused on distributing those resources based on the needs of each individual.

When creating a language access policy, many hospitals and health systems assume that providing access to interpretation services delivers an equitable experience. But that’s not always the case. In this post, we’ll explain why that approach misses the mark – and how you can develop organization-wide strategies to advance health equity.

Language Access Alone is Not Enough

In a healthcare setting, interpretation and translation services can offer equal access to provider communication for every patient, regardless of their native language. But creating a patient experience that’s equitable depends largely on how these language services are implemented.

The goal of promoting health equity through your language access program is to help patients who are limited-English proficient (LEP), deaf, or hard-of-hearing achieve the same outcomes as English-speaking patients. But while many efforts have been made to incorporate language services into LEP patient care, significant health disparities still exist:

• LEP patients are less likely to have insurance, see a doctor, and obtain high-quality care compared to their English-proficient counterparts.^[1]
• LEP patients are 40% more likely to experience physical harm associated with an adverse event than English-speaking patients.^[2]
• 20% of LEP patients admit to not seeking healthcare services for fear of not understanding.^[3]

To underscore the scope of the problem, consider this: The U.S. Census Bureau reports 68 million people speak a language other than English at home. If 20% of those people are not seeking healthcare because of language barriers, that represents more than 13 million people across the country.

In summary, simply providing access to language services is not enough to achieve true health equity for LEP patients. However, there are plenty of opportunities to improve outcomes by incorporating translation and interpretation services across the patient journey.

Promoting Health Equity for LEP Patients

Clear communication is a cornerstone of providing equitable care. Follow this checklist to help determine how you can better promote health equity through your language access plan:

1. Evaluate the patient journey.

   Start by thinking about how patients interact with your organization across the care journey. If an LEP patient starts at your website, will they have access to digital content in their native language? If they make a phone call to an office, will the person answering the phone know how to accommodate them? Auditing how language services are engaged throughout the patient journey can help identify ways to offer more equitable care to LEP patients.
   
   

2. Improve interpreter access.

   Multiple studies have shown that it’s important to offer interpreter access at admission and discharge. But how well are your language services being integrated during other important patient touchpoints? Do you have an iPad available in exam rooms for immediate interpreter access? Or does finding an interpreter feel like an afterthought when delivering care for LEP patients? Remember, making language services visible is often the first step in increasing the utilization of these important tools – which lead to shorter length-of-stay and reduced readmissions.
   
   

3. Educate staff and providers.

   Normalizing the use of language services in healthcare requires continual training and education. Whether it’s during new hire orientation or annual training sessions, be sure to equip staff and providers with the information needed to understand how – and when – to engage an interpreter during patient encounters. By improving the communication between LEP patients and providers, you can expect shorter encounter times and better adherence to care plans.
   
   

4. Assess community needs.

   To provide the best care possible for patients in your community, take a deep dive into your latest community needs assessment. This research can help you identify the language needs of the community you serve – and identify and service gaps or disparities in care.
   
   

5. Educate the community.

   Most LEP patients in your community probably don’t realize they have a legal right to medical interpretation. Educating patients on their rights, as well as the language services that are available, can go a long way toward improving language access and health equity.
   
   

6. Insist on certified interpreters.

   During patient encounters, always use a certified medical interpreter. Relying on patient family members or untrained bilingual staff has been shown to increase health disparities for LEP patients – and may also leave your organization vulnerable to lawsuits.
   
   

7. Identify care gaps.

   It’s not uncommon for LEP patients to be turned away from an appointment when an interpreter isn’t available; or to receive more testing than is medically necessary to compensate for a lack of communication. To promote health equity for LEP patients in your community, gather feedback from staff and providers throughout your organization. Identify the areas where care gaps may occur, then develop a plan to improve language access in each scenario.
   
   

8. Make equity a priority.

   Promoting health equity for LEP patients at an organizational level means the language access team has a “seat at the table” as strategic plans are being developed. When health equity is an organizational priority, interpreters will be treated as an essential medical service – which can normalize their use in day-to-day operations.
   
   

By following these simple steps, you can ensure every patient has a fair and equitable access to high-quality care. To learn how AMN Healthcare Language Services can help you advance health equity for LEP patients, visit www.amnhealthcare.com/language-services.

[1] Borders T, Brannon-Goedeke A, Arif A, Xu K. Parents’ reports of children’s medical care access: are there Mexican-American versus non-Hispanic white disparities? Med Care. 2004;42:884–92. doi: 10.1097/01.mlr.0000135818.47100.8c.

[2] Chandrika Divi et al., Language Proficiency and Adverse Events in U.S. Hospitals: A Pilot Study, 19 Int’l J. Qual. Health Care 60 (2007).

[3] Wilson E, Chen AH, Grumbach K, Wang F, Fernandez A. Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med 2005. Sep;20(9):800-806. 10.1111/j.1525-1497.2005.0174.x