delivery of quality health care - réseau santé en ... · ssf work in collaboration to improve...

The Impact ofCommunicationChallengeson the

Delivery of QualityHealth Careto

Minority LanguageClients & Communities

A Position Papersubmitted by thePEI French Language Health Services NetworkIn collaboration with the Société Santé en français

ACKNOWLEDGEMENTS

The Prince Edward Island French Language Health Services Network would like to thank all those whohave contributed to the production of this position paper.

Research and report writing: HRA Consulting FirmPatsy MacLeanConstance RobinsonKay Lewis (Quest Hospital Planning Solutions)

Advisory Committee: Joanne Donahoe Lizanne ThorneMelissa Doucette Garth WaiteJulie G. Gilman (Chair)

Resource person: Caroline Currie

Collaborators: Société Santé en français

Translation: Acadian and Francophone Affairs Division, Government of P.E.I.

Graphic design & layout: TechnoMedia

Printing: Kwik Kopy

The production of this position paper has been made possible through a financial contribution fromHealth Canada through the Société Santé en français.

The views expressed herein do not necessarily represent the views of Health Canada.

For more information, please contact:

The Prince Edward Island French Language Health Services Network48 Mill Road, P.O. Box 58Wellington, PEC0B 2E0Tel: (902) 854-7441Fax: (902) 854-7255Email: [email protected]: www.santeipe.ca

A production of the Prince Edward Island French Language Health Services Network

MARCH 2007

�

INDEXMessage from the Co-Chairs of the Prince Edward IslandFrench Language Health Services Network.................................................................................................2

Message from the Société Santé en français Board Chairand President and Executive Director..........................................................................................................3

HistoryofthePEIFLHSN............................................................................................................................4WorkofthePEIFLHSN...............................................................................................................................4PEIFLHSNPositionStatement.....................................................................................................................5RecognitionofthePurposeofCCHSA..........................................................................................................5CommunicationChallenges&QualityofCare..............................................................................................6WhyCommunicationIsImportant................................................................................................................6 Access.......................................................................................................................................................7 Prevention................................................................................................................................................7 Consent....................................................................................................................................................8 ProfessionalCodeofEthics.......................................................................................................................8 QualityofCare.........................................................................................................................................8 Patientsafety............................................................................................................................................9 MedicalErrors........................................................................................................................................�0 HospitalAdmissions...............................................................................................................................�� DiagnosticTesting..................................................................................................................................�� PatientFollow-Up..................................................................................................................................�� MentalHealthCare................................................................................................................................�� Safety......................................................................................................................................................�� Outcomes...............................................................................................................................................�2 PatientSatisfaction.................................................................................................................................�2 PatientCompliance................................................................................................................................�2 ResearchContinues................................................................................................................................�2Language&Standards.................................................................................................................................�4Conclusion...................................................................................................................................................�5References....................................................................................................................................................�6

APPENDIX ACCHSAStandardsRelatingToLanguageAccess..........................................................................................�9LeadershipAndPartnership.........................................................................................................................�9Environment................................................................................................................................................22HumanResources........................................................................................................................................23InformationManagement............................................................................................................................24AcuteCare...................................................................................................................................................25AmbulatoryCare..........................................................................................................................................29CommunityHealthServices.........................................................................................................................33CriticalCare.................................................................................................................................................38HomeCare..................................................................................................................................................43Long-termCare............................................................................................................................................47Maternal/Child............................................................................................................................................52MentalHealth..............................................................................................................................................56Rehabilitation...............................................................................................................................................60

APPENDIX BLanguageAccessResources&Tools.............................................................................................................65

APPENDIX CEvidenceForMonitoringCommunicationChallenges.................................................................................67

2

Message from the Co-Chairs of the Prince Edward IslandFrench Language Health Services Network

ThePrinceEdwardIslandFrenchLanguageHealthServicesNetwork,incollaborationwiththeSociétéSantéenfrançais,ispleasedtosubmitthispositionpapertotheCanadianCouncilonHealthServicesAccreditation(CCHSA).

WhentheP.E.I.FrenchLanguageHealthServicesNetworkdevelopeditsAction Plan for the Delivery of Primary Health Care Services in Frenchon Prince Edward Islandin2006,oneofitsrecommendationswasthatfromanationallevel,theSociétéSantéenfrançaisbeincited“…toconsiderusingtheexistingAccreditationFrameworkoftheCCHSAasawayofencouraginghealthcareorganizationstoimprovethedeliveryofFrenchlanguageservices”asitisrecognizedthatlanguageandcultureimpactqualityofcare.Thispositionpaperisinresponsetothisrecommendation.

Onceagain,ourcollaborativeapproach,whichunitestheNetwork’scommunityandprovincialgovernmentpartners,hasprovedsuccessful.WeareconfidentthattheCCHSAcanusethisnewtooltocontinuetoraisethebarforqualityinhealthservicesandmeetitscommitmenttobealeaderinimprovingpatientsafety.WelookforwardtoacontinuedcollaborationwiththeCCHSAsowemaymeetourjointgoalofimprovingqualityofcareforminoritylanguageclientsandcommunities.

DonaldDesRoches ClaudeBlaquièreGovernment Co-Chair Community Co-Chair

Delivery of Quality Health Care…

3

Message from the Société Santé en français Board Chair, President and Executive Director,

WeareverypleasedtoannouncethattheSociétéSantéenfrançaisisteamingupwiththePrinceEdwardIslandFrenchLanguageHealthServicesNetwork(PEIFLHSN)tosubmitthepositionpaperThe impact of communication challenges on the delivery of quality health care to minority language clients & communitiestotheCanadianCouncilonHealthServicesAccreditation(CCHSA).

Inthispaper,weaccuratelypointouttheinevitablecharacterofcultureandlanguageassystematicparametersforassessingthequalityofservices,withinthescopeofaccreditinghealthcareinstitutions.

AvastreviewofCanadianandinternationalliteratureonthesubjecteloquentlysupportstheimportanceofintegratingqualitystandardsforcommunicationbetweentheinstitutions,stakeholdersandtheFrancophonecommunitiestheyserveintoaccreditationprocesses.Inthisregard,thePEIFLHSNisproposingverypromisingsolutionsthatarein-linewiththeperspectiveoftheCCHSAorientations.TheSociétéSantéenfrançaisfullysupportsthePEIFLHSN’sworkonbehalfofallitsaffiliatednetworks.Weareconvincedthatthiscollaborativeeffortwillinevitablyresultinimprovedqualitystandardsforpatientcareandsafety,whichinturnwillleadtobetteraccesstoFrench-languageservices,improvedefficiencyofinterventionsandgreatersatisfactionamongusersoftheseservices.

Dr.BrianConway HubertGauthierBoard Chair President and Executive Director

… to Minority Language Clients and Communities

4

History of the PEI FLHSN

TheGovernmentofPrinceEdwardIslandadoptedFrenchlanguageserviceslegislationinApril�999.Whiletheprovisionswhichwouldappreciativelyimpacthealthserviceshaveyettobeproclaimed,thecurrentlegislationdoeshaverepercussionsonthedeliveryofhealthandsocialservices.ThepartialproclamationoftheFrench Language Services ActillustratestheProvince’sintenttoimproveaccesstoFrenchlanguagehealthandsocialserviceswhileprovidingservicesofcomparablequalitytoEnglish-languageservicestobenefittheAcadianandFrancophonecommunity.

WhiletheProvincehasacknowledgedtheprincipleofincreasedprovisionofservicesinFrench,thereisaneedtodeterminehowthiscanbeachieved.Todothis,theAcadianandFrancophonecommunityincitedtheMinisterresponsibleforAcadianandFrancophoneAffairsandtheMinisterofHealthandSocialServicestoestablishajointgovernment-communitynetworkdedicatedtothetaskofproposingpracticalsolutionsforthedeliveryofFrenchlanguagehealthandsocialservicesinPEI:thePrinceEdwardIslandFrenchLanguageHealthServicesNetwork(PEIFLHSN). ThePEIFLHSNisnotuniqueinitswork.Itispartofanationalnetworkofsimilarorganizationsineachprovinceandterritory:theSocietéSantéenfrançais(SSF).Provincial,territorialandregionalnetworksandtheSSFworkincollaborationtoimproveaccesstoFrenchlanguagehealthservicesforFrenchlanguageminoritycommunities.

The PEI FLHSN vision is: ToensurethatAcadiansandFrancophonesofPrinceEdwardIslandhaveaccesstoacompleterangeofFrenchlanguagehealthandsocialservicesofcomparablequalitytothoseprovidedinEnglish.

ItseekstoachievethisvisionbyproposingsolutionsthatincreaseaccesstoFrenchlanguagehealthandsocialservicesthroughworkinginpartnershipwithotherorganizationsandthecommunity.

Work of the PEI FLHSNInarecentPEIFLHSNreport,Action Plan for the Delivery of Primary Health Care Services in French (a.k.aSetting the Stage, 2006),theassessmentoftheexistinglevelofserviceconcludesthatcurrentFrenchlanguageservicesareinadequate,poorlyplannedandpoorlydistributed.Itobservedthat,todate,theimplementationoftheFrench Language Services Acthasbeendisappointingintheareaofprimaryhealthcareservices.IntheentireprovinceofPrinceEdwardIsland,onlyonefamilyhealthcentreactivelyoffersFrenchlanguagehealthservices.Elsewhere,peoplewishingtoaccessFrenchlanguagehealthservicesmustaskfortheserviceand,giventhefewbilingualemployeesspreadacrossthesystem,thereisnoguaranteethatsuchaservicewillbeprovided.Only0.9%ofpositionsinthehealthandsocialservicessystemaredesignatedbilingualwhile3.�%ofemployeesclaimedsomelevelofknowledgeofFrenchwhenlastsurveyed;thiscomparesto4.4%ofthepopulationwhichreportedFrenchastheirfirstlanguageinthe200�Censusand�2.�%ofIslanderswhoclaimtheycanspeakFrench.

ThePrinceEdwardIslandDepartmentofHealthiscurrentlyworkingtorespondtotheSetting the Stage report.Its Departmental Strategic Planhasadoptedasoneofitsgoals:

To improve access to health care: access for linguistic and ethnic minorities

Operationally,theDepartmenthasalsotakenstepstoaddresscommunicationchallenges,butthisprocesshassignificanthumanresourceimplications,andwilltaketimetoresolve.


5

The Setting the StagereportrecommendedthatthePEIFLHSNencouragetheSociétéSantéenfrançaistoconsiderusingtheexistingAccreditationFrameworkoftheCanadianCouncilonHealthServicesAccreditation(CCHSA)asameansofraisingawarenessofhowcommunicationchallengesaffectthedeliveryofhealthcareservices.Becausecommunicationchallengesnegativelyaffectthequalityofhealthcareandcreatesanunacceptablelevelofrisk,thisisanissueofconcernforallhealthorganizationsacrossthecountry.

ThePEIFLHSNfollowedthisrecommendationbydirectingthatapositionpaperbeprepared.ThisdocumentwaspreparedunderthedirectionofthePEIFLHSN,byHRA,aCharlottetown-basedhumanresourceconsultingfirm.JulieGilman,FLHSNCoordinator,oversawtheworkperformedbyHRAconsultantsPatsyMacLeanandConstanceRobinson,inassociationwithKayLewisofQuestHospitalPlanningSolutionsInc.

PEI FLHSN Position StatementThePEIFLHSNbelievesthattheAccreditationFrameworkusedbytheCanadianCouncilonHealthServicesAccreditation(CCHSA)isanexistingmechanismwithinthegovernancestructureofthehealthsystemwhichcanbeusedtoimproveaccesstoFrenchlanguagehealthservicestotheFrancophonepopulationandreduceriskswithinthesystem.

ThePEIFLHSNtakesthefollowingposition:

That the CCHSA should continue to increase awareness of the impact of communication challenges on those accreditation standards that consider how health institutions respond to the language needs of the linguistic minority communities, clients and families through the following actions:

• AspartoftheircontinuingeducationCCHSAsurveyorsshouldbeapprisedoftheresearch regardingtheimpactofcommunicationchallengesonaccessibilityofqualityofcare,andshould beadvisedtoaddresstheseissuesintheiraccreditationwork;• Strengthenguidelinesforstandardsandcriteriaonhowtoaddresscommunicationchallenges;• Includelanguageaccessindicators,orothermeansofevidence,forreportingthatanorganization is“linguisticminorityfriendly”;• ProvidetheSelf-AssessmentTeamswithanopportunitytodetermineiftheteammembership reflectsthediversityofthecommunityitserves.

Recognition of the Purpose of CCHSA

ThePEIFLHSNrecognizesthattheCCHSAplaysauniqueroleinthedeliveryofhealthservicesbyassistinghealthserviceorganizationsacrossCanadaexamineandimprovethequalityofcareandservicetheyprovidetotheirclients.AreviewoftheCCHSAstandardsandcriteriatoidentifyareaswherecommunicationandlanguagearealreadypartoftheaccreditationprocessisattachedinAppendixA.Itillustratestheintegralrolecommunicationsplayinthedeliveryofqualityhealthcare.

BecausetheCCHSAmissionisdrivenbyqualityofcareissuesratherthanrights,thispaperfocusesonhowlanguagebarrierissuesimpingeonqualityofcare,andtheimportanceofheighteningthisfactorintheaccreditationprocess.Thispaperprovidesabriefoverviewoftheresearchthathighlightstheconcernslanguagebarriersraiseforachievingqualityofcare,discussesthelegalobligationsthatexistinthisarena,andreviewshowexistingCCHSAstandardsapplytolanguagebarriers.AppendixAtothispaperisareviewoftheCCHSAstandardsrelatingtolanguageandcommunication.BecausethemissionofthePEIFLHSNisnotonlytoraiseissues,buttoencouragethedevelopmentofsolutions,theresourcesandtoolsfoundintheprocessofpreparingthispaperarelistedinAppendixB.


6

Communication Challenges & Quality of CareNote on terminologyCommunicationchallengesareassociatedwithunder-useofprimaryandpreventiveservices,limitedcomprehensionofmedicalinformation,lackofadherencetomedicaladvice,andlesscost-effectiveuseofmedicalservices,includingagreaterneedfortestsandlongermedicalvisits(Weissetal.2006).AsnotedintheseminalworkofSarahBowen,inCanada,mostresearchonhealthserviceutilizationandhealthstatushasfocusedontheeffectsofsocioeconomicfactors,andtoalesserextentonregionaldifferences.Researchexaminingtheimpactofcultureandethnicityhastendedtofocusondifferencesattributedtoculturalbeliefsandpractices,andnotontheeffectofsystemicbarrierstoaccess(Bowen,200�).Furthermore,inCanada,thediscussionconcerningaccesstohealthservicesinaperson’sfirstlanguage,particularlywherethatlanguageisanOfficialLanguageofthestate,tendstobeframedasa“rights”issue.However,whiletherearerightsaspectstothediscussion,fromahealthcareperspectivethefundamentalissueispatientsafetyandrisk:thereareinherentrisksassociatedwiththefailuretoaddresslanguagebarriersencounteredduringtheprovisionofhealthcareservices.

Internationally,thereisagrowingbodyofliteraturedocumentingtheimpactofcommunicationchallengesonaccess,useandqualityofmedicalservices.Thevocabularyforthesestudiesvaries,referringtolanguageaccess,languagebarriers.Theframeworkforthesestudiesalsovaries,oftenturningonlegalrightsofaccess,orasinthecaseofseveraloftheAmericanstudies,specifichealthcaredeliverymodelissuesrelatingtonon-insuredhealthcareorspecificsocialandethnicpolicyconcerns.Becausethispositionpaperfocusesonthemoreneutralconcernofqualityofcare,andappliestoalltypesofcommunicationchallengesincludinglinguisticminoritycommunityconcernsaswellashealthcareliteracy,thePEIFLHSNusestheterm“communicationchallenges”toembracethelargerscopeofqualityofcareandriskthatarisewhenhealthcareconsumerandhealthcareproviderhavedifficultiesexchanginginformation.Wherethispaperreferstoaspecificresearchpaperoradirectquote,deferenceisgiventotheauthor’schoiceofterminology.

Why Communication Is ImportantResearchindicatesthatcommunicationchallengeshaveanegativeimpacton:

•accesstotreatment•participationinpreventivemeasures•abilitytoobtainconsent•abilityforhealthprofessionalstomeettheirethicalobligations•qualityofcare,including -hospitaladmissions -diagnostictesting -medicalerrors•patientfollow-up•qualityofmentalhealthcare•patientsafety

Theeffectsofcommunicationchallengesonhealthcaredeliveryhavebeenconsideredinothercountries.AccordingtotheInstituteofMedicineoftheNationalAcademies(U.S.)�,communicationchallengescontributetoreducedquality,adversehealthoutcomes,andhealthdisparities(2004).Furthermore,thereisevidencethatcommunicationchallengesmayresultinincreaseduseofexpensivediagnostictests,increaseduseofemergencyservicesanddecreaseduseofprimarycareservices,andpoorornopatientfollow-upwhensuchfollow-upisindicated(Greising,2006).

� An American non-profit organization that provides evidence-based advice for the improvement of medicine http://www.iom.edu


7

TheseareallissuesthattheCCHSAencouragesaccreditedfacilitiestoaddressintheon-goingjourneyofqualityimprovement.Abriefreviewofjustsomeoftheresearchthatlinkslanguageandqualityofcareissetoutbelow.

AccessThereiscompellingevidencethatcommunicationchallengeshaveanadverseeffectoninitialaccesstohealthservices.Thesechallengesarenotlimitedtoencounterswithphysiciansandhospitalcare.Patientsfacesignificantbarrierstohealthpromotionanddiseasepreventionprograms:thereisalsoevidencethattheyfacesignificantbarrierstofirstcontactwithavarietyofproviders(Bowen,200�).Theresearchindicatesthatthereisageneralpatternofloweruseofmanypreventiveandscreeningprogramsbythosefacinglanguagebarriers(Woloshinetal.,�997).Higherusehasbeenreportedforsomeemergencydepartmentservices,andforadditionaltestsorderedtocompensateforinadequatecommunication(Bowen,200�).

PreventionAnumberofstudiesfocusonutilizationofcancerscreeningprograms.FoxandStein(�99�)foundthatthemostimportantvariablethatpredictedwhetherwomenofallracialgroupshadamammogramwaswhethertheirdoctorshaddiscussedmammographywiththem.Hispanicwomen,comparedtoblackorwhitewomen,werelesslikelytohavephysicianswhodiscussedscreeningwiththem.Languagepreference(EnglishversusSpanish)wasstronglycorrelatedwithwhetherthephysiciandiscussedmammographywiththewomanornot.InaBritishstudyofparticipationincervicalscreeningprogramsbyNaishetal.(�994),languageandadministrationwereseentobebarrierstoparticipationbyclients,not,asreportedbyphysicians,lackofinterestinpreventionprograms.Solisetal.(�990)foundthatlanguageabilitypredictedtheuseofscreeningservices.Theysuggestedthattheeffectoflanguageonscreeningpracticeswasanaccessfactor(i.e.proficiencyinEnglishincreasedaccesstoservice).InastudyofhealthbehaviourofolderHispanicwomen,Marksetal.(�987)foundthattheuseofEnglishlanguagewasassociatedmostcloselywithincreaseduseofscreeningprograms.

InaCanadianstudy,Woloshinetal.(�997)analyzedself-reportedutilizationdataonbreastexamination,mammographyandPapscreeningfromthe�990Ontario Health Survey.HefoundthatFrenchspeakersweresignificantlylesslikelytoreceivebreastexaminationsormammography.Theseresultspersistedevenwhenadjustedforsocialandeconomicfactors,contactwiththehealthcaresystem,andmeasuresofculture.

ConsentConsenttotreatmentisafundamentalpillarofqualityofcare.Legislationprotectspatientsfromproceduresforwhichtheyhavenotprovidedinformedconsent.Furthermore,thecommonlawinCanadaprovidesthatwhereapatientdoesnotspeakanofficiallanguage,thephysicianmustensurethatthepatientunderstandstheinformationthatiscommunicatedbeforeadministeringtreatment.Forexample,inAnan vs. Davis,arefugeewassterilizedaftersheconsentedtowhatshethoughtwasaproceduretotreataninfectionthathadoccurredafterbirth.Therulinginthiscaseconcludedthatthedutytoensurethepatientunderstoodtheinformationincludedanobligationtobeattentivetothelanguageabilityoftheinterpreter,andtoensurethatthepatientwasreturningreasonableandresponsivereplies.InKorollos vs. Olympic Airways,aphysicianobtainedconsentfromafamilymemberoverthetelephoneforapatient’ssurgery.Thefamilymemberlaterstatedthathegaveconsentonlybecausehemisunderstoodtheurgencyofthesituation.Thecourtconcludedthatthedutyofthedoctorextendedbeyondcommunicationofthefacts,butalsorequiredapositivedutyonthedoctortoensurethatthepatientactuallyunderstoodtheinformation(Bowen,200�).


8

Professional Codes of EthicsCodesofethicsregulatingthehealthprofessionsstresstheneedfortheprovidertoobtaininformedconsent,provideexplanations,ensureconfidentiality,andrefrainfrompracticingtheprofessionunderconditionsthatmayimpairservicequality.Fortheseethicalstandardstobeachieved,itisnecessarytoaddresscommunicationchallenges,whethertheyarisebecauseofalinguisticminoritycontextorbecauseofahealthcareliteracyissue(Bowen,200�).

Inrecognitionthat“communicatingcomplexinformationclearlyandeffectivelyisachallenge,butitiscriticalforethical,high-qualityhealthcare,”(EthicalForceProgram,2006,p.7)theAmericanMedicalAssociationEthicalForceProgramisdevelopingapatient-centeredcommunicationframework.TheDraftFrameworkreads:

Anorganizationshoulddeterminewhatlanguageassistanceisrequiredtocommunicateeffectivelywiththepopulationsitserves,makethisassistanceeasilyavailableandtrainitsworkforcetoaccessanduselanguageassistanceresources(EthicalForceProgram,2006,p.8,5b).

Quality of CareCasestudiesillustratehowcommunicationchallengesleadtodelayeddiagnosis,mis-diagnosis,andinappropriatereferral.Failuretoexplainthepatient’sconditionorrecommendedcare,orfailuretoensureconfidentialityorobtaininformedconsenthavebeendocumented.(Bowen&Kaufert,2000;Haffner,�992;Stevens,�993;Floresetal.,2000).Furthermore,communicationchallengesareassociatedwithincreasedriskofhospitaladmission,increasedriskofintubationforasthmatics,differencesinprescribedmedication,greaternumbersofreportedadversedrugreactions,andlowerratesofoptimalpainmedication.Thereisalsopreliminaryevidencethatsuchbarriersarerelatedtolessadequatemanagementofchronicdiseasessuchasasthmaanddiabetes.

Patient Safety Thefocusofpatientsafetyactionplansisshiftingfromretrospectiveanalysesofadverseeventsor“medicalerrors”,tomoreproactivestudiesofclinicalsystems,includingtheroleofinterpersonalcommunicationsinpatientsafety.Forexample,theUniversityofCalifornia,SanDiegoCenterforPatientSafetyiscurrentlyengagedinstudiesoftheroleoffailedinterpersonalcommunication(clinician-patient&clinician-clinician)inpatientsafety.2

Recently,theemphasisonsafetyhasalsobeenraisedinAustralianresearch.Megan-JaneJohnstoneandOlgaKanitsaki’spaperCulture, language, and patient safety: making the linksuggeststhatthefailuretorecognizethecriticallinkbetweencultureandlanguageandpatientsafety“unacceptablyexposespatientsfromminorityethno-culturalandlanguagebackgroundstopreventableadverseeventsinhospitalcontexts(2006,p.383)”.Theygoontosuggestthat

inordertoensurethattheminorityaswellasthemajoritypatientinterestsinreceivingsafeandqualitycareareproperlyprotected,theculture-language-patient-safetylinkneedstobeformallyrecognizedandthevulnerabilitiesofpatientsfromminorityculturalandlanguagebackgroundsexplicitlyidentifiedandactivelyaddressedinpatientsafetysystemsandprocesses(p.383).

2 SanDiego County Patient Safety, Goals of the SDCPs, http://meded.ucsd.edu/SDCPS/goals.html


9

UndertheleadershipofthePatientSafetyAdvisoryCommittee,theCCHSAhasdevelopedPatientSafetyGoalsandRequiredOrganizationPractices.Nationalandinternationalliteraturewasreviewedtoidentifythemajorpatientsafetyriskareas,aswellaspatientsafetybestpractices.CCHSAcarriedoutadetailedreviewofitspatientsafety-relatedaccreditationsurveyrecommendations,conductedananalysisoftopcomplianceissues,andresearchedrelatedactivitieswithinotheraccreditingbodiesinternationally.

Thecommitteereviewedandprovidedrecommendationsonalistofpotentialpriorityareasforpatient/clientsafety.TheoutcomewasthecreationoffivePatientSafetyareas,sixPatient/ClientSafetyGoals,and2�RequiredOrganizationalPractices(ROPs).ThefivePatientSafetyAreaswereidentifiedasbeing:

•Culture

•Communication

•Medications

•Workforce/Worklife

•InfectionControl

AccordingtotheCCHSAwebsite,thegoalforthepatientsafetyareaofcommunicationisto:

Improvetheeffectivenessandcoordinationofcommunicationamongcare/serviceprovidersandwiththerecipientsofcare/serviceacrossthecontinuum.

The ROPs related to this goal are listed as being:

•Informandeducatepatients/clientsabouttheirroleinpatientsafety(writtenandverbalcommunication)

•Employeffectivemechanismfortransferofinformationatinterfacepoints

•Implementverificationprocessesandothercheckingsystemsforhigh-riskcare/serviceactivities

•Reconcilethepatient’s/client’smedicationsuponadmissiontotheorganizationandwiththeinvolvementofthepatient/client

•Reconcilemedicationswiththepatient/client’smedicationstothenextproviderofservice

BecausetheROPshavebecomepartoftheaccreditationprocesstoensurethatorganizationsaremeetingkeypatientsafetyissues,thePEIFLHSNrecommendsthattheapplicationoftheseROPsbeconsideredwithregardtohowtheorganizationaddressesthechallengesarisingfromcommunicationbarriers.Certainlytheinformingandeducatingofpatientsandclients,orthereconciliationofmedicationscannotbeeffectiveifcommunicationbarriersarenotaddressed.


�0

Medical ErrorsQuality, Patient Safety and Hospital Care for Latino Children: Addressing Parent and Provider Communication Challengesexaminedpatientsafetyissues,citingthatmistakesbyinterpreterswereasignificantcauseofmedicalerrorsinapediatricpopulation(Floresetal.,2003),andthat63%oferrorsduetoincorrecttranslationswereconsideredseriousenoughtohavemedicalconsequences–mistakesbyfamilymemberswereshowntobemoreseriousthanthosebyhospitalinterpreters.Italsocitedpoorcommunicationasthenumberonecauseofsentinelevents.3

“Theoneissuethatwouldhavethegreatestimpactonpatientsafetyisimprovedcommunication.”– Richard Croteau, MD, Executive Director of Strategic Initiatives, Joint Commission on Accreditation of Health care Organizations in a Sentinel Event Alert

TwoBritishColumbiacasesillustratetheliabilityriskforfailuretoaddresscommunicationchallenges.Inonecase,theB.C.SupremeCourtfoundadoctornegligentinhisexaminationanddiagnosisofamanwhoselegwasamputatedastheresultofthismis-diagnosis.Thecourtruledthatthepatient’slanguagedifficultyshouldhavemadethedoctorespeciallycarefulinconductinghisphysicalexamination.Thepatientwasawarded$�.3million(Needham&Wolff,�990).Inanothercase,languagebarrierswereidentifiedasacontributingfactorinthedeathofapregnantVietnamesewoman.ThecoronerinthecaserecommendedthattheCollegeofPhysiciansandSurgeonsassesstheneedforinterpretersforpatientswhospeaklittleornoEnglish(Walton,�996).Theissueoftheinterpreter’sroleinobtainingconsentwasalsoraisedintherecentinquiryintopediatriccardiacdeathsinManitoba(Sinclair,200�).

Closelylinkedwithpatientsafety,medicalerrorsarealsoakeytargetoftheCCHSAROPs.Asnotedabove,thePEIFLHSNrecommendsthattheapplicationoftheseROPsbeconsideredwithregardtohowtheorganizationaddressesthechallengesarisingfromcommunicationbarriers.

Hospital Admissions Leeetal.(�998)indicatedthatadultswhodidnotspeakthesamelanguageastheirhealthcareproviderhada70%greaterchanceofbeingadmittedtohospitalthanpatientswhodid.Theauthorsofthestudyproposedthataprovider,whentreatingpatientswherecommunicationchallengeswerepresent,wouldbemorelikelytoadmitthemtohospitalasaprecautionarymeasure.

Diagnostic Testing Hampersetal.(�999)foundthatincaseswherealanguagebarrierexisted,patientsweremorelikelytobegivenintravenousfluidsandadmittedtohospital.Theoverallaveragechargefortestswasalsosignificantlyhigher.

Patient Follow-up SarverandBaker(2000)foundthatbothpatientswhousedaninterpreter,andthosewhodidnotuseaninterpreterbutfeltonewasneeded,weresignificantlymorelikelytobedischargedwithoutafollow-upappointment.

3 The Joint Commission, an American hospital accreditation organization, defines a sentinel event as “an unexpected occur-rence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase, “or the risk thereof ” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.” http://www.aracnet.com/~oahhs/issues/jcaho/sentnl12.htm


��

Mental Health Care Canadianresearchersidentifylanguageasthemostpervasivechallengetoaccessingappropriatementalhealthservices.Studiesindicatethatevenwhenpatientshavecontactwiththehealthcaresystem,theymaydelayseekingcareformentalhealthproblemsduetolanguagebarriers,andthereforeunderutilizementalhealthservices(CanadianTaskForceonMentalHelathIssuesAffectingImmigrantsandRefugees,�988;Nyman,�99�;Trauer,�995:Startetal.,�996:Roberts&Crockford,�997).Studiesalsoindicatethatpatientswithpsychiatricconditionsandlanguagebarriersaremorelikelytoreceiveadiagnosisofseverepsychopathology(Flores,2006).Counselingprogramproviders(includingthoseinareassuchasaddictionsandfamilyviolence)oftenmakenoaccommodationforlanguageaccess.Insteadtheymayreferclientstogeneric“helping”agencies(suchasorganizationsprovidinggeneralsettlementservicestoimmigrants)thatdonothavespecializedexpertise.Thisresultsinatwo-tierlevelofservice(CanadianTaskForceonMentalHelathIssuesAffectingImmigrantsandRefugees,�988;Stevens,�993;CanadaDrugStrategy,�996).

SafetyItistritetosaythatclinician-patientcommunicationisavitalelementinthedeliveryofhealthcare.Studieshaveshownthatmorethan70%oftheinformationonwhichphysiciansbasetheirdiagnosescomesfromthehistoryandphysicalexam:

Anythingthatcompromisesthequalityofthecommunicationbetweenpatientsandphysiciansrepresentsathreattothequalityofcareprovided.Clearcommunicationishardenough,evenwithEnglish-speakingpatients,whenthereareissuesoflowliteracyoragetoconsider.WhenthepatientdoesnotspeakEnglish,communicationbecomesthatmuchmoredifficult.Ina2003studyconductedbytheCaliforniaAcademyofFamilyPhysicians,almosthalfthephysicianssurveyedwerepersonallyfamiliarwithincidentsinwhichqualityofcarewascompromisedbylanguagebarriers(Roat,2005,p.3).

Theimpactofcommunicationchallengesinhealthcaredeliverywasillustratedina2002studytitledWhat a Difference an Interpreter Can Make: Health Care Experiences of Uninsured with Limited English Proficiency (Andrulis,Goodman&Prior).Inthatstudy,27%ofthosewhoneededbutdidnotgetaninterpretersaidthattheydidnotunderstandtheinstructionsfortakingtheirmedications,comparedtoonly2%ofthosewhoeithergotaninterpreterordidnotneedone.

OutcomesStudiesindicatethatcommunicationchallengescanalsohavenegativeeffectsontreatmentoutcomes.Forexample,aU.S.studyofoutpatientdrugcomplicationsbyGandhietal.(2000)demonstratedthataprimarylanguageotherthanEnglishorSpanishwassignificantlycorrelatedtoreporteddrugcomplications.LeSon&Gershwin(�996)foundthatpatientsunabletospeakEnglishwereover�7timesmorelikelytobeintubatedthanpatientswiththesamecharacteristicswhowerefluentinEnglish.Thiswasastrongercorrelationthanwitheducationlevels,orevenbeinganactivesmoker.Asimilarstudyofpediatricpatientsalsofoundthatalanguagebarrierwasasignificantpredictorforintubation(LeSon&Gershwin,�995).Moudgil&Honeybourne(�998)founddifferencesinpatientunderstandingofthediseaseandself-management.

Patient SatisfactionPatientsatisfactionisarecognizedandwidelyusedmeasureofeffectivenessofprovider-patientcommunication.Itisalsoanoutcomeofcare.Communicationchallengeshaveadditionallybeenfoundtobeassociatedwith:increasedtimespentintheemergencydepartment(Hampersetal.,�999),decreasedgeneralsatisfactionwithcare(David&Rhee,�998),andlowersatisfactionwithanumberofnon-clinicalaspectsofcare(Madhoketal.,�992).HuandCovell(�986)foundthatthepercentageofpatientsdescribingtheircareasmorethanadequatewasalmosttwiceashighforEnglishspeakingthannonEnglishspeakingpatients.


�2

Patient ComplianceAreviewoftheliteraturerevealsconsistentandsignificantdifferencesinunderstandingandcompliancewhenacommunicationchallengeexists.Thismaybeduetothefactthatpatientswhohadmoredifficultyunderstandingtheirphysicianarelesslikelytofollowtreatmentdirections,andalsobecausegoodcommunicationcanbeasourceofmotivation,reassuranceandsupport,aswellasanopportunitytoclarifyexpectations(Kaplanetal.,�989).GiventheagingoftheCanadiandemographicandtheaccompanyingincreaseinchronicdiseases,theimpactofpatientnoncompliancerelatingtodiseasemanagementwillgrowovertime.Improvingcompliancethroughimprovedcommunicationoptionswillbenefitallhealthcaredeliverystakeholders.

Research ContinuesRecentstudiescontinuetoidentifycommunicationasanimportantfactorinthedeliveryofhealthcareinthreekeyareas:qualityofcare,accesstocare,andcostofcare.CynthiaE.Roat(2005,p.32),inAddressing Language Access Issues in Your Practice: A Toolkit for Physicians and Their Staff Members,providedarecentscanoftheliteraturerelatingtotheAmericanexperience:

quality of care•A200�surveyshowedthatHispanicswhospokeSpanishathomeweremorelikelytounderstandonly

“someoralittle”ofwhatthephysiciansaid,morelikelytohavequestionstheydidn’task,andmorelikelytoidentifyproblemscommunicatingwiththeirphysician.

•Primarylanguageisanindependentpredictorofpatient-reporteddrugcomplications.•PatientswhoseprimarylanguagewasnotEnglishweresignificantlylesswillingtoreturntothesame

emergencydepartmentforfuturecare,andreportedmoreoverallproblemswithcare,communication,andtesting.

•NonEnglishspeakingpatientswhohadphysicianswhospoketheirlanguagehadbettermedicationcompliance,betterappointmentcompliance,andfeweremergencydepartmentvisitsthanlimitedEnglishproficientpatientswhosephysiciansdidnotspeaktheirlanguage.

access to care•Spanishspeakingpatientsarelesslikelytoseeaphysicianforpreventativehealthcaresuchasinfluenza

vaccinationsoramammogram.•SpanishspeakingpatientsdischargedfromemergencydepartmentsarelesslikelythanEnglishspeaking

patientstounderstandtheirdiagnosis,prescribedmedications,specialinstructions,andplansforfollow-upcare.

•InanationalU.S.survey,almost20%ofSpanishspeakingrespondentsreportednotseekingcarewhenneededduetolanguagebarriers.

cost of care •Whenpatientstakelongertobeseen,

-theirhealthissuesareusuallymoreadvanced,andhencemorecostlytoaddress,-theyaremorelikelytousetheemergencydepartmentratherthanprimarycare,whichisagreatercosttothehealthsystem,-theyaremorelikelytorequiremoretesting.

•Whenpoorcommunicationsaffectqualityofcare,-thereisagreaterlikelihoodofamalpracticesuit.

•Whentherearelanguagebarriers,-pediatricpatientstendtohavelongerhospitalstays,-emergencydepartmentvisitstendtobeshorter,withfewertests,butresultinmorerepeatvisits.


�3

Language & Standards

AsillustratedinthereviewoftheCCHSA’sexistingstandardsandcriteriathatrelatetocommunicationandlanguage(AppendixA),therehasbeenalong-standing,albeittacit,acknowledgmentoftheimportanceofcommunicationchallengestoqualitycare.Therefore,thispositionpaperisnotaskingfornewstandardsorcriteria.Theyarealreadyinplace.However,thePEIFLHSNbelievesitistimeforamoreexplicitrecognitionoftheimportanceoflanguageandcommunicationintheaccreditationprocessthroughtheaccreditationdialogue.

Canadaisnottheonlyjurisdictionfacingthischallenge.Forexample,theUnitedStateshasundertakenareviewofnationalstandardsforculturallyandlinguisticallyappropriatehealthcare.Thesestandardsexplicitlyaddresstheclients’righttobilingualstafforinterpretationservices,accesstoinformationintheirownlanguage,professionalstandardsforinterpreters,andinclusionoflanguageidentifiersindatacollection.ThesestandardsarebasedonU.S.legislationandenforcementcapabilities,anddescribealevelofservicewhichiscertainlynotyetavailableforminoritylanguagespeakersinCanada(OfficeofMinorityHealth,�999).Belgiumhasmadeacommitmenttoa“culturalmediator”modelforhealthinterpretation,andisactivelypromotinganddisseminatingresearch(Verrept&Louckx,�998).InAustralia,apublicinquiryexaminedrightstointerpreterservicesinthejusticesystemandinhealthcare(Lawrie,�999).

IntheUnitedStates,theJointCommission(theaccreditationbodyforAmericanhospitals)acknowledgesthat“…alackofsensitivityandresponsivenesstothelinguisticneedsandhealthbeliefsofdifferentculturesimpactsqualityofcare,patientsafety,andpatientsatisfaction”(TheJointCommission,n.d.a).Itswebsitestates:

TheJointCommissionviewsthedeliveryofservicesinaculturallyandlinguisticallyappropriatemannerasanimportanthealthcaresafetyandqualityissue.Healthcareorganizationsareencouragedtoprovideequitablecare,treatment,andservicesacrossdiversepopulations(TheJointCommission,n.d.b).

Toaddressthisconcern,theJointCommissioninitiateda30monthresearchprojectin2004toexaminehowhospitalsprovidehealthcaretodiversepopulations.TheworkwasconcludedinJune2006withareportentitled:Hospitals, Language, and Culture: A Snapshot of the Nation (Wilson-Stronks&Galvez).Thepurposeofthisprojectwasnottodevelopnewstandardsorsetnewrequirementsforaccreditation,butrathertobetterunderstandcurrentpracticeanddeveloprecommendationsthatwouldassisthealthcareprovidersingrapplingwiththechallengesofhealthcaredeliverytoadiversepopulation.Californiaispilotingaprogramtocreatesystem-widelanguageaccess(Jameson,2006).

SarahBowen,aleadCanadianresearcherintheeffectsoflanguagebarriersonthequalityofcareobservedthatthereisaneedfordevelopmentofnationalstandardsrelatedtolanguageaccesstohealthcare.Her200�reportonlanguageaccessinhealthcarepreparedforHealthCanadamadeseveralrecommendationsthatarerelevanttothePEIFLHSNpositionpaperfortheCCHSA:

•Examinethefeasibilityofincorporating,aspartofhealthsystemdatacollection,informationonpatientproficiencyinanofficiallanguage.

•Developinitiativestopromoteawarenessoftheimportanceofprovider-patientcommunicationandtheprofessionofinterpretationwithinthehealthprofessions.Promotetrainingontheeffectsoflanguagebarriersandworkingwithinterpretersasarequiredcomponentofpre-serviceprofessionalpreparation.

•Developstrategiestopromotedisseminationofresearchonlanguageaccesstopolicymakersandhealthserviceplanners.


�4

TheCCHSAstandardsalreadyrequirethatcommunicationchallengesbeaddressedifthestandardsandcriteriaareappliedappropriately.AppendixAtothispaperreviewsrelevantCCHSAstandards,relatedcriteriaandhowcommunicationsbarrierscanbeaddressedthroughstrengthenedCCHSAguidelines.Furthermore,becauseofthedevelopmentoftheCCHSAPatientSafetyROPspertainingtocommunication,healthcareorganizationsmustaddresscommunicationbarriersaspartoftheirsafetyculture.ThePEIFLHSNbelievesthatthisobjectivewillbeenhancediftheCCHSAadoptstherecommendationsofthispaper.

ConclusionAchievingaccreditationbytheCanadianCouncilonHealthServicesAccreditation(CCHSA)iscriticalforhealthcareorganizationstoenablethemtodemonstratetothepublicthattheyprovidequalityhealthcareservices.Equallyasimportant,accreditedorganizationsattracthighqualityhealthprofessionals.Accreditationstandardsareusedtoassessthequalityofservicesprovidedbyanorganizationandareconstructedaroundthedimensionsofquality:

•Responsiveness;•Systemcompetency;•Client/communityfocus;and,•Worklife

Anorganizationcannotaddresstheclient/communityfocusdimensionwithouttakingintoaccountanybarrierstoeffectivecommunicationsbetweenthehealthcareproviderandconsumer.Thereisasignificantbodyofresearch,includinganimpressiveamountintheCanadiancontext,asidentifiedbySarahBowen’swork,thatidentifiescommunicationchallengesashavingsignificantqualityandriskmanagementimplicationsby:

•Limitingaccess;•Inhibitingparticipationinpreventivehealthcare;•Interferingwiththeabilitytoprovideinformedconsent;•Drivinguphospitaladmissionsandunnecessarydiagnostictesting;and,•Causingmedicalerrors,

andhenceunderminingpatientsafety.Moreover,theliteraturedemonstratesthatprovidingservicesinaclient’sfirstlanguage:

•Improvesaccesstohealthservices,particularlyhealthpromotionanddiseasepreventionactivities;•Improvestheaccuracyofhealthassessment;•Enablesinterpersonalinteractionthusenhancingthetherapeuticrelationshipwhichleadstomore

positiveclinicaloutcomes;•Leadstobetterunderstandingofandadherencetotheprescribedtreatmentplan;•Improvesclientsatisfaction;•Improvesqualityofcare;and•Reducesincidenceofriskmanagementissuesinservicedelivery.

Therearemanypotentialmeansofovercomingcommunicationchallengesinhealthcaredelivery.Ratherthanbeingprescriptive,thispaperisintendedtoheightentheawarenessoftheCCHSAtotheroleofcommunicationchallengesforminoritylanguagecommunitiesinqualityandpatientsafety.


�5

ThePEIFLHSNdoesnotnecessarilyendorseorpromoteanyonestrategyoveranother.Itskeyconcernisthatorganizationsneedsupportandencouragementtodevelopstrategiesthatenableappropriateaccesstoservicesinthehealthcareconsumer’sfirstlanguage.ThisiscriticaltoensuringthatthehealthcaresystemismeetingthequalityofcareexpectedwithinCCHSAaccreditedorganizations.Tothatend,thePEIFLHSNrespectfullyasksthattheCCHSAadoptthefollowingPEIFLHSNrecommendations:

Recommendation�: StrengthenCCHSAstandardsandguidelinesrelatedtolanguage-cultureaccessforminoritylanguagecommunitiesandclients.Examplesmaybedrawnfrom

AppendixA; Recommendation2: EncourageSelf-AssessmentTeamstoreviewtheircompositiontoreflectthe

communicationneedsofthecommunity,clientsandfamiliesinthedeliveryofhealthcare.Forexample,FrenchlanguageserviceproviderscouldbeincludedasmembersofSelf-AssessmentTeams;

Recommendation3: Developindicatorsorothermeansofevidencerelatedtolanguageaccess.Examplesmay

bedrawnfromAppendixC;

Recommendation4: Identifytheaccreditationstandardswhichrepresentthehighestpotentialrisktopatientsduetocommunicationchallenges.Anexamplemightincludeinformedconsent.

ThePEIFLHSNbelievesthattheaccreditationmodelforaddressingcommunicationchallengesforminoritylanguagecommunitieskeepsthefocusonthemostimportantaspectsofhealthcare:qualityandsafety.Theintentisnottoforceorganizationstoadoptanysingleformulaforachievingthesevalues.Instead,achievingqualityandpatientsafety(andaddressinglanguagebarriers)requirestheorganizationalintegrationofthesevaluesandtheinstillingofasustainableprocessofcreatingandnurturingaculturethatsupportsthesevalues.Thiswillresultinimprovedservicesandoutcomesforeveryone.


�6

References

Andrulis,D.,Goodman,N.,&Pryor,C.(2002,April).What a Difference an Interpreter can Make: Health Care Experiences of Uninsured with Limited English Proficiency.TheAccessProject.Boston,MA.

Bowen,S.(200�).Language Barriers in Access to Health Care,HealthCanada.

Bowen,S.&Kaufert,J.M.(2000).Measuringthe‘costs’:usingcasestudiesintheevaluationofhealthinterpreterservices.MMIA News.3:2-5.

CanadaDrugStrategy.(�996).Immigrant Women and Substance Abuse: Current Issues, Programs and Recommendations.Ottawa:HealthCanada,PopulationHealthDirectorate,OfficeofAlcohol,Drugs,andDependencyIssues.

CanadianTaskForceonMentalHealthIssuesAffectingImmigrantsandRefugees(�988).After the Door Has Been Opened: Mental Health Issues Affecting Immigrants and Refugees.Ottawa:MinisterofSupplyandServicesCanada.

David,R.A.&Rhee,M.(�998).TheimpactoflanguageasabarriertoeffectivehealthcareinanunderservedurbanHispaniccommunity.Mt. Sinai Journal of Medicine,65,393-397.

EthicalForceProgram.(2006).AnEthicalForceProgramConsensusReport.Improving Communication – Improving Care. How health care organizations can ensure effective, patient-centered communication with people from diverse populations.AmericanMedicalAssociation.

Flores,G.,Abreu,M.,Schwartz,I.,&Hill,M.(2000).Theimportanceoflanguageandcultureinpediatriccare:casestudiesfromtheLatinocommunity.Journal of Pediatrics,�37,842-848.

Flores,G.,Laws,M.B.,Mayo,S.J.,Zuckerman,B.,Abreu,M.,Medina,L.,&Hardt,E.(2003).Errorsinmedicalinterpretationandtheirpotentialclinicalconsequencesinpediatricencounters.Pediatrics, ��(�).

Flores,G.(2006).LanguagebarrierstohealthcareintheUnitedStates.The New England Journal of Medicine,355(3),229-23�.

Fox,S.A.&Stein,J.A.(�99�).Theeffectofphysician-patientcommunicationonmam-mographyutilizationbydifferentethnicgroups.Medical Care,29,�065-�082.

Gandhi,T.K.,Burstin,H.R.,Cook,E.F.,Puopolo,A.L.,Haas,J.S.,Brennan,T.A.,&Bates,D.W.(2000).Drugcomplicationsinoutpatients.Journal of General Internal Medicine,�5,�49-�54.

Greising,C.H.(2006),Patients with Limited English Proficiency: Results from a National Survey. BriefofHasnain-Wynia,R.,Yonek,J.,Pierce,D.,Kang,R.,&Greising,C.H.(2006,October),HospitalLanguageServicesForPatientswithLimitedEnglishProficiency:ResultsfromaNationalSurvey,Chicago,IL:HealthResearchandEducationalTrust.

Haffner,L.(�992).Translationisnotenough.Interpretinginamedicalsetting.Western Journal of Medecine,�57,255-259.

Hampers,L.C.,Cha,S.,Gutglass,D.J.,Binns,H.J.,&Krug,S.E.(�999).Languagebarriersandresourceutilizationinapediatricemergencydepartment.Pediatrics,�03,�253-�256.

Hu,D.J.&Covell,R.M.(�986).HealthcareusagebyHispanicoutpatientsasfunctionofprimarylanguage.Western Journal of Medicine,�44,490-493.


�7

InstituteofMedicine.(2004,April).Health Literacy: A Prescription to End Confusion,ReportBrief,retrievedMarch2007fromhttp://www.iom.edu/?id=�9750

Jameson,W.(2006).Creating System-wide Language Access Improvements Using QI Methods and Leadership Engagements: the LEADing Organizational Change Experience.PresentedtotheNationalAssociationofPublicHospitals&HealthSystemsAnnualConferenceJune23,2006.

Johnstone,M.-J.&Kanitsaki,O.(2006).Culture,language,andpatientsafety:makingthelink.International Journal for Quality in Health Care,�8(5),383-388.

TheJointCommission.(n.d.a).What is Joint Commission policy regarding cultural competency?Retrieved fromPatientSafety,Hospitals,Language,andCultureFrequentlyAskedQuestions www.jointcommission.org/HLC/FAQ.htm

TheJointCommission.(n.d.b).About Hospitals, Language, and Culture.RetrievedfromPatientSafety,Hospitals,Language,andCulture,www.jointcommission.org/HLC/FAQ.htm

Kaplan,S.H.,Greenfield,S.,&Ware,J.E.(�989).Assessingtheeffectsofphysician-patientinteractionsontheoutcomesofchronicdisease.Medical Care, 27,S��0-S�27.

Lawrie,D.(�999).Report: Inquiry into the Provision of an Interpreter Service in Aboriginal Languages by the Northern Territory Government.OfficeoftheNorthernTerritoryAntidiscriminationCommissioner,Australia.

Lee,E.D.,Rosenberg,C.R.,Sixsmith,D.M.,Pang,D.,&Abularrage,J.(�998).Doesaphysician-patientlanguagedifferenceincreasetheprobabilityofhospitaladmission?Academic Emergency Medicine,5,86-89.

LeSon,S.&Gershwin,M.E.(�995).Riskfactorsforasthmaticpatientsrequiringintubation.I.Observationsinchildren.Journal of Asthma,32,285-294.

LeSon,S.&Gershwin,M.E.(�996).Riskfactorsforasthmaticpatientsrequiringintubation.III.Observationsinyoungadults.Journal of Asthma,33,27-35.

Madhok,R.,BhopalR.S.,&Ramiah,R.S.(�992).Qualityofhospitalservices:astudycomparing“Asian”and“nonAsian”patientsinMiddlesbrough.Journal of Public Health Medicine,�4,27�-279.

Marks,G.,Solis,J.,Richardson,J.L.,Collins,L.M.,Birba,L.,&Hisserich,J.C.(�987).HealthbehaviorofelderlyHispanicwomen:doesculturalassimilationmakeadifference?American Journal of Public Health,77,�3�5-�3�9.

Moudgil,H.&Honeybourne,D.(�998).DifferencesinasthmamanagementbetweenwhiteEuropeanandIndiansubcontinentethnicgroupslivinginsocio-economicallydeprivedareasintheBirmingham(UK)conurbation.Thorax,53,490-494.

Naish,J.,Brown,J.,&Denton,B.(�994).Interculturalconsultations:investigationoffactorsthatdeternon-Englishspeakingwomenfromattendingtheirgeneralpractitionersforcervicalscreening.British Medical Journal,309,��26-��28.

Needham,P.andWolff,D.(�990).Amputeetoget$�.3millioninlawsuitovermisdiagnosis.Vancouver Sun,March27,�990.

Nyman,B.(�99�). Developing Culturally Accessible Mental Health Programs for Immigrants and Refugees.Winnipeg.CanadianMentalHealthAssociation,ManitobaDivision.


�8

OfficeofMinorityHealth,U.S.DepartmentofHealthandSocialServices.(�999).Ensuring Cultural Competence in Health Care: Recommendations for National Standards and an Outcome-based Agenda.OfficeofMinorityHealth,U.S.DepartmentofHealthandSocialServices.

PrinceEdwardIslandFrenchLanguageHealthServicesNetwork.(2006,March).Action Plan for the Delivery of Primary Health Care Services in French on Prince Edward Island.

Roat,C.E.(2005).Addressing Language Access Issues in Your Practice: A toolkit for physicians and their staff members.CaliforniaAcademyofFamilyPhysicians.

Roberts,N.&Crockford,D.(�997).PsychiatricadmissionsofAsianCanadianstoanadolescentinpatientunit.Canadian Journal of Psychiatry,42,847-85�.

Sarver,J.&Baker,D.W.(2000).Effectoflanguagebarriersonfollow-upappointmentsafteranemergencydepartmentvisit.Journal of General Internal Medicine,�5,256-264.

Sinclair,C.M.(200�).The Report of the Manitoba Pediatric Cardiac Surgery Inquest: An Inquiry into Twelve Deaths at the Winnipeg Health Sciences Centre in 1994.Retrievedfrom www.pediatriccardiacinquest.mb.ca

Solis,J.M.,Marks,G.,Garcia,M.,&Shelton,D.(�990).Acculturation,accesstocare,anduseofpreventiveservicesbyHispanics:findingsfromHHANES�982-84.American Journal of Public Health,80Suppl,��-�9.

Stevens,S.B.(�993).Community Based Programs for a Multicultural Society: A Guidebook for Service Providers.Winnipeg:PlannedParenthoodManitoba.

Stuart,G.W.,Minas,I.H.,Klimidis,S.,&O’Connell,S.(�996).Englishlanguageabilityandmentalhealthserviceutilisation:acensus.Australian and New Zealand Journal of Psychiatry,30,270-277.

Trauer,T.(�995).EthnicdifferencesintheutilisationofpublicpsychiatricservicesinanareaofsuburbanMelbourne.Australian and New Zealand Journal of Psychiatry,29,6�5-623.

Verrept,H.&Louckx,F.(�998).HealthadvocatesinBelgianhealthcare.InA.Ugalde&G.Garenas(Eds.),Health and Social Service Among International Labor Migrants.Austin:CMASBooks,UniversityofTexas.

Walton,P.(�996).MedicalSystemFailedWoman.Nanaimo Daily Free Press.June�,�996.

Weiss,L.,Bauer,T.,Hill,C.,Fuld,J.,&Bergman,J.(2006,May)Language as a Barrier to Health Care for New York City Children in Immigrant Families: Haitian, Russian and Latino Perspectives, DivisionofHealthPolicyandtheNewYorkForumforChildHealth, www.nyam.org/library/docs/LanguageBarrierReportMay2006.pdf

Wilson-Stronks,A.&Galvez,E.(2006).Hospitals, Language, and Culture: A snapshot of the nation. Exploring cultural and linguistic services in the nation’s hospitals. TheJoint-Commission.OakbrookTerrace,IL.

Woloshin,S.,Swartz,L.,Katz,S.,&Welch,G.(�997).Islanguageabarriertotheuseofpreventiveservices.Journal of General Internal Medicine,�2,472-477.


�9

LEADERSHIP AND PARTNERSHIP (6.0)

Standard&Criteria/Guidelines* PEIFLHSNComment

�.0 Addressingneeds

Theorganizationanticipatesandrespondstothecommunity’schangingneedsandhealthstatus.

TheFrench-speakingcommunityhasaneedforaccesstohealthcareinitsprimarylanguage.

�.� Communityprofile Shouldacknowledgelanguageaspectofdemographicsforcatchmentareaandidentifycommunicationneeds.

�.2 Maintainsinformation •Sharesinformationwithcommunity.

TrackingthestatisticsoftheFrenchlanguagepopulationshouldbeanongoingexerciseOrganizationslikePEIFLHSNshouldbeconsideredpartnersinthisinformationprocess.

2.0 Havingapositiverelationshipwiththecommunity.

Workingcollaboratively,theorganizationenhancestheefficiencyandeffectivenessofitshealthservicesinmeetingtheneedsofclients.

2.� Communicatewithhard-to-reachpopulations.

SpecificactionoutlinedinCCHSAshouldbenotedinaccreditationreport.

2.2. Theorganization’scommunicationactivitiesandstrategiesareeffective.

WorkwithorganizationslikethePEIFLHSNtodevelopmeasurementtools.

2.3 Organizationformslinkagesandpartnershipsacrosscontinuumofsectors.

WorkwithorganizationslikethePEIFLHSN,suchasinvolvingtheseorganizationsinPatientSafetyAdvisoryCouncils.

3.0 Promoteongoingcommunitydevelopment.

3.� Supportingactivitiesthatinformandeducatethecommunity.

InformationandeducationneedtobeinFrenchforFrench-speakingpopulation.

APPENDIX ACCHSA Standards Relating To Language Access

Appendix A

* Usually abbreviated or summarized to maintain focus on language access.

20

Appendix A




4.0 Meetingtheorganization’smandate

Theorganization’smissiongivesitdirection.

4.� MissionStatementhasinputfromcommunity.

ThisrequiresdialoguewithFrench-speakingcommunity.

4.2 Missiondescribeswhomtheorganizationserves.

NeedstoreflectpresenceofFrench-speakingcommunity.

5.0 Beingaccountabletoallstakeholders.

Organizationiseffectivelyandefficientlygoverned.

Whereaboardispresent,itsmembershipshouldreflectthediversityofthecommunityserved.

5.6 Sharesinformationwithcommunity. Informationneedstobecommunicatedinappropriatelanguagesandinaccessiblevocabulary.

6.0 Beingethical

Theorganizationdeliversservicesandmakesdecisionsinaccordancewithitsvalues,andwithitsowncodeofethicsorotherrecognizedcodesofethics.

Ethicalrequirementsforconsenttotreatment,equityofaccessrequireaddressinglanguageaccessissues.

7.0 Havingacleardirection

Theorganizationhasacleardirectionandachievesthedesiredresults.

Thestrategicplanshouldaddresshowcommunicationneedswillbeaddressed.

9.0 Appropriateallocationofresources. Thisshouldincludelanguageaccessresources.

9.� Consideringethics,values,socialcostsandbenefits.

9.2 Reviewingplanningpriorities.

�0.0Managingrisk

Thegoverningbodyandmanagerspreventandmanageanyriskstotheorganization.

2�

Appendix A




�0.� Organizationidentifies,assessesandmanagesrisk.

•Considerethics,values,socialcostsand benefitswhenmakingdesicionsabout howtomanagerisk.

Researchshowsthatlanguagebarrierscreaterisks.

�0.2 Governingbodyandmanagersactivelysupportriskmanagementpractices.

�0.5 Organizationminimizesrisks. Howisthisdonewithrespecttolanguageaccessissues?

��.0 Organization’sfinancialresourcesareprotectedandcontrolled.

�2.0 Contractedservicesaredeliveredaccordingtothetermssetoutinthecontract.

�6.0Beingalearningorganizationandachievingpositiveoutcomes.

Theorganizationhasaclearlydefinedandcoordinatedqualityimprovementsystemtocontinuallymonitor,evaluate,andimprovequality.

Islanguageaccessaddressedintheirqualityimprovementplans?

�6.2 Provideenoughresourcesandtrainingtosupportqualityimprovementactivities.

�7.0 Theorganizationachievesthebestpossibleresultsoroutcomes.

Researchsuggeststhatlanguagebarriershavenegativeimpactsonoutcomes.Clientsatisfactionsurveysshouldincludeacommunicationandlanguageofaccesscomponent.

�7.2 Involvestaff,clients,otherorganizations,andthecommunity.

�7.3 Useresearchandbestpracticeinformationtoimprovemanagementpracticesandtheorganization’sperformance.

Isorganizationawareofworkbeingdoneonlanguageaccessissuesandqualityofcareandriskmanagement?

22

Appendix A

ENVIRONMENT (6.0)


�.0 Providingasuitableenvironment.

Theorganization’sphysicalenvironmentcontributestothewell-beingofclients,staff,andvisitors.

�.� Allsignsandsymbolsmustconsiderlanguageandliteracy.

ImprovedsignageinFrench.

3.0 Minimizingadverseevents. Theorganizationminimizespotentialhazardsandriskswherevertheclientsreceiveservices.

3.� Teachclientsandfamiliesaboutpotentialsafetyhazards,infectioncontrol,safeandproperuseofequipment,suppliesandmedicaldevices,howtocontacttheorganizationinanemergency.

Thisrequirescommunicationinappropriatelanguage.

5.0 Theorganizationpreventsandcontrolsinfections.

5.5 Theorganizationworkswithothersandthecommunitytopromptlydetectandrespondtothepresenceofnewandresistantvirusesandbacteria.

ThisrequirestheabilitytocommunicatewiththeFrench-speakingcommunity.

5.9 Theorganizationleads,participatesin,andsupportsactivitiesthatteachthecommunityhowtoreducetheriskofinfectionandpreventinfectionsfromspreadinginthecommunity.

ThisrequirestheabilitytocommunicatewiththeFrench-speakingcommunity.

8.0 Beingalearningorganizationandachievingpositiveoutcomes.

8.� Regularlyevaluatesandimprovesitsprocessesbyanalyzingclientandstaffsatisfaction.

Researchfindscorrelationbetweenlanguageofaccessandclientsatisfaction.


23

HUMAN RESOURCES (6.0)


�.0Addressingneeds

Theorganization’sdocumentedhumanresourcesplananticipatesandrespondstocurrentandfuturehumanresourcesneeds.

�.�Regularlyassessescurrentandfuturehumanresourcesneedsintheareasofstaffing,competenceandcomplyingwithlegislation.

Humanresourceplanshouldacknowledgeservicedeliverylanguageneeds.

�.2Theplanningprocessaddressesclients’needsandexpectations,methodsusedtodeliverservices,availableresources.

Researchfindscorrelationbetweenlanguageofaccessandclientsatisfaction.Humanresourceplanshouldacknowledgeservicedeliverylanguageneeds.

�.3Theorganizationinvolvesclientsinplanninganddevelopinghumanresourcesprocessesorservices.

Organizationshouldnotassumeitunderstandsclients’needs,butshouldengageinproductivedialoguewithclientcommunities.

�.4Theorganizationhaslinkagesandpartnershipswithotherorganizations.

2.0Beingalearningorganizationandachievingpositiveoutcomes.

Theorganizationregularlyevaluatesandimproveshumanresourceprocessestoachievethedesiredresults.

Staffshouldbekeptapprisedofresearchrelatingtoimpactofcommunicationschallengesonqualityofcareandpatientsafety.

3.0Havingtherightpeople

Theorganizationhasadequatenumbersofqualifiedstaff,independentpractitioners,andvolunteerstoprovidequalityservices.

PEIFLHSNtakesthepositionthatqualificationsshouldalsoincludelanguageabilitiestomeettheneedsofclients.

3.�Theorganizationselectsandrecruitsstaffbasedoncommunityneeds,statisticsandtrends.

6.0Enhancingperformance

Theorganization’sleaders,staff,andvolunteersdemonstratecompetence.

Appendix A


24

Appendix A


INFORMATION MANAGEMENT (6.0)


�.0 Addressingneeds

Theorganization’sinformationmanagementprocessesmeetcurrentandfutureinformationneedsandenhanceitsperformance.

�.� Theorganizationregularlyassessescurrentandfutureinformationneedssothatitcandeliverclientservices,andprovideappropriateeducationtousers,clients,andfamilies.

3.0 Supportingevidence-baseddecisionmaking

Theorganizationcollectsandreportsrelevantdataandinformationinawaythatirtimely,efficient,accurate,andcomplete.

Needsassessmentshouldincludepreferredlanguageofaccess,availabilityofalternatecommunicationresources(includingqualifiedinterpreter)forqualityimprovementanalysisandevaluationatthecommunitylevelandattheindividuallevel.

5.0 Staff,serviceprovides,clients,andfamilieshaveaccesstoinformationtosupportdecision-makingandimproveknowledge.

Thisrequiresinformationtobeavailableinappropriatelanguage.

5.3 Theorganizationmakeseducationmaterial,referencematerial,andresearchinformationavailabletostaff,clients,andfamilies.

HUMAN RESOURCES (6.0)


6.2Theorganizationencourages,supports,andprovidesongoingeducation,training,anddevelopmenttocarryoutqualityimprovementactivities.

Doesorganizationsupportofficiallanguagetraining?

25

Appendix A

ACUTE CARE (6.0)


�.0 Beingalearningorganizationandachievingpositiveoutcomes.

Theteamcontinuallyplansanddesignsitsservicestomeetthecurrentandfutureneedsofthepopulationsitserves,andtoachievethebestpossibleoutcomes.

ThisrequiresunderstandingofneedforFrenchlanguageresources,clientneedsforaccesstoappropriatelanguageforservicedelivery,andcorrelationbetweenlanguagebarriersandoutcomes.

2.0 Theteamusesresearch,evidence,andbestpracticeinformationtodevelopandimproveitsservices.

2.2 Informclientsaboutresearchactivitiesthatrelatetotheirserviceneeds,andhelpclientsaccesstheseactivitiesiftheywish.


3.0 Theteammonitorsandimprovesthequalityofitsservicestoachievethebestpossibleoutcomes.

3.2 Whenevaluatingitsservices,theteaminvolvesclients,families,andotherorganizations.

Involvementrequiresstaffwhocancommunicatewithclients.

4.0 Achievingwellness

Theteam,workingwiththecommunity,promoteshealth,preventsordetectshealthproblemsearly,andmaximizesthewell-beingofthoseitserves.

Primaryhealthpromotionrequiresabilitytocommunicateinlanguageoftheaudience.

5.0 Beingresponsive

Theteam’sservicesareintegratedandcoordinatedtoensurecontinuityofserviceforthepopulationsitserves.

5.3 Theteamisawareofandusescomplementaryservicesofotherprovidersandorganizations;makingiteasierforclientstomovethroughtheservicesystem.

Istheorganizationusinglanguageresourcesavailablefromcomplementaryprovidersandorganizationstoaddresslanguagebarriers?


26

Appendix A


ACUTE CARE (6.0)


6.0 Theclients’firstcontactswiththeteamleadtothebestdecisionaboutservices.

Languagebarriersmustbeaddressed.Researchindicatesthatlanguagebarriersinhibitordelayfirstcontact.Researchalsosupportsneedforclearcommunicationinmakingappropriatecarechoices.

6.� Allpotentialclients,providers,andreferringorganizationscanaccesstheteam’sservices.

•Theteamidentifiesandremovesbarriers thatpreventclients,families,providers, andorganizationsfromaccessingservices.

Thisshouldincludeexplicitassessmentoflanguagebarriersandhowtoremovethem.

6.3 Theteamgivespotentialclients,families,providers,andorganizationssimple,writteninformationabouttherangeofservicesandtheircost,effectivenessandoutcomes,andalternatives

Tobeusefulthisinformationmustbeprovidedinappropriatelanguage.

6.4 Theteam’sprocessfordecidingwhethertoofferservicestopotentialclientsandfamiliesincludes

•Obtaining,withconsent,thepotential client’shistory. •Identifyingandaddressingclient’s immediateandurgentneeds.

•Consentismeaninglessiftheclientdoesnotunderstandwhatisbeingasked.

•Needsidentificationshouldincludelanguageofserviceneeds.

6.6 Whentheteamcannotmeettheneedsofpotentialclients,providers,andreferringorganizations,itexplainsthereasonswhy.

Suchexplanationsneedtobecommunicatedinappropriatelanguage.

7.0 Addressingneeds

Theteamaccuratelyandappropriatelyassessesitsclients.

7.� Theteamdeterminestheassessmentmethod,scopeandintensitybyconsideringanumberoffactorsincludinglanguage

•Theassessmentiscarriedoutwith adequateresources.

Languageisanessentialpartoftheassessmentprocess.Withadequatelanguageandcommunicationresources.

7.2 Assessmentofclients’strengths,abilities,needs,andforeseeablerisks,includesclients’abilitytocommunicateandcareforthemselves.

Onalargerscale,theabilitytocommunicateisanessentialpartoftheassessmentprocess.

27

Appendix A


ACUTE CARE (6.0)


7.3 Theteamsharestheassessmentresultswithclientsandfamiliesinaclearandeasy-to-understandway.

Thisrequiresthatlanguageaccessbeavailable.

7.4 Theteamhasprocessesforassessingandmanagingtheclient’spain.

Researchindicatesthatlanguagebarrierscanleadtoanundermanagementofpainissues.

9.0 Empoweringclients

Theteamworkswithclientsandfamiliestohelpthemactivelyparticipateinservicedeliveryandcarryouttheirresponsibilities.

Informationmustbeinappropriatelanguage.Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.

9.� Theteamregularlygivesclientsandfamiliestimely,complete,andaccurateinformation.

Thissteprequirestheinformationbeunderstood.

9.2 Theteamprovidesappropriateeducationtoclientsandfamilies.

•Theeducationprocessconsidersthe clients’andfamilies’languageand ensuresthattheyunderstandthe information.

Thisrequiresanunderstanding&availabilityoftheappropriatelanguageforcommunicatingtheinformation.

9.3 Theteamprovidesappropriateemotionalsupportandcounselingtohelpclientsandfamilies.

Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.

9.4 Theteamworkswithclientsandfamiliestocarryouttheirresponsibilitiesby

•Helpingclientsunderstandwhatthey areresponsiblefor. •Teachingpositivebehaviour.


�0.0 Theteamobtainsinformedconsentbeforestartinganyserviceorintervention.

Informedconsentrequiresthattheclientunderstandthechoicesandtheimplicationsofthedecisions.

�0.2 Theteamhasaprocessfordeterminingwhetherclientsarecapableofgivingtheirinformedconsent.


�0.3 Theteamobtainsclients’informedconsentbyverifyingthattheclientunderstandsalltheverbalandwritteninformation.


28

Appendix A


ACUTE CARE (6.0)


��.0 Theteamprotectsandpromotestherightsofitsclientsandfamilies.

��.� Theteamisawareofandrespectstherightsofclientsandfamiliestotakepartinallaspectsoftheirserviceandmakepersonalchoices.

Howistheteamrespectingthisinlightoflanguageaccess?

��.3 Theteamcontinuallyeducatesitsclientsandfamiliesabouttheirrightsandhelpsthemexercisetheirrights


��.5 Theteamhasaprocessforprocuringanddonatingorgansandtissuesthatincludesmakingthefamiliesorclientsawareoftheoptiontodonate.


��.6 Theteamhasaprocessforhandlingclients’andfamilies’complaintsthatincludesexplainingtoclientshowtheycanfileacomplaint.


�2.0Settinggoalsandmonitoringachievements

Theteamhasanappropriateandintegratedserviceplanforeachclient.

�2.� Theteamworkswithclientsandfamiliestosettheclients’goalsandexpectedresults.


�2.4 Theteam’sclientsachievetheirsetgoalsandexpectedresults

•Theteamidentifiesandaddressesany barriersthatarepreventingclientsfrom reachingtheirsetgoalsandexpected results.

Languagebarriersshouldbepartofthisassessment.

�3.0 Deliveringservices

Theteamdeliverssafe,efficientandeffectiveservices.

Researchindicatesthatlanguagebarrierscanunderminethesafety,efficiencyandeffectivenessofservices.

�3.3 Theteamtakesallreasonablestepstokeepclientssafefrompreventableadverseevents,injuries,orinfectionsbyeducatingclientsandfamiliesonpreventingrisks.

Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.

29

Appendix A

AMBULATORY CARE (6.0)












ACUTE CARE (6.0)


�3.8 Theteammeetstheuniqueneedsofdyingclientsbyhelpingclientsmanagetheirpainandsymptoms.

Researchindicatesthatlanguagebarriersaffectpalliativecare.

�4.0 Theuseofmedicationsandothertherapeutictechnologiesissafe,efficient,effective,andpromotesthebestpossiblequalityoflife.

�4.2 Theteamgivesitsclientswrittenandverbalinformationaboutthemedicationsorothertherapeutictechnologiesthatareavailable.


30

Appendix A






Primaryhealthpromotionrequiresabilitytocommunicateinlanguageoftheaudience.

5.0 Beingresponsive




6.0 Theclients’firstcontactswiththeteamleadtothebestdecisionaboutservices





6.3 Theteamgivespotentialclients,families,providers,andorganizationssimple,writteninformationabouttherangeofservicesandtheircost,effectivenessandoutcomes,andalternatives.



•obtaining,withconsent,thepotential client’shistory. •identifyingandaddressingclient’s immediateandurgentneeds.



3�

Appendix A






7.0 Addressingneeds


7.� Theteamdeterminestheassessmentmethod,scopeandintensitybyconsideringanumberoffactorsincludinglanguage.








Researchindicatesthatlanguagebarrierscanleadtoanundermanagementofpainissues.



Informationmustbeinappropriatelanguage.Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.




•Theeducationprocessconsidersthe clients’andfamilies’languageand ensuresthattheyunderstandtheinformation.




32

Appendix A




9.4 Theteamworkswithclientsandfamiliestocarryouttheirresponsibilitiesby:

•helpingclientsunderstandwhattheyare responsiblefor. •teachingpositivebehaviour.











��.3 Theteamcontinuallyeducatesitsclientsandfamiliesabouttheirrightsandhelpsthemexercisetheirrights.


��.5 Theteamhasaprocessforprocuringanddonatingorgansandtissuesthatincludesmakingclientsawareoftheoptiontodonate.






33

Appendix A


COMMUNITY HEALTH SERVICES (6.0)









�2.4 Theteam’sclientsachievetheirsetgoalsandexpectedresults:



�3.0Deliveringservices



�3.3 Theteamtakesallreasonablestepstokeepclientssafefrompreventableadverseevents,injuries,orinfectionsbyeducatingclientsandfamiliesonpreventingrisks.





34

Appendix A










4.0 Beingresponsive







•Theteamidentifiesandremovesbarriers thatpreventclients,families,providers, andorganizationsfromaccessing services.


5.3 Theteamgivespotentialclients,families,providers,andorganizationssimple,writteninformationabouttherangeofservicesandtheircost,effectivenessandoutcomes,andalternatives


35

Appendix A





•obtaining,withconsent,thepotential client’shistory. •identifyingandaddressingclient’s immediateandurgentneeds

•Consentismeaninglessiftheclientdoesnotunderstandwhatisbeingasked




6.0 Addressingneeds






Therequiresthatlanguageaccessbeavailable.


Theteamworkswiththecommunitytosupportthedevelopmentofthecommunity’scapacitiestoimproveitsownhealthandwell-being.

Thisrequiresthatlanguageaccessbeavailablethatisappropriateforcommunityserved.

8.� Theteamworksasapartnerwiththecommunitysharinginformation,knowledge,skillsandresources.

Whichrequiresworkinginappropriatelanguage.

8.2 Theteamsupportsthecommunity’sinvolvementinhealthandwellnessissues.


8.3 Theteamsupportscommunityactionstoimprovehealthandwellness.


36

Appendix A




9.0 Theteamworkswithclientsandfamiliestohelpthemactivelyparticipateinservicedeliveryandcarryouttheirresponsibilities.

Informationmustbeinappropriatelanguage.




















37

Appendix A








�2.0Settinggoalsandmonitoringachievements.




�2.4 Theteam’sclientsachievetheirsetgoalsandexpectedresults.

•Theteamidentifiesandaddressesany barriersthatarepreventingclientsfrom reachingtheirsetgoalsandexpectedresults.


�3.0Achievingwellness



�3.2 Theteam,withitspartners,carriesoutactivitiestoreducetheriskandonsetofhealthproblems,andmaximizesthewell-beingofthepopulationitserves,providingongoinginformationandeducationtoclients,otherproviders,otherorganizations,andthepublicaboutcurrentandemerginghealthissues.

Partnershiprequireseffectivecommunication.

�4.0 Withitscommunitypartners,theteamprotectsthecommunityagainsthealthhazards.


38

Appendix A

CRITICAL CARE (6.0)











�4.3 Theorganizationhasprocessesformanagingandsharinginformationaboutthehealthhazardsthatexistinthecommunity.





�5.3 Theteamtakesallreasonablestepstokeepclientssafefrompreventableadverseevents,injuriesorinfectionsbyeducatingclientsandfamiliesonpreventingrisks.


�6.0 Theuseofmedicationsissafe,efficient,effective,andpromotesthebestpossiblequalityoflife.

�6.2 Theteamgivesitsclientswrittenandverbalinformationaboutthemedicationsthatareavailable.


39

Appendix A


CRITICAL CARE (6.0)








4.2 Theteam,withitspartners,carriesoutactivitiestoreducetheriskandonsetofhealthproblems,andmaximizesthewell-beingofthepopulationitserves,providingongoinginformationandeducationtoclients,otherproviders,otherorganizations,andthepublicaboutcurrentandemerginghealthissues.


5.0 Beingresponsive







40

Appendix A


CRITICAL CARE (6.0)




6.4 Theteam’sprocessfordecidingwhethertoofferservicestopotentialclientsandfamiliesneedstobeadjustedforclientsandfamilieswithdiverseneedssuchaslanguageandculture.



7.0 Addressingneeds








Researchindicatesthatlanguagebarriersaffectmanagementofpain.






4�

Appendix A


CRITICAL CARE (6.0)

















��.� Theteamisawareofandrespectstheclients’andfamilies’righttotakepartinallaspectsoftheirserviceandmakepersonalchoices.




��.5 Theteamhasaprocessforprocuringanddonatingorgansandtissuesthatincludesmakingthefamiliesorclientsawareoftheoptiontodonate.


42

Appendix A


CRITICAL CARE (6.0)




�2.0 Settinggoalsandmonitoringachievements





•Theteamidentifiesandaddressesany barriersthatarepreventingclientsfrom reachingtheirsetgoalsandexpectedresults.





�3.3 Theteamtakesallreasonablestepstokeepclientssafefrominjuries,orinfectionsbyeducatingclientsandfamiliesonpreventingrisks.





43

Appendix A


HOME CARE (6.0)


�.0 Beingalearningorganizationandachievingpositiveoutcome.




2.2 Theteaminformsclientsaboutresearchactivitiesthatrelatetotheirserviceneeds,andhelpsclientsaccesstheseactivitiesiftheywish.








4.2 Theteam,withitspartners,carriesoutactivitiestoreducetheriskandonsetofhealthproblems,andmaximizesthewell-beingofthepopulationsitserves,providingongoinginformationandeducationtoclients,otherproviders,otherorganizations,andthepublicaboutcurrentandemerginghealthissues.


5.0 Beingresponsive

Theteam’sservicesareintegratedandcoordinatedtoensurecontinuityofserviceforthepopulationitserves.

44

Appendix A


HOME CARE (6.0)











6.4 Theteam’sprocessfordecidingwhethertoofferservicestopotentialclientsandfamiliesincludes:




6.6 Whentheteamcannotmeettheneedsofpotentialclients,providers,andreferringorganizations,itexplainsthereasonswhy


7.0 Addressingneeds


45

Appendix A


HOME CARE (6.0)















•Theeducationprocessconsidersthe clients’andfamilies’languageand ensurestheclientsandfamilies understandtheinformation.





•helpingclientsunderstandwhattheyare responsiblefor •teachingpositivebehaviour.


�0.0Theteamobtainsinformedconsentbeforestartinganyserviceorintervention.


46

Appendix A


HOME CARE (6.0)




�0.3 Theteamobtainsclients’consentbyverifyingthattheclientunderstandsalltheverbalandwritteninformation.



��.� Theteamrespectstheclients’andfamilies’righttotakepartinallaspectsoftheirserviceandmakepersonalchoices.
















47

Appendix A


LONG-TERM CARE (6.0)











HOME CARE (6.0)




�4.0 Theteamprevents,monitors,andpromptlyrespondstoanyadverseeffectsresultingfrommedicationusebyclients.

�4.� Theteamgivesitsclientswrittenandverbalinformationaboutthemedicationsorothertherapeutictechnologiesthatareavailable.


48

Appendix A









5.0 Beingresponsive


5.3 Teamisawareofandusescomplementaryservicesofotherprovidersandorganizations;makingiteasierforclientstomovethroughtheservicesystem.









49

Appendix A




6.4 Team’sprocessfordecidingwhethertoofferservicestopotentialclientsandfamiliesincludes:

•Obtaining,withconsent,thepotential client’shistory. •Identifyingandaddressingclient’s immediateandurgentneeds.



6.6 Whentheteamisunabletoprovideservicestoclients,ittellsclientsandfamilies,providers,andreferringorganizations,thereasonswhythesevicewasrefused.


7.0 Addressingneeds




Languageisanessentialpartoftheassessmentprocess.•Withadequatelanguageandcommunication

resources.

7.2 Assessmentofclients’strengths,abilities,needs,andforeseeablerisks,includesclients’abilitytocommunicate.




7.4 Thereisaprocessforassessingandmanagingtheclient’spain.





50

Appendix A





•Theeducationprocessconsidersthe clients’andfamilies’languageand ensurestheclientsandfamilies understandtheinformation.




9.4 Theteamworkswithclientsandfamiliestocarryouttheirresponsibilitiesby














��.6 Theteamhasaprocessforproviding,forgoing,andwithdrawinglife-sustainingtreatmentthatincludessharingtheguidelineswithclientsandfamilies.


5�

Appendix A


















�4.0 Theuseofmedicationsissafe,efficient,effective,andpromotesthebestpossiblequalityoflife.

�4.2 Theteamgivesitsclientswrittenandverbalinformationaboutthemedicationsavailable

Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation

52

Appendix A

MATERNAL/CHILD (6.0)
















5.0 Beingresponsive



53

Appendix A














•obtaining,withconsent,thepotential client’shistory •identifyingandaddressingclient’s immediateandurgentneeds





7.0 Addressingneeds

Thetheteamaccuratelyandappropriatelyassessesitsclients




resources.

54

Appendix A










•Theinformationthattheteamgivesto itsclientsandfamiliesisavailableinthe languageofthepopulationgroupsserved.

Thissteprequirestheinformationbeunderstood.ClearlythisrequiresFrenchlanguageservicesfortheFrench-speakingpopulation.










�0.2Theteamhasaprocessfordeterminingwhetherclientsarecapableofgivingtheirinformedconsent.


�0.3Theteamobtainsclients’consentbyverifyingthattheclientunderstandsalltheverbalandwritteninformation.


��.0Theteamprotectsandpromotestherightsofitsclientsandfamilies.

55

Appendix A




��.�Theteamrespectstheclients’andfamilies’righttotakepartinallaspectsoftheirserviceandmakepersonalchoices.


��.3Theteamcontinuallyeducatesitsclientsandfamiliesabouttheirrightsandhelpsthemexercisetheirrights.


��.5Theteamhasaprocessforhandlingclients’andfamilies’complaintsthatincludesexplainingtoclientshowtheycanfileacomplaint.






�2.4Theteam’sclientsachievetheirsetgoalsandexpectedresults.






�3.3Theteamtakesallreasonablestepstokeepclientssafefrompreventableadverseevents,injuriesorinfectionsbyeducatingclientsandfamiliesonpreventingrisks.


�4.0Theteamprevents,monitors,andpromptlyrespondstoanyadverseeffectsresultingfrommedicationusebyclients.

�4.2Theteamgivesitsclientswrittenandverbalinformationaboutthemedicationsorothertherapeutictechnologiesthatareavailable.


56

Appendix A

MENTAL HEALTH (6.0)
















5.0 Beingresponsive



57

Appendix A


MENTAL HEALTH (6.0)











6.4 Team’sprocessfordecidingwhethertoofferservicestopotentialclientsandfamiliesincludes:




6.6 Whenteamcannotmeettheneedsofpotentialclients,providers,andreferringorganizations,itexplainsthereasonswhy.


7.0 Addressingneeds





resources.

58

Appendix A


MENTAL HEALTH (6.0)








•Theinformationthattheteamgivesto itsclientsandfamiliesisavailableinthe languageofthepopulationgroupsserved.









�0.0Theteamobtainsinformedconsentbeforestartinganyserviceorintervention.


�0.2Theteamhasaprocessfordeterminingwhetherclientsarecapableofgivingtheirinformedconsent.


�0.3Theteamobtainsclients’consentbyverifyingthattheclientunderstandsalltheverbalandwritteninformation.


��.0Theteamprotectsandpromotestherightsofitsclientsandfamilies.

59

Appendix A


MENTAL HEALTH (6.0)


��.�Theteamrespectstheclients’andfamilies’righttotakepartinallaspectsoftheirserviceandmakepersonalchoices.


��.3Theteamcontinuallyeducatesitsclientsandfamiliesabouttheirrightsandhelpsthemexercisetheirrights.


��.5Theteamhasaprocessforhandlingclients’andfamilies’complaintsthatincludesexplainingtoclientshowtheycanfileacomplaint.




�2.�Theteamworkswithclientsandfamiliestosettheclients’goalsandexpectedresults.


�2.4Theteam’sclientsachievetheirsetgoalsandexpectedresults.



�3.0DeliveringServices

Theteamdeliverssafe,efficient,andeffectiveservices.


�3.3Theteamtakesallreasonablestepstokeepclientssafefrompreventableadverseevents,injuriesorinfectionsbyeducatingclientsandfamiliesonpreventingrisks.


�4.0Theuseofmedicationsandothertherapeutictechnologiesissafe,efficient,effective,andpromotesthebestpossiblequalityoflife.

60

Appendix A


REHABILITATION (6.0)














MENTAL HEALTH (6.0)


�4.2Theteamgivesitsclientswrittenandverbalinformationaboutthemedicationsorothertherapeutictechnologiesthatareavailable.


6�

Appendix A






5.0 Beingresponsive







•Theteamidentifiesandremovesbarriersthatpreventclients,families,providers,andorganizationsfromaccessingservices.




6.4 Theteam’sprocessfordecidingwhethertoofferservicestopotentialclientsandfamiliesincludes:




62

Appendix A






7.0 Addressingneeds




Languageisanessentialpartoftheassessmentprocess.•Withadequatelanguageandcommunicationresources.






9.� Theteamregularlygivesitsclientsandfamiliestimely,complete,andaccurateinformation.

•Theinformationthattheteamgivesto itsclientsandfamiliesisavailableinthe

languageofthepopulationgroupsserved.


9.2 Theteamprovidesappropriatehealtheducation,emotionalsupportandcounselingtohelpclients.







63

Appendix A











��.3 Theteamcontinuallyeducatesitsclientsandfamiliesabouththierrightsandhelpsthemexercisetheirrights.












Theteamdeliverssafe,efficient,andeffectiveservices.


64

Appendix A






�4.0 Theuseofmedicationsissafe,efficientandeffective,andpromotesthebestpossiblequalityoflife.

�4.2 Theteamgivesitsclientswrittenandverbalinformationabouthowtousemedicationsafelyandproperly.


65

APPENDIX B

Language Access Resources & Tools

Studies & Reports

Andrulis,D.,Goodman,N.,&Pryor,C.(2002,April).What a Difference an Interpreter can Make: Health Care Experiences of Uninsured with Limited English Proficiency.TheAccessProject.Boston,MA.

Bowen,S.(200�).Language Barriers in Access to Health Care,HealthCanada.

CRICO/RMF.(2006).What Works: Effective Practices for Office-based Care.SeeLanguageInterpretation(Section6)oftheirwebsite:http://www.rmf.harvard.edu/

EthicalForceProgram.(2006).An Ethical Force Program Consensus Report. Improving Communication – Improving Care. How health care organizations can ensure effective, patient-centered communication with people from diverse populations.AmericanMedicalAssociation.

TriadResearchInc.(2002).Final Evaluation Report, Evaluation of the Language and Culture Facilitation Pilot Project for Seniors Residing at the Jewish Senior Apartment Complex and Seniors in the Community Who Speak Russian and Yiddish,Calgary.

Weiss,L.,Bauer,T.,Hill,C.,Fuld,J.,&Bergman,J.(2006,May)Language as a Barrier to Health Care for New York City Children in Immigrant Families: Haitian, Russian and Latino Perspectives,DivisionofHealthPolicyandtheNewYorkForumforChildHealth,www.nyam.org/library/docs/LanguageBarrierReportMay2006.pdf

Wilson-Stronks,A.&Galvez,E.(2006).Hospitals, Language, and Culture: A snapshot of the nation. Exploring cultural and linguistic services in the nation’s hospitals.TheJoint-Commission.OakbrookTerrace,IL.

Resource Guides

Hardt,E.(200�).Research Issues on Medical Interpretation: Bibliography.TheNationalCouncilonInterpretinginHealthCare, www.ncihc.org

Jacobs,E.,Agger-Gupta,N.,Chen,A.Hm,Piotrowski,A.,&Hardt,E.J.(2003).Language Barriers in HealthCare Settings:AnannotatedBibliographyoftheResearchLiterature.TheCaliforniaEndowment,www.calendow.org

Sampson,A.(2006).Language Services Resource Guide for Health Care Providers,NationalHealthLawProgram.

Appendix B

66

Sample Policies, Standards & Toolkits

Improving Communication – Improving Care, Ethical Force Program Consenus Report,AmericanMedicalAssociation,ContentArea5b.Language

OfficeofMinorityHealth,National Standards on Culturally and Linguitically Appropriate Services (CLAS),www.omhrc.gov/templates/browse.aspx?lvl=2&1v1ID=15

Paras,M.(2005).Straight Talk: Model Hospital Policies and Procedures on Language Access,CaliforniaHealthCareSafetyNetInstitute.

Roat,C.E.(2005).Addressing Language Access Issues in Your Practice: A Toolkit for Physicians and Their Staff Members,CaliforniaAcademyofFamilyPhysicians.

WinnipegRegionalHealthAuthority,PoliciesonFrenchLanguageServiceshttp://www.wrha.mb.ca/about/policy.php

Patient Information Pamphlets

AmericanHospitalAssociationAwardWinningPoint-to-TalkBookletswww.massgeneral.org/interpreters/pointtalk.asp

Web Sites & Portals

http://cchsa.ca/Default.aspx–CanadianCouncilonHealthServicesAccreditationwebsiteoffersinformationonthestandards,andROPs

http://www.patientsafetyinstitute.ca/index.html–CanadianPatientSafetyInstitutewebsite

www.calendow.org/reference/publications/cultural_competence.stmOffersmanualsandworkbooks.Whiletheemphasisisonculturalcompetencies,languagebarriersarealsoincluded.

www.jointcommission.org/HLC/compiled_list.htmIncludesaddressesfortoolkits,guidelinesandstandards,andtrainingresources–whilethefocusisonaddressingneedsofSpanishpopulation,thereisgreatpotentialforcross-over

www.hablamosjuntos.org/mission.default.mission.aspHablamosJuntosoffersresourcesregardinglanguagepolicyandpracticeinhealthcare.WhilethefocusisontheneedsofSpanish-speakingpopulation,thereisgreatpotentialforcross-over

Appendix B

67

Appendix C

APPENDIX C

Evidence For MonitoringCommunication Challenges

• Publicsignageisbilingualinhealthcarefacilities.

• Patientbrochures,educationmaterialandpatient/clientconsentsareprovidedinappropriatelanguagesandreadinglevels.

• Assessmenttooltoidentifyneedforinterpreter/Accesstointerpretersasrequired.

• DirectoriesofFrenchspeakingstaff,whichincludelevelofcompetency,areavailable.

• Clientsatisfactiontoolsreflectlanguagerequirementsofpopulationandallowforinputonlanguageneeds.

• Patientsafetyeducationandcommunicationmaterials,includingmedicationinformation,areavailableinrelevantlanguagesandappropriatereadinglevels.

• Staffreceiveeducation/trainingonlanguageandcultureissues,inamannerwhichreflectscurrentresearchevidence,inrelationtoqualityofcareandpatientsafety.

• Theorganizationhasroutinedatacollectionprocessestoidentifyandmonitorlanguageneeds.Examplesincludecommunityneedsassessments,administrativedatacollectionatservicedeliveryentrypoints,andmonitoringindicators.

• Theorganizationstrategicplanaddressesaccessissuesrelatedtolanguageandorculture.ExamplescouldincludegoalsorobjectivesrelatedtoHRplanning,patientsafety,orqualityofcarewhichaddressortakeintoaccountanaccessissuerelatedtolanguageorculture.

delivery of quality health care - réseau santé en ... · ssf work in collaboration to improve...

Documents