COMMUNICATION KEY TO PATIENT SAFETY
IMIA International Conference on Medical Interpreting
“Pioneering Healthy Alliances”
Boston, Massachusetts
Oct. 5 – 7, 2007
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Presented by:
Sandra Sanchez, M.S.,
Director, Multi-Cultural Affairs
Grady Health System, Atlanta
and
Linda Joyce, M.S.,
Language Access Consultant
Interpreter
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Objectives of the Presentation
Understand patient safety issues
Recognize the relevance of language and
culture in patient safety
Discuss some of the strategies that have
worked
Show how collaborating will lead to better
health outcomes for all, including culturally
and linguistically diverse patients
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Patient Safety Definitions
 Adverse Event/ Occurrence:
Any unintended harm to the patient by an act of
commission or omission rather than by the
underlying disease or condition of the patient.
 Near Miss/Close call:
A potential injury that did not happen to the patient.
 Sentinel Event:
An unanticipated death or major loss of function, not
related to the natural course of the patient’s illness or
underlying condition.
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Why the focus on patient safety?
Joint Commission, Dec., 2006
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Is it safe to go to the hospital?
An average of 195,000 people in the USA died
due to potentially preventable, in-hospital
medical errors in each of the years 2000, 2001
and 2002, according to a 2004 study of 37
million patient records
HealthGrades Patient Safety in American Hospital Study
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Joint Commission - Dec. 2006
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2007 National Patient Safety Goals
Patient Identification
Improve communication
Medication Safety
Reconcile Medications
Patient involvement
Focused risk assessment
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“Effective Communication”
U. S. Department of Health and Human
Services initiative to strengthen language
access
Along with the Office of Civil Rights,
collaborating with hospital associations in nine
states
Assessment includes looking at the needs of
small, rural hospitals
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WHO (World Health Organization)
Patient Safety Solutions
Patient identification
Communication
Assuring medication accuracy
Look-alike, sound-alike medication
names
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We are part of a mosaic:
 There are more than 6 categories for race and about 2.5% of
the population identified themselves as having 2 or more races
 About 12% of the US population is foreign born
 About 18% of the US population speak a language other than
English at home (Approx. 47 million)
 About 8.1% of the population 5 Years and Over Speak
English Less Than “Very Well” (Approx. 21 million)
US Census Bureau
 Federal and Accreditation Mandates
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Language and culture 101
Basic considerations to improve patient
safety
Primary/preferred Language
Cultural Background
Health Literacy Levels
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Cases to consider
10 month old baby with iron-deficiency
anemia
3-year old child with abdominal pain
Girl falling from bicycle
“Intoxicado”
Hysterectomy
Hmong child with epilepsy
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Your real time examples
Experiences that you have had in your
health care setting where communication
has been, or could have been the cause of
incidents
Experiences where cultural
considerations have led, or could have led
to incidents
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“Language proficiency and adverse
events in U.S. hospitals: a pilot study”
Adverse events involving some physical harm
 Almost half (49.1%) of LEP patients vs.
 Almost a third (29.5%) of patients who speak English
Patients with moderate temporary harm to death:
 46.8% of the LEP vs. 24.4% of English speaking
patients
Communication errors:
 52.4% of the LEPs vs.
 35.9% of the English speaking patients
Joint Commission - Chandra Divi, Richard G. Koss,
Stephen P. Schmaltz and Jerod M. Loeb
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Adverse event type characteristics for English
speaking and LEP patients
Adverse event characteristic
English speaking N (%)
Limited English proficient N (%)
P-value
Communication
299 (35.9)
130 (52.4)
<0.001
Inaccurate/incomplete information
132 (15.9)
39 (15.5)
0.44
Questionable advice/interpretation
29 (3.5)
28 (11.2)
0.002
Questionable consent process
10 (1.2)
7 (2.8)
0.33
Questionable disclosure process
7 (0.8)
8 (3.2)
0.042
Questionable documentation
171 (20.6)
59 (23.5)
0.77
Questionable assessment of patient needs
53 (6.4)
37 (14.7)
<0.001
467 (56.1)
133 (53.0)
0.12
Questionable delegation
14 (1.7)
10 (4.0)
0.69
Questionable tracking and follow-up
182 (21.9)
61 (24.3)
0.30
Questionable use of resources
257 (30.9)
60 (23.9)
0.18
154 (18.5)
36 (14.3)
0.47
152 (18.3)
32 (12.8)
0.77
Patient management
Clinical performance
Correct diagnosis questionable intervention
Joint Commission – C.Divi et al.
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Hospitals, Language and Culture: A
Snapshot of the Nation
 Quality controlled translations
 Qualified interpreters and cultural brokers
 Education on cultural competency
 Avoid stereotyping
 Discuss impact of language and culture on patient
safety
 Expand Joint Commission Nat’l Safety Goals
 Better data and research effect of language and
culture in adverse events
Joint commission - Wilson-Stokes
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CLAS, OCR and
The Joint Commission
 Effective and understandable communication
 Written information in patient’s language
 Interpretation and translation services
 Staff competence (Qualified interpreters and translators)
 Cultural, linguistic and learning needs
 Records of communication with patients
 Patient involvement
 Hospitals provide services in accordance to laws and
regulations
 Patients with comparable needs receive same standard of
care
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Grady Health System
Department of Multicultural Affairs
 Language Interpretive Services (LIS)
 Qualified professional interpreters and translators
 Continuous education sessions for interpreters
 Language Proficiency Assessments
 Multicultural Programs
 Outreach and education
 Community Partnerships
 Cultural Competency Training
 International Medical Center (IMC)
 Primary care – Patient centered (one-stop shop)
 Bilingual and culturally sensitive staff and providers
 Education in waiting room
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Interdepartmental
Collaboration at Grady Health System
Patient Safety
Risk Management
Customer service / Patient Advocacy
Training and Development
Nurse Residency Program
Facilities Management
Public Relations
Human Resources
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The Goal:
Patient-centered care
Assessing language and cultural needs
Listening to the patient
Asking the patient what they are doing to
address their health issues
Involving the patient and families at all
transitions
Using “teach-back” or “show-back”
techniques
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What can we do together?
What can health care systems do to
include language and culture in its patient
safety plan?
What can language service departments
do?
What can interpreters do?
What can providers and patients do?
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Conclusions
 Language and culture have to be considered to achieve all the
National Patient Safety Goals for 2007.
 Organizational collaboration is key to preventing
communication errors.
 To reduce the risks to patient safety related to language and
cultural barriers, always:





Use qualified medical interpreters
Collect data on preferred language
Document use of medical interpreters
Confirm understanding with “teach back” or “show back” approach
Learn about practices and customs of the patient population in the
service area
 Attend cultural competency trainings when possible
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References
 www.jointcommission.org
 Hospitals, Language and Culture: A Snapshot of the Nation
 What did the doctor say? Improving Health Literacy to Protect Patient
Safety
 National Patient Safety Goals
 www.LEP.gov
 www.omhrc.gov
 National Standards for Culturally and Linguistically Appropriate
Services
 www.census.gov
 www.hhs.gov/ocr
 www.publimed.org
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Thank You!
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