Health, Language and Culture

Imagine the experience of our culturally diverse

patients.

• Language and cultural barriers

• A very different healthcare system to navigate.

• Consider this:– The phrase “What brought you here today?”

Improving Communication with our PatientsInterpreter Services provided by trained medical Interpreters

helps improve patient outcomes, quality and satisfaction.

It’s the Law

•Federal Laws preventing discrimination include language.•Massachusetts Law mandates that we provide face to faceInterpreter Services in the Emergency Department and Acute Psyche encounters in our most common spoken languages.

•Patients who are deaf and or hard of hearing are entitled to a Sign Language, or Sign Language and Certified Deaf Interpreter under the American Disabilities Act.

Working with Professional Medical Interpreters

• Interpreters are part of the care team for the patient. In addition to interpretation services, they can help providers understand cultural differences.

•Hold a pre or post conference with the interpreter for briefing or feedback. Very important for telephonic interpretation.

• Make sure the patient understands that interpreter services are free of charge.

•Document in the Medical Record •Use of Interpreter•Refusal of Interpreter Services

Can’t I just find someone to interpret?

•Clinical Information must be interpreter by a trained medical interpreter- consents, information about treatment, medications, discharge instructions….

•For non- clinical information- you may use a family member or non-trained bilingual employee ONLY for non clinical situations such as registration, giving directions, ordering a meal, and informing that a medically trained interpreter is on the way.

Minor children should NEVER be asked to interpret. It places too large a responsibility on the child. Also, adults patients are unlikely to be forthcoming with sensitive information.

Can I interpret?•At Mount Auburn Hospital only medically trained interpreters interpret.•Trained medical interpreters do not add, omit, distort, or change the register of the message.

•Many providers are fluent in other languages and choose to speak to their patients in those languages. •Growing attention nationally. Some organizations have tested providers language skills. Reports cite a 30%-60% pass rate.

I-POP Interpreter

Phone on Pole• All inpatient and most

outpatient units

• Quick access to 150 languages

• Will often stay in patient rooms

• Turn off between conversations

Any phone

Interpreter Services

Page # 6681

For scheduled appointments with more than 48 hours notice fax Request Form to x5091. Interpreter Services on Portal www.home.caregroup.org

Interpreter Services

Page # 6681For scheduled appointments with more than 48 hours notice

fax Request Form to x5091. Interpreter Services on Portal www.home.caregroup.org

Spoken Languages

Monday - Friday 8:30am-5pm • Staff Languages page:

– Spanish: #6681, – Portuguese: #6852– Armenian/Russian: #6692

• All other languages

– Use Phone

After 5pm, weekends + holidays

•Spanish page #6681 •Other Languages use phone

I-POP

Interpreter Services

Page # 6681For scheduled appointments with more than 48 hours notice

fax Request Form to x5091. Interpreter Services on Portal www.home.caregroup.org

Spoken Languages

Monday - Friday 8:30am-5pm • Staff Languages page:

– Spanish: #6681, – Portuguese: #6852– Armenian/Russian: #6692

• All other languages

– Use Phone

After 5pm, weekends + holidays

•Spanish page #6681 •Other Languages use phone

American Sign Languageanytime Page #6681

I-POP

Interpreter Services

Page # 6681For scheduled appointments with more than 48 hours notice

fax Request Form to x5091. Interpreter Services on Portal www.home.caregroup.org

Spoken Languages

Monday - Friday 8:30am-5pm • Staff Languages page:

– Spanish: #6681, – Portuguese: #6852– Armenian/Russian: #6692

• All other languages

– Use Phone

After 5pm, weekends + holidays

•Spanish page #6681 •Other Languages use phone

For special patient circumstances any time

page #6681.

American Sign Languageanytime Page #6681

I-POP

• Translation services arranged thru Interpreter Services

• JACHO requires we use certified translators

• Interpreters may translate one time, patient specific short documents.

• DO NOT USE TRANSLATION PROGRAMS SUCH AS Google Translator…

• People have more of a “culture” than their American neighbors if they were born in a foreign country and continue to honor family traditions.

• Everything considered to be “common sense” is determined by culture.

• Communication styles are rooted in culture and impact clinical interactions.

• To improve cross-cultural interactions, the first step recommended by experts is to understand the cultural values and beliefs of others.

Cultural Quiz-What do you think?University of Toronto www.cmeutroronto.ca/edoflife

False

True

True

False

In every patient encounter there are at least 5 cultures involved.

Patient

Caregiver Biomedical

Hospital

American

Health DisparitiesHealth Inequity

Institute of Medicine 2002• Even among the better-controlled studies,

the vase majority indicated that minorities are less likely than whites to receive needed services.

• Although myriad sources contribute to these disparities, some evidence suggests that bias, prejudice and stereotyping on the part of healthcare providers may contribute to differences in care.

• Racial differences in patients’ attitudes, such as their preferences for treatment do not vary greatly and can not fully explain racial and ethnic disparities in healthcare.

IOM Report-Solutions

• Report highlighted no one cause of disparities and therefore no one solution.

• Culturally and Linguistically Appropriate Services (CLAS) Standards– Interpretation Guidelines– New JACHO guidelines Communication – Cultural Competency Education

Cultural Competence

Res

pec

t Cu

rio

sit

y

Em

pat

h

y

Cultural Humility

From good to GREAT:

From Common Knowledgeto

Common Practice

What is “common” is related to Culture.

“I think this would look great in my Living Room.”It is a Decoration

“Let’s bring this back from our trip to India.” It is a Souvenir

“I use this everyday when I pray.”It is a Place of Prayer

People from different cultures will describe the same object differently.

StatusA well decorated

war hero. StatusAn expensive pampered pet.

StatusA wise elder.

People from different cultures will describe the same word differently.

Cultural PassportThink about the answers to these questions:

• What words or phrases describe your cultural views of health and illness?

• If you loved ones were receiving in-patient treatment for serious illness, what should providers understand about your cultural view of medical care?

• What aspects of your cultural background do you feel could strengthen your interactions with and care for patients and their families?

“It is much more important to know what sort of a patient has a

disease than what sort of

a disease a patient has.”

Sir William Osler, MD

Worlds Apart Video Series

Explanatory ModelsCommunication tools used to elicit increased

understanding when those communicating have

diverse cultural perspectives. • The Explanatory Model-Kleinman

– What do you think caused your problem?

– Why do you think it started when it did?

– What do you think your sickness does to you?

– How serve is your sickness? Do you think it will last a long time, or be better soon in your opinion?

– What kind of treatment do you think you should receive?

– What are the most important results you hope to get from this treatment?

• The LEARN Model-Berlin, Fowles

– Listen with sympathy and understanding to the patient’s perception of the problem

– Explain your perceptions of the problem

– Acknowledge and discuss the differences and similarities

– Recommend treatment– Negotiate agreement

Thank You