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In the United States the Joint Commission requires the completion of a Learning Needs Assessment. During this assessment language needs and barriers are assessed. Ideally these findings are used to provide communication in the patients preferred language and learning style. Typically this process is a self stated assessment. This process done superficially can be less than optimal. While I may have conversational skills in a language., I may lack the skills need complicated medical conversations that frequently include the use off medical jargon.What tools or methods has our community of health care professionals used to determine the patients preferred language and learning method
I normally have trained the care teams to ask the patient directly in which language they prefer to receive their healthcare; however, if the patient does not answer this question, or we do not know in which language to ask, it can be difficult. I usually refer team members to the language ID card available on the unit, or to call our over-the-phone provider who is skilled in language identification.I would be interested to see what other innovative ideas are there for identifying a patient’s language. One example I have seen trailed is providing the patient with a language ID wallet card for future visits; however, if this is the patient’s first visit to the facility, what other innovative methods can be used?
A new provision in the Accountable Care Act requires enhanced signage to encourage/empower patients with knowledge that there services are available at no charge
There has also been a lot of conversation about digitally enabling LEP patients with interactive language links an a healthcare systems website as well! For example, each web page could be enabled with a quick link in the system's top languages which patients would click and be advised the system provides services in their language, in addition to basic information about the hospital, what to do/ bring to a first visit, how to communicate an interpreter is needed, etc.
Kati, You post an interesting and creative solution. Are you aware of exemplar in using this technology ?Tom
I like the ideas that have been presented thus far. In addition, I think providers can best identify a patient's language/interpretation needs by considering ethnic and cultural factors in addition to the dominant language spoken in an individual's country of origin. I have previously worked in social services with refugee populations, and advocating for interpretation in a language that they not only understand but that also takes into consideration their prior trauma experiences is essential. For instance, Burmese ethnic minorities resettled in the U.S. often do not speak Burmese well and would prefer interpretation in the language that corresponds to their ethnic group. Furthermore, in my experience, Burmese interpreters from the dominate Burman ethnicity have sometimes triggered the persecution and trauma that ethnic minorities experienced in their home country, regardless of how professional and unbiased the interpreter has been. Such considerations are also needed for individuals whose cultural or religious backgrounds require interpreters of the patient's same gender to be utilized in order for the individual to feel comfortable discussing health needs. Failing to take these factors into account could cause patients to feel uncomfortable in sharing their health concerns or fear that what they have shared will be misrepresented by the interpreter. Of course it can be very challenging to identify these factors during an initial patient's visit when significant language barriers exist, as Mark pointed out. One solution may be to use a telephone interpreter to identify those cultural considerations, as it may lessen feelings of intimidation or an imbalance of power that the patient might feel with an in-person interpreter in the room.
Globalization has resulted to the creation of diversity and the need for cultural competency. It has resulted to the creation of teams comprising of members from different geographical and cultural backgrounds. These members have different beliefs, interests and experiences. There are multiple definitions to the concept of CULTURAL COMPETENCE. The one that caught our attention states: “Cultural Competence is a set of values, behaviors, attitudes, and practices within a system, organization, program, or among individuals, which enables them to work effectively cross culturally. It also refers to the ability to honor and respect the beliefs, language, interpersonal styles and behaviors of individuals and families receiving services, as well as staff who are providing such services.” Striving to achieve Cultural Competence is a dynamic, ongoing, developmental process that requires a long term commitment of time. Refugee resettlement program in the U.S has a long successful history. Although, language barriers and multiple “new” dialects that arise with new arrivals in the U. S. such as Chin or Rohinga dialects, finding resources to cover the basic needs of communication for these languages may become quite challenging. http://www.cal.org/areas-of-impact/immigrant-refugee-integration/refugee-inte...
This is a great discussion, and similar to one happening in the Malaria community right now (https://www.ghdonline.org/malaria/discussion/teaching-cultural-competency-in-...)I was recently introduced to the term "cultural humility" as a substitute for "cultural competency" (I'm attaching some resources here.) Have others begun using this term in health practice or education? Abdullahi, I want to highlight your point that cultural competence is a dynamic, ongoing, developmental process–it should be a process rather than an end point. One takeaway from the Arthur Kleinman piece attached here: "If we were to reduce the six steps of culturally informed care to one activity that even the busiest clinician should be able to find time to do, it would be to routinely ask patients (and where appropriate family members) what matters most to them in the experience of illness and treatment. The clinicians can then use that crucial information in thinking through treatment decisions and negotiating with patients."
Link leads to: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0030294
Link leads to: http://www.apa.org/pi/families/resources/newsletter/2013/08/cultural-humility.aspx
Link leads to: https://www.youtube.com/watch?v=SaSHLbS1V4w
Tom - I have not yet seen this implemented but I know several systems actively and independently exploring it with their Web Design and marketing departments and will be happy to advise on further developments.Regarding your mention of the signage being encouraged by the new regulations - I feel compelled to remind that this simple solution should not be undermined by the desire for sophisticated solutions. Posting basic information in an organizations top languages, and making that information accessible to staff and patients is an incredibly effective way to communicate services are available at no patient cost!
Kathleen, I completely agree. I think some times we look for complex solutions and at times overlook the simple options that are extremely effectiveTom