This chapter discusses language access services and cross-cultural communication in healthcare. It notes that over 50 million people in the US speak a language other than English, including 8% who have limited English proficiency. When language barriers are present, healthcare encounters can result in misunderstandings and medical errors. The chapter reviews legislative requirements for language services, resources available, and the importance of using trained interpreters rather than ad hoc interpreters to avoid problems. Effective communication involves awareness of linguistic and cultural differences in areas like non-verbal behavior and concepts of illness.

1. Chapter 8Chapter 8
Language Access Services andLanguage Access Services and
Crosscultural CommunicationCrosscultural Communication

2.  To become familiar with the extent of language differences in the
US population
 To appreciate the serious impact that language barriers can have
on communication in health care
 To become aware of legislative, regulatory, and accreditation
requirements surrounding the provision of language access
services (LAS)
 To understand that provision of LAS is a quality of care and safety
issue
 To become familiar with the many models and resources available
for providing language services in health care
 To become alert to the pitfalls of using untrained interpreters and
translators
 To become acquainted with aspects of nonverbal communication
and cultural perspectives as they affect communication
Chapter ObjectivesChapter Objectives

3. 52 million (19.4 % of total US population)
speak a language other than English – this
includes:
 34% of population in Western states
 8% (23 million total) have LEP (limited
English proficiency)
Large urban cities serve areas where over
100 languages are spoken
Language Use in the USLanguage Use in the US

4.  Complexity of health care systems often
confusing and difficult, even for English
language speakers
 Exchanges between patients and care
providers is critically dependent on clear
oral and written communication
 Adverse outcomes from medical errors are
more serious among LEP
Language Differences in HealthLanguage Differences in Health
Care EncountersCare Encounters

5.  Emotionally charged – fear, anxiety, pain,
denial, uncertainty, confusion and
vulnerability
 Miscommunication and misinterpretation
has dangerous consequences
 Focused on subjects of extreme delicacy
 Medical/health care language is often
highly technical
Special Issues in Health Care EncountersSpecial Issues in Health Care Encounters

6.  When in Rome….
 Why don’t they learn to speak English?
 Stereotypes occur when communication
breaks down
Early Attitudes toward Limited EnglishEarly Attitudes toward Limited English
SpeakersSpeakers

7.  Unacceptable – reflects a low standard of
care
 Dangerous – invites misinterpretation by
person unfamiliar with medical
terminology
 Unfair – breaches confidentiality/role
conflicts
 Can result in medical malpractice
Ad hoc interpretersAd hoc interpreters

8.  Title VI of the Civil Rights Act of 1964 –
prohibits discrimination based on limited
English proficiency
 State of California (2007) – stipulated that
to have matched state and federal health
services covered by HMO, language access
requirements must be met
 17 states and DC have now enacted LAS
legislation
Pivotal EventsPivotal Events

10.  Joint Commission
 National Commission on Quality
Assurance
 American Medical Association
LAS and AccreditationLAS and Accreditation

11.  Cost and time to provide services
 Lack of knowledge about how to plan for,
staff, and organize services
Stumbling BlocksStumbling Blocks

12.  Federal Center for Medicaid/Medicare,
 National Health Law Program
 How-to guides are publically available
 The Commonwealth Fund
 The California Endowment
 Robert Wood Johnson Foundation
 National Health Law Program
 California Primary Care Association
Resources for Providing LASResources for Providing LAS

13.  Dedicated organizational champions
 Collect and assess information on service
need
 Hire bilingual staff
 Hire trained interpreters
 Use language banks, telephonic and
remote video-interpreting services
Addressing language needsAddressing language needs

14.  Linguistic distortion
 Unfamiliar with medical/health care terminology
 Embarrassment over discussion of bodily functions
 Intentional or unintentional editing of clinician or
patient utterances
 Deletion of info by paraphrasing
 Intimidation or fearfulness
 Unwillingness to deal with unpleasant news
 Potential breach of confidentiality
Common Problems withCommon Problems with
Untrained InterpretersUntrained Interpreters

15.  Faster than average job growth
 Expansion of training opportunities
 Growth of professional organizations
 Certification requirements
Medical Interpretation as an ExpandingMedical Interpretation as an Expanding
ProfessionProfession

16.  Match age, gender, background to patient
 Introduce and obtain permission from family to use an
interpreter
 Physically position interpreter behind patient or
provider, not in between
 Speak directly to patient, not interpreter
 Use the first person – expect same from interpreter
 Don’t speak too long without allowing interpreter to
interpret
Tips for working effectively withTips for working effectively with
interpreters - 1interpreters - 1

17.  Learn basic words and phrases in target
language
 Return to issue if misunderstanding is
suspected
 Ask interpreter about any unfamiliar
beliefs or behaviors in target culture
 Respect the interpreter as a health care
professional
Tips for working effectively withTips for working effectively with
interpreters - 2interpreters - 2

18.  Interpreters (oral language) vs. translators
(written language)
 Translators – insurance, admission, medical,
history, consent forms; laboratory and
discharge instructions; prescription and
health education materials
 Sensitive to cultural issues, including use of
color, numbers, pictures, diets
Role of TranslationRole of Translation

19.  Language is embedded in culture in
complex ways
 Communication also involves behavior
 Proxemics – study of space and spacial
distance in communication
 Cultural differences in non-verbal
communication – touch, eye contact,
gestures
Communication – More than WordsCommunication – More than Words

20.  Language and culture are inextricably
intertwined
 Values, beliefs, attitudes, gestures are
encoded in words – form the basis of
knowledge and worldview within a culture
 Etiology, meaning of symptoms – cultural
differences and meaning
Communication, Culture and MeaningCommunication, Culture and Meaning

21. Key TermsKey Terms
• Ad hoc interpreters
• Dual role interpreter
• Face-to-face interpretation
• Interpretation
• Language access services
(LAS)
• Language barriers
• Language concordance
• Limited English proficiency
(LEP)
• Medical and healthcare
interpreter certification
• Nonverbal communication
• Trained health care and
medical interpreters
• Translation