Language Access Guide for Healthcare
Introduction
In many ways, hospital administrative teams are the unsung heroes of this decade. While you may infrequently—or perhaps never—interface with patients, you show up every day to ensure medical providers are appropriately resourced to deliver top-notch patient care.
Since the onset of the COVID-19 pandemic, hospital administrators have faced difficult and unfamiliar circumstances:
- Rising labor costs made balancing budgets a challenge.
- Patient surges overwhelmed hospital systems.
- Resource limitations forced difficult decisions on spending priorities.
Hospital Labor Expenses between 2019 and 2022
Patient Surges in the COVID-19 Pandemic
Declining Hospital Margins
Patient Surges in the COVID-19 Pandemic
Declining Hospital Margins
These big-picture statistics illustrate industry-wide challenges with balancing budgets, expenses, and future spending. There’s no doubt that language access teams have taken a hit. According to the Centers for Medicare and Medicaid Services (CMS), foreign language interpreter and TTY (teletypewriter) availability dropped by more than two points between 2022 and 2023.
If you are responsible, in all or some part, for your hospital system’s patient language access plan, you know exactly what we’re talking about. Perhaps you’ve been asked to reduce your department’s spending despite observing increased demand for language services. Or, your program’s allocated resources may have remained stable but have not adequately increased to meet current and future demand.
Either way, it’s undeniable that the need for hospital language services is growing. Nearly 8 million patients in the U.S. would be best served in a language other than English (HRSA, 2022).
This reality cannot be ignored. Otherwise, limited English proficient (LEP) patients may slip through the cracks—which could significantly impact business, resulting in increased costs, higher readmission rates, and ultimately a reduction in throughput. It’s crucial to consider this aspect in your decision-making process.
You need to develop an advocacy strategy to avoid these outcomes and deliver a future-proofed, comprehensive language access program—one that is grounded in equal parts compassion and data. There is a moral obligation and a financial case to be made. This handbook will help you do just that.
Patients with limited English proficiency (LEP) should be afforded the same standard of care as their English-speaking counterparts. Clear communication between healthcare providers and patients is essential for accurate diagnosis, treatment, and informed decision-making, regardless of language.
When there is a language barrier, it can lead to misunderstandings, misinterpretations, and potentially harmful medical errors.
When advocating for LEP patients, you must align your asks with the big picture and speak the language of budget decision-makers. Most importantly, you have to prove you can deliver outcomes that support the delivery of top-priority, hospital-wide performance and fiscal objectives.
This guide offers a step-by-step guide to developing an advocacy strategy that will achieve the following:
- Build patient satisfaction and trust when receiving care in their preferred language and reduce disparities.
- Reduce demand for and consumption of avoidable tests and consults.
- Lower the rate of complications for LEP patients.
- Improve risk management by delivering equitable care to LEP patients.
- Enhance compliance with federal financial assistance requirements, including Medicare Parts A, C, and D.
If you’re able to truly understand the depth of care gaps experienced by LEP patients, and show how it impacts your hospital system both in terms of risks and costs, while also demonstrating that your language access plan will bring about a positive return on investment.
Chapter Summary
Chapter 1: Data Report: Changing Patient Demographics and Communication Preferences, LEP Patients on the Rise
Patient Demographic Changes
The number of individuals in the U.S. who speak a language other than English at home is increasing rapidly. This group is growing at a faster rate than the U.S. population.
- Between 2011 and 2021, the U.S. Census recorded an 11.8% increase in individuals who speak a language other than English.
- The population growth rate in the U.S. between 2010 and 2020 was 7.4%.
American Citizens/Residents Who Speak a Language Other Than English (LOTE) (in millions): 12% Increase Over 10 Years
American Citizens/Residents Who Speak a Language Other Than English (LOTE) (in millions): 2% Increase Over 1 Year
American Citizens/Residents Who Speak a Language Other Than English (LOTE) (in millions): 12% Increase Over 10 Years
American Citizens/Residents Who Speak a Language Other Than English (LOTE) (in millions): 2% Increase Over 1 Year
Even over a recent one-year period, the U.S. Census counted millions more individuals who speak a language other than English at home. Since a significant subset of this group has limited English proficiency, hospital systems must prepare to accommodate the increasing demand for language access services. The solutions must be prepared to perform effectively at increasing scale.
U.S. Population Growth between the 2010 and the 2020 Census (in millions)
Over 69 million American citizens/residents speak a language other than English at home, and 26.5 million of this group report speaking English less than “very well.”
Over 60% of these 69 million multilingual residents—or 42 million individuals—speak Spanish at home. 16.7 million people from this group report speaking English less than “very well.”
11.2 million American residents speak one Asian/Pacific (APAC) language at home, representing 16% of the 69 million multilingual American residents. 4.9 million individuals from this group report speaking English less than “very well.”
Multilingual American Citizens/Residents and English-Speaking Proficiency (in millions)
Speak a language other than English at home
AND identify as limited English speaking
Speak a language other than English at home
AND identify as limited English speaking
Five Most Frequently Spoken Languages Other Than English (LOTE) in the U.S. (Individuals in millions)
Spanish/Spanish Creole
Chinese
Tagalog
Vietnamese
Arabic
Spanish/Spanish Creole
Chinese
Tagalog
Vietnamese
Arabic
English-Speaking Proficiency of Spanish-Speaking American Citizens/Residents (in millions)
Speak Spanish at home
AND identify as limited English speaking
Speak Spanish at home
AND identify as limited English speaking
English-Speaking Proficiency of APAC-Language-Speaking American Citizens/Residents (in millions)
Speak an APAC language at home
AND identify as limited English speaking
Speak an APAC language at home
AND identify as limited English speaking
Interpreting Patient Demographic Trends
The significance of these patient demographic trends cannot be overstated. When a patient is limited English proficient (LEP), language access services become an obligation of the healthcare system administering care.
With millions of American households that cannot adequately communicate with a medical provider, patient care and equity are at stake.
Your CMS rating and federal funding—for Medicare, Medicaid, CHIP, and value-based incentive payments—are also at risk if the hospital cannot overcome language barriers to meet strict standards of care.
Jump to Chapter 2 for a deeper dive into the relationship between language access and your CMS Star Rating.
Virtual Healthcare Trends
Have you ensured that your patient communication systems are equipped to meet the increasing demand for telehealth and digital communication?
The COVID-19 pandemic expedited the transition to online-based care and communication for many providers, but these virtual healthcare trends originated before 2020.
Are these trends making an impact within your hospital? These can be useful reminders that you may need to develop alternative engagement strategies to ensure LEP patients can communicate remotely and in person.
Trend #1: Patients expect digital appointment reminders
A 2022 patient satisfaction survey showed that 70% of patients preferred text messaging, and 90% (9/10) chose to use text messaging again for their care. None of the surveyed patients were dissatisfied with text communication.
Information communication strategies should also consider the patient profile and the impact on patient compliance.
Younger patients prefer digital communications for appointment and medication reminders. These methods improve adherence to medical appointment attendance and post-care instructions. They have a similar impact as a phone call with a lower cost for SMS.
If LEP patients cannot receive appointment reminder content in their target language, your organization runs the risk of cancellations, no-shows, and scheduling errors which impact your bottom line and the user experience.
Takeaway: If your appointment system cannot deliver automated content in target languages, consider how else can you engage LEP patients to increase the user experience
Trend #2: Telehealth appointments are increasingly in demand
Consideration: Are your LEP patients accessing telehealth at the same rates as English-speaking patients?
Language barriers in telehealth settings are a widespread industry problem. According to a 2022 study, telemedicine is generally well-liked by patients who use it. Telehealth is an effective method for many types of patient care. However, certain patient categories, including those who are non-white, tend to use this service at lower rates.
Takeaway: It is likely that LEP patients are using telehealth services at lower rates than English-speaking patients in your hospital. Consider engagement strategies to help LEP patients become aware of this option, especially for preliminary consults.
Chapter 1 Takeaways
→ Due to demographic shifts and millions more LEP households, language access is an increasingly essential service. Patient equity and federal hospital funding are at stake.
→ Language access needs have evolved. To ensure all patients receive the same standard of care, digital communications and telehealth must be accessible in languages other than English. Patients must be informed of their language access options early and often.
Chapter 2: Quantifying the Risks of an Incomplete Language Access Plan
What is an incomplete language access plan? And why is it important to understand the risks associated with one?
Let’s start by defining what we mean by an incomplete language access plan.
If a patient’s language barrier cannot be solved with meaningful access, professional interpretation—such as in-person, phone, or virtual services—and/or preexisting professionally translated materials—such as web pages, brochures, and consent forms—then a language access plan is incomplete.
By this definition, most language access plans in U.S. hospitals are likely to be incomplete.
Additionally, just because these resources exist doesn’t mean they’re leveraged as often as they should be. LEP patients must also be made aware of all available language access resources to support their journey. Staff must also receive timely, appropriate training to recognize when and how to activate these resources.
Signage and staff communication must be designed to help patients fully leverage the available interpretation and translation services.
By this understanding, if an LEP patient experiences doubts at any point during their interactions with a healthcare facility or provider, a language access plan should also be considered incomplete.
For example, if a patient is unable to provide or understand information during any of the following steps of a patient journey, a language access plan requires revisions:
- Communicating symptoms before, during, or after a provider visit.
- Responding to provider questions in real time.
- Comprehending and engaging in their treatment plan.
- Understanding aftercare instructions, prescription including dosage and side effects.
- Understanding the consent for procedures and testing.
- Completing follow-up and referral visits.
- Navigating payment and insurance obligations.
A Note on Bilingual Staff
Bilingual staff is a valuable asset, but relying on their language skills is not a sound strategy. You have to be certain that every bilingual hire received their medical training in English and in the target language(s) they speak, which is often not the case. Only qualified medical interpreters and translators can deliver the assurance and accountability required for the sensitivities of this job.
Top 4 Risks of an Incomplete Language Access Plan
When designing and implementing a language access plan, most hospital administrators in the U.S. have to make the most of their available resources. This often means accepting the implied risks of unsolved language barriers in patient care.
Let’s confront the primary risks—and unpack how your role can protect the hospital from inequitable patient outcomes and financial liabilities that impact the bottom line.
Risk #1: Providing care without qualified interpretation leads to higher rates of resource consumption
- Doctors treating without the help of an interpreter may need to run more tests and procedures to ensure proper treatment.
- For patients without insurance, these tests can be costly to medical facilities and patients.
- When professional interpreters are not used at admissions and/or discharge, LEP patients often incur longer hospital stays.
Risk #2: LEP patients experience higher rates of complications, clinical errors, and near miss/close calls
- Adverse events, such as surgical complications, are more frequent and severe when medical providers face communication barriers.
- Pediatric patients with Spanish-speaking LEP families have a much greater risk for serious medical events during hospitalizations than patients whose families are English proficient.
LEP patients have greater difficulty understanding discharge instructions, including how to manage their condition, take their medications, recognize symptoms that should prompt a return to care, and know when to follow up.
Risk #3: LEP patients experience post-hospitalization readmission risk at higher rates
- Persons with limited English proficiency often report difficulty with accurate and safe communication with healthcare providers, including those in charge of post-hospitalization care.
- A study of 90,221 post-hospitalization patients and 6.5 million home health care visits shows LEP patients have a higher hospital readmission risk.
- Spanish speakers may experience the highest readmission risk of the language groups studied.
Risk #4: Failing to engage language access services when treating LEP patients can result in legal and financial liabilities for the hospital
- A study of pediatric encounters over a 7-month period showed that most medical interpretation errors have potential clinical consequences.
- LEP patients are at greater risk of line infections, surgical infections, falls, and pressure ulcers due to longer hospital stays than English-speaking patients with the same clinical condition.
- A study analyzed medical malpractice claims when language barriers may have resulted in harm to the patient. In 35 claims, the carrier paid $2,289,000 in damages or settlements and $2,793,800 in legal fees.
- 2.5% of malpractice suits may be related to language/interpretation problems and cost around $5 million to the malpractice carrier.
Under the fourth risk factor, the same study pointed out that in 32 of 35 analyzed malpractice cases, the healthcare providers did not use qualified interpreters. Twelve of them counted on family members or friends to interpret medical information, including minor children in two cases. More than 10 did not translate any informed consent forms or discharge instructions. Nearly all the cases highlighted poor documentation of a patient’s limited English proficiency and the need for an interpreter.
These oversights led to millions of dollars in increased malpractice premiums, patient settlements, and legal fees.
While each risk factor bears significant costs, not all readmissions, complications, or clinical mistakes can be avoided. Considering LEP patients experience all of these risk factors at higher rates than their peers, the need for deliberate interventions becomes urgent.
A comprehensive language access plan can improve LEP patient outcomes. It can also apply hospital resources more effectively, contribute to improved financial performance, and enhance your hospital’s rating.
There is another major risk factor that deserves its own section: compliance with laws and regulations governing LEP patients’ rights.
Federal Compliance
Hospitals that receive funding for Medicare, Medicaid, and CHIP have an obligation to perform medicine without discrimination on the basis of race, color, or national origin.
According to the U.S. Bureau of Primary Healthcare (BPHC):
All health centers that apply for or receive Federal award funds under the Health Center Program authorized by section 330 of the Public Health Service (PHS) Act (42 U.S.C. 254b) (“section 330”), as amended (including sections 330(e), (g), (h), and (i)), as well as subrecipient organizations and Health Center Program look-alike, must:
- Develop a plan and make arrangements for interpretation and translation that are responsive to the needs of such populations, for providing health center services to the extent practicable in the language and cultural context most appropriate to such individuals; and
- Provide guidance to appropriate staff members with respect to cultural sensitivities and bridging linguistic and cultural differences.
Applicable facilities must conduct a language access needs assessment, and, based on that assessment, develop a written language access plan.
We recommend completing the language access needs assessment as advised by the BPHC. Since compliance is not the only matter at stake, we recommend pursuing this obligation to a greater extent.
Language Access, CMS Star Ratings, and HCAHPS
When attempting to justify increased resources for your language access program, the CMS Star Rating is an important lever to pull. The number of stars out of five directly impacts the hospital’s access to Medicare incentive funding. It’s simple: the higher the rating, the greater the funding awarded for excellent care. Plus, this rating is visible to Medicare patients. When they’re making a choice about where to seek treatment, a higher rating sends a strong message.
HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems, pronounced “H Caps”) is how CMS develops its star ratings and calculates related incentive payments. It is a national, standardized, public survey about patients’ hospital experiences. Your mean score is the basis for calculating the value-based incentive payments awarded by CMS.
HCAHPS includes a person and community engagement domain to assess the quality of patient communication at nearly every touch point during a hospital visit. If this section repeatedly scores poorly, it is unlikely that your facility will be able to qualify for larger incentive payments or earn/retain a higher star rating. If LEP patients are shown to experience worse care outcomes, such as higher rates of procedure complications, the score will also be impacted.
As stated earlier, the foreign language interpreter and TTY availability score dropped by more than two points between 2022 and 2023. With the broader context in mind, improving this score for your facility could result in a larger-than-usual impact.
A complete patient journey mapping exercise and gap analysis will help reduce the number of LEP patients who report provider communication difficulties—and, ideally, help maintain or bolster your hospital’s star rating.
Health Equity and Racial Inclusivity
As a social determinant of health, racial inclusion can be a matter of life or death. Vital patient outcomes—such as life expectancy—are often determined by the patient’s access to a comparable standard of care relative to age-group peers.
A rankings program recently quantified the urgent need to improve racial inclusivity in U.S. hospitals. Hospital market segregation is measurable in many major cities—meaning a hospital’s patients served do not reflect the complete makeup of the surrounding community. As indicated with LEP patients, multi-cultural competency can make all the difference between a smooth procedure and patient experience or readmission due to complications.
Only 3% of surveyed hospitals achieved a five-star (out of five) rating concerning racial inclusion.
Health equity goals and language access strategy must work hand-in-hand. Depending on where a LEP patient lives, they may also face hospital market segregation and additional barriers to care. Racial inclusivity plans must also consider the overlapping needs of LEP patients, dedicate resources towards language access, and tie LEP patient outcomes to their success measures.
Chapter 2 Takeaways
→ Hospitals are exposed to costly legal and financial liability if their language access plans do not meet patient needs.
→ Federal funding is also at stake if language access needs are not met.
→ Compliance is an important starting point, but it is not the finish line for a comprehensive, well-resourced language access plan.
→ HCAHPS shows a decline in language access availability between 2022 and 2023.
→ Your CMS star rating is at stake when language access plans are not comprehensive.
→ Health equity and language access must be synchronized to achieve the best outcomes for LEP patients.
Chapter 3: Mapping the Journey of a Limited English Proficiency Patient
This chapter will guide you through the healthcare journey of a patient via the lens of their lived experience. Your plan must always keep these perspectives top of mind. When a language barrier is present, the process can be overwhelming every step of the way.
A language access plan cannot remove every stressful element of a doctor’s visit. What it should do: preserve individual dignity, facilitate clear and accurate communication, comply with legal requirements, reduce health disparities, and improve patient safety and satisfaction.
By embedding trained interpreters, translated materials, and accessible support processes into the everyday makeup of your hospital’s operations, you can reliably offer the same high standard of care to every individual who passes through your facility. That will not go unnoticed.
Before Care Begins
Before a patient seeks care, they will research providers and interact with online resources to determine who can treat their concerns. Perhaps they will notice the hospital’s star rating, though apart from the number of stars out of five, they might not know exactly what it means.
The first point of communication must be easy to understand. Offer clear content in the primary language of the communities you serve, whether through online resources, marketing materials, or printed collateral.
Trust in healthcare providers begins early. At this stage, the patient will be considering many questions about their symptoms and much to share about their health history. A website or preliminary phone call will indicate whether the office can answer and understand their questions—or whether the patient will have to jump through hoops to access language resources.
If you do, the patient will attempt to set an appointment using the most accessible method you have made available. Or, in an acute situation, they will be walking into the nearest hospital that can treat their problem, ideally one with clearly stated language access services.
If the patient is not confident they will be able to communicate effectively during their visit, fear, shame, or sadness may rear their ugly heads. In such an instance, the LEP patient may abandon their intent to seek care altogether—which means a potentially life-threatening illness may go untreated longer, and worse outcomes are possible.
To prevent this, consider how your points of entry can create a welcoming environment for LEP patients. Explore solutions beyond the requirements for compliance. Posting your language access policy is likely not enough to solve this problem.
Day-of-Care
If you were someone with limited English proficiency, how would you feel walking into a healthcare setting? Hospitals are already stressful environments for patients. A doctor’s visit can feel like a dreaded, painful experience before it begins. Introduce a language barrier—and the difficulties LEP patients face become even more tangible.
When appointment day finally arrives, or when a patient takes their first step into a walk-in clinic or emergency room, they likely have a lot on their mind. Anxiety has been linked to lower rates of patient satisfaction. It’s no surprise—if a patient is concerned about being understood, they may not perceive the care they receive to be quality, accurate, or trustworthy.
These anxieties may be completely valid. But, if language access is a seamless process from the beginning—say, a QR code that provides access to a hospital map in the target language, or a front-desk staff member who used a phone interpreter to provide intake instructions—those fears are likely to be addressed quickly.
During Care
After making it as far as the waiting room, the patient will have a sense of whether their language barrier will be a defining factor in their care that day. The impact of those entry points is significant, especially on a patient’s mindset. What happens next will have the greatest impact on their overall health outcomes.
Consider the grave importance of professionalism in this context. Hospitals must treat language services as a vital role in patient care. Since interpreters are trained linguists and adept cultural mediators, they ensure precise, culturally sensitive communication between patients and providers. Their strict adherence to deontological ethics guarantees the confidentiality, impartiality, and neutrality vital in healthcare settings, which preserves the integrity of sensitive interactions and privacy of patient information.
Unless a provider has received qualified interpreter training in the target language in addition to English, there are matters of communication and culture that could be missed—and introduce inadvertent barriers to patient care.
Follow-up Care
For some patients, their visit with a Healthcare Professional (HCP) is just the beginning of their journey. Whether the follow-up care is minor or significant, a language access plan needs to account for the complex, sometimes hard-to-follow post-care instructions that will keep a patient on the road to good health.
Language access administrators must also consider care coordination. Can your process facilitate end-to-end language access if the patient requires referrals to other providers for adjacent conditions or symptoms? If this provider is outside your facility, do you notify them of language access needs to encourage minimal interruption to patient care?
Billing and Insurance
Your language access plan must also include resources for your billing department. Activating language services to support insurance, preauthorization, and payment processes can help hospitals stabilize revenues. Addressing language barriers could be the difference between bills paid on time and hours of productivity spent following up on overdue statements.
Communication Entry Points
Website, Patient Portal, Phone System
Appointment Confirmation and Reminders
Email, SMS, Automated Phone Calls, Live Phone Calls
Related Language Access Resources:
• Website translation and localization
• Patient portal translation
• Intake paperwork translation
• Pre-recorded phone menus in threshold languages
• Appointment confirmation and reminder translations
• Real-time phone interpretation
Parking Lot / Transit Signage
Building Navigation
Front Desk Intake
Identification, Insurance, Consent Forms
Kiosk Intake
Related Language Access Resources:
• Outdoor/indoor signage and map translation
• Audio or video remote interpretation
• Consent form translation
• Patient portal translation
• Digital menu and intake form translation
Medical Assistant Intake
History & Symptoms Reporting
Provider Interactions
History & Symptoms Reporting, Consent for Testing and Procedures, Treatment Plan, Prescriptions, Consults & Referrals
Insurance Authorization
Related Language Access Resources:
• Audio interpretation
• Video remote interpretation for sensitive conversations
• In-person interpretation for complex or sensitive conversations
• Test and procedure information translation
• Post-care instructions translation
• Medication use and side effects translation
Follow-Up Visit Scheduling
Appointment Reminders
Prescription Use Instructions
Care Coordination Across Providers/Referrals to Other Offices
Related Language Access Resources:
• Website translation and localization
• Patient portal translation
• Appointment reminder translation
• Medication instructions translation
• Care coordination plan
Payments
Online Payments, Mail Payments, Phone Payments, Payment Plans, Discount Plans
Insurance Authorization
Related Language Access Resources:
• Audio interpretation
• Billing paperwork translation
• Insurance-related paperwork translation
• Payment plan terms translation
• Discount plan terms translation
• Patient advocate resources translation
Communication Entry Points
Website, Patient Portal, Phone System
Appointment Confirmation and Reminders
Email, SMS, Automated Phone Calls, Live Phone Calls
Related Language Access Resources:
• Website translation and localization
• Patient portal translation
• Intake paperwork translation
• Pre-recorded phone menus in threshold languages
• Appointment confirmation and reminder translations
• Real-time phone interpretation
Parking Lot / Transit Signage
Building Navigation
Front Desk Intake
Identification, Insurance, Consent Forms
Kiosk Intake
Related Language Access Resources:
• Outdoor/indoor signage and map translation
• Audio or video remote interpretation
• Consent form translation
• Patient portal translation
• Digital menu and intake form translation
Medical Assistant Intake
History & Symptoms Reporting
Provider Interactions
History & Symptoms Reporting, Consent for Testing and Procedures, Treatment Plan, Prescriptions, Consults & Referrals
Insurance Authorization
Related Language Access Resources:
• Audio interpretation
• Video remote interpretation for sensitive conversations
• In-person interpretation for complex or sensitive conversations
• Test and procedure information translation
• Post-care instructions translation
• Medication use and side effects translation
Follow-Up Visit Scheduling
Appointment Reminders
Prescription Use Instructions
Care Coordination Across Providers/Referrals to Other Offices
Related Language Access Resources:
• Website translation and localization
• Patient portal translation
• Appointment reminder translation
• Medication instructions translation
• Care coordination plan
Payments
Online Payments, Mail Payments, Phone Payments, Payment Plans, Discount Plans
Insurance Authorization
Related Language Access Resources:
• Audio interpretation
• Billing paperwork translation
• Insurance-related paperwork translation
• Payment plan terms translation
• Discount plan terms translation
• Patient advocate resources translation
Chapter 3 Takeaways
→ LEP patients may opt out of pursuing care unless language access resources are advertised at entry points, such as websites and through appointment booking systems.
→ The complete LEP patient journey is extensive. Consider their needs from a holistic point of view. Review each touch point to ensure your language access plan provides full coverage.
→ Relying on bilingual staff and/or family-provided interpretation cannot shield the hospital from liability.
Chapter 4: Assess Your Language Access Plan
Language access managers work hard on behalf of patients. If you plan to solicit greater resources and funding for your department, a gap analysis can help you identify the areas of highest need and impact and develop the justification necessary for advocacy.
The following gap analysis assessment will help to assess the current language access plan. Through this process, you can learn where there is room for the program to expand and improve on behalf of LEP patients and overall hospital performance.
Pre-Visit Communication
- Can patients request language services at the time of making an appointment?
- Is the patient portal available in threshold languages?
- Are hospital marketing and communication materials available online in threshold languages?
- Is pre-appointment communication offered in threshold languages?
- Are LEP patients canceling or no-showing at higher rates?
Navigating Intake
- Are printed facility maps or QR codes linking to maps available in threshold languages?
- Is there exterior signage/nearby transit signage available in threshold languages?
- Is there a language identification notice at all access points?
- Are intake, admission, and insurance instructions available in threshold languages?
- Does intake staff know how and when to access an audio interpreter request?
- Does intake staff know how and when to access an in-person or video interpreter request?
During Care
- What is the Average Response Time (ART) when dialing in for an interpreter?
- Are consent forms available in threshold languages?
- Do providers and staff know how and when to access an audio interpreter request?
- Do providers and assistants know how and when to access an in-person or video interpreter request?
- Does your hospital system have a policy on family member-provided interpretation?
Follow-up Care and Outcomes
- Are treatment plans, test results, and prescription instructions available in threshold languages?
- Are requests and explanations for insurance authorization available in threshold languages?
- Does your language access plan account for care coordination across referred providers and departments?
- Do you measure LEP patient compliance with follow-up visits?
- Do you survey LEP patients about their experiences with your system’s language access services?
- Do you survey Healthcare Professionals (HCPs) and staff about their experiences with your system’s language access services?
- Do you review LEP patient outcomes, satisfaction, and feedback regularly?
Reviewing the Results
After going through the patient journey and gap analysis, you may have sparked new ideas to elevate your program on behalf of LEP patients.
The next chapter will help you pursue your most ambitious ideas and perform the necessary internal advocacy to bring them to life. Keep up the momentum—we’ve got your back.
Chapter 5: Develop Your Language Access Plan
Language access planning is far from simple. Lean into structure and checklists to simplify where you can. This step-by-step checklist will help you break down the process into manageable pieces and stay organized.
Step 1: Understand the Big Picture
Here’s a difficult reality that needs to be acknowledged from the get-go. Most hospital stakeholders are not overly concerned with language access. Some may view language access services as a cost center and compliance obligation that does not yield returns.
This is not the whole story. You have the opportunity to highlight the positive impact, both financially and legally, as well as the ethical significance, that is woven into this vital work.
You can work within this context by aligning your program with your stakeholders’ primary concerns:
- What are the hospital’s big-picture goals right now?
- What are the primary concerns, threats, and risks we are facing collectively as a hospital system?
- How does my language access program fit into the big picture?
- How do my solutions contribute to hospital success—outside of my personal objectives?
Your answers must consider:
- Hospital finances
- Program budgets
- Current pain points
- Funding compliance requirements
- Overall patient experience and patient outcome objectives
Step 2: Identify Your Top Priorities
What did the gap analysis teach you? Focus on the zeros, ones, and twos. Identify the most important areas for remediation within your facility to build out your 12-month plan.
You may want to pick some easy wins to go after in the first year. When it comes to the more challenging asks, you’ll need to pick your battles—and above all, be ready to justify with a solid return on investment calculation.
Include a continuous improvement process in your plan. Implement, assess results, and improve. This will provide you with the necessary data to continue advocating for your program’s value.
Step 3: Develop a Financial Forecast
Using demographic data, hospital financial data, patient data, and other reputable sources, generate an expected program return on investment.
If you have access to internal numbers, use them. Develop financial projections based on the risk factors of insufficient language access. Gather case studies about malpractice suits and premium increases. Calculate the financial impact of reducing avoidable tests and procedures in exchange for investing in more robust, on-site or virtual language services.
Summarize these findings into a realistic, easily digestible figure that predicts outcomes. For example: if the hospital is anticipated to admit X number of LEP patients in 12 months, implementing this plan is expected to reduce admission costs by Y%. Show your work. Don’t overestimate your impact—it’s always better to underpromise and overdeliver.
Step 4: Educate and Advocate
Diversity, equity, and inclusion is not just a buzzy phrase. Language access has tangible financial and legal implications. Your education and advocacy effort must continually remind decision-makers and stakeholders of the realities and liabilities they face without sufficient resourcing.
This work will improve patient outcomes and contribute to cost containment at scale. They may not know this yet, but now, you have all the tools to prove it.
LEP patients are counting on you—and we know you can get the job done.
Partner with PGLS to Close the Care Gap for your LEP Patients
Delivering a comprehensive language access program for LEP patients isn’t just good business sense. It’s also the right thing to do.
This is a chance to lead by example, create an equitable and inclusive healthcare environment, and improve patient outcomes for some of our society’s most vulnerable.
As your preferred language access partner, PGLS will help you navigate the complexities of delivering comprehensive language access to your patients while ensuring you remain compliant with government mandates.
Our world-class team of translators and interpreters are proficient in over 200 languages and regional varieties and will effectively and accurately translate and interpret healthcare-related content with sensitivity, accuracy, and cultural awareness. PGLS offers comprehensive phone, video, and on-site interpretation services and translation services to facilitate patient-provider communication in their preferred language, so they can understand and make informed decisions about their care.
You can count on PGLS to help you:
- Ensure access to all vital language services in the healthcare industry
- Improve patient satisfaction
- Reduce litigation risk
- Meet language access regulations and government mandates
Contact PGLS today to learn more about our healthcare solutions.