IMIA International Conference on Medical Interpreting “Pioneering Healthy Alliances”

1. COMMUNICATION - KEY TO PATIENT SAFETY IMIA International Conference on Medical Interpreting “Pioneering Healthy Alliances” Boston, Massachusetts Oct. 5 – 7, 2007

2. Presented by: Sandra Sanchez, M.S., Director, Multi-Cultural Affairs Grady Health System, Atlanta and Linda Joyce, M.S., Language Access Consultant Interpreter

3. 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

4. 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. Patient Safety Definitions

5. Why the focus on patient safety? Joint Commission, Dec., 2006

6. 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

7. Joint Commission - Dec. 2006

8. 2007 National Patient Safety Goals • Patient Identification • Improve communication • Medication Safety • Reconcile Medications • Patient involvement • Focused risk assessment

9. “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

10. WHO (World Health Organization) Patient Safety Solutions • Patient identification • Communication • Assuring medication accuracy • Look-alike, sound-alike medication names

11. 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

12. Language and culture 101 Basic considerations to improve patient safety • Primary/preferred Language • Cultural Background • Health Literacy Levels

13. 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

14. 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

15. “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

16. Adverse event type characteristics for English speaking and LEP patients Joint Commission – C.Divi et al.

17. 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

18. 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

19. Grady Health SystemDepartment 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

20. 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

21. 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

22. 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?

23. 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

24. 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

25. Thank You!