Abstract
Background:
In 2015, Swedish Medical Center recorded 114,282 patient requests for interpretation in 143 different languages. CHNAs and interviews with community leaders identified the importance of cultural and linguistic competency when designing healthcare services. Our goal was to reduce language barriers for the most-used languages and improve the care experience for limited English proficiency (LEP) communities at Swedish.
Methods:
We began by reviewing CHNAs and having discussions with various LEP community stakeholders about their experiences at Swedish. We developed an in-language patient satisfaction survey for baseline and compiled translated forms and documents. Once we reviewed the data, we created a communication plan for units and clinics that would engage charge nurses, and we distributed language aids. We created updated forms and documents and developed a training program to internally share and educate caregivers. Postintervention, we again conducted the patient satisfaction survey.
Results:
LEP patients’ knowledge of how to use interpretive services increased from baseline to postintervention, and LEP patients’ reported ease of communication also improved. This intervention showed that we could raise awareness through project presentation to leadership and staff, that we should develop interpreter services training and embed a presentation about these services in the monthly and yearly new provider and resident orientation, and that we should include language scenarios in the Culture of Safety training.
Conclusion:
LEP patients and staff alike have frustrations when it comes to the impact of communication limitations on patient care. We believe that the interventions developed in this project have the potential to improve numerous patient/staff interactions and patient experiences. Although data collection to support this conclusion has been difficult, we received positive feedback from the nursing staff regarding the compilation and organization of frequently used documents. Our hope is that our Interpretive Services Department can build upon this work to sustain, scale, and spread our efforts to the entire Swedish Health Services system.
PROJECT MANAGEMENT PLAN – In Their Own Words: Improving Interpretation and Language Access.
| Vision Statement | Our vision is to improve engagement, bridge communication gaps, and deliver culturally responsive care to the limited English proficiency (LEP) communities we serve. |
| Team Objectives | Our objectives were to reduce language barriers for the most-used languages and to improve the care experience for LEP communities at Swedish. Our project targets were the top 5 non-English speaking communities: Spanish, Chinese (Cantonese and Mandarin), Vietnamese, Somali, and Amharic. Our project scope was First Hill Campus Inpatient Units (medical/surgical, postpartum, and pediatric units) and Outpatient Clinics (First Hill and Cherry Hill Family Medicine Resident Clinics). Our project assumptions were that lack of culturally sensitive menus (translated menus, special diets) for inpatients, lack of translated forms/documents for clinical communication, need for universal signage for wayfinding, and limited and suboptimal user experience of interpreter services all contribute to impaired communication and suboptimal hospital experiences for LEP patients. Our measures of success were increased use of interpreter services and translated forms, increased awareness of the organization’s language support and resources, improved patient satisfaction scores, increased physician satisfaction when providing care to LEP patients, and meeting communities’ cultural needs as part of culturally competent care. |
| Success Factors | The most successful part of our work was presenting our project to Swedish executive leadership and administrative teams, as well as getting the unexpected approval of including an interpreter services presentation during new provider orientation as part of onboarding training. We were inspired by the passion and engagement of our own teammates. This project was driven, planned, and executed purely by residents who voluntarily dedicated time to support and contribute to the project with the goal of doing the right thing for our LEP patients. |
| Barriers | The largest barrier encountered was that the resources for data extraction and analysis (technical or operational) were not as rich as the group had originally anticipated. We worked to overcome this challenge by acknowledging missing gaps and remaining flexible to adjust project approaches while keeping our goals on target. |
| Lessons Learned | The single most important piece of advice to provide another team embarking on a similar initiative is to have a strong leadership sponsor to help manage change and clear system obstacles for the project. |