Providing Culturally and Linguistically Appropriate Services

Department of Multicultural Affairs

Effective Communication, Cultural Competence, and Patient-and-Family-Centered Care

Providers and staff at Grady® are committed to Effective communication, Cultural Competence, and Patient-and- Family-Centered Care. This commitment demonstrates our efforts to:

•Eliminate disparities in healthcare and promote equal access

•Respond effectively to diverse patient and staff demographics

•Increase the quality of care and health outcomes

•Compliance with state, federal and accreditation mandates (Title VI

of the Civil Rights Act of 1964, Americans with Disabilities Act,

HIPAA, Joint Commission, and CLAS standards, etc.)

•Improve customer service and increase market share

Differences in “the overall rate of disease incidence, prevalence, morbidity, mortality or survival rates."

U.S. Department of Health and Human Services' Office of Minority Health

Main factor for health disparities: Culture

What are health disparities?

What is Cultural Competence?

• a set of congruent behaviors, attitudes, and policies that come together and enable effective response to cultural and linguistic needs of patients

• Developing cultural competence results in an on-going ability to learn, understand, and effectively communicate and interact with people across cultures.

• Cultural competence is not an endpoint, but an ongoing commitment to decrease health disparities.

Department of Multicultural Affairs (DOMA)Mission:To eliminate barriers to healthcare access and to encourage provision

of culturally and linguistically appropriate services to decrease health disparities.

DOMA provides organizational support for effective communication, cultural competence, and patient-and-family-centered care and fosters compliance with the accreditation standards and federal mandates regarding cultural and linguistic issues.

The Department of Multicultural Affairs consists of the following areas:

• International Medical Center (IMC)

• Injury Free Coalition for Kids (IFCK)

• Multicultural Programs

• Language Interpretive Services (LIS)

International Medical Center404.616.6689

• Patient-and-family-centered approach

• Diverse Staff and Providers• Community-specific clinics• Internal medicine• Gynecology• Obstetrics

• Pediatrics• Mental health• Social Services• Financial Counseling• Health Education

Primary Care Services in a culturally and linguistically appropriate environment

Facilitate outreach and safety promotion initiatives to reduce the number of pediatric injuries

- Baby Safety Shower & Safety House Program

- Car Seat Instruction and Distribution

- Occupant Safety Certification Training

404-616-1403

Multicultural Programs 404.616.4993

• Serve as a liaison with the community and GHS departments

• Advocate for cultural competence, patient-and-family-centered care

• Community outreach and promotion of GHS services

• Offer cultural competence trainings– More information at http:gradyu.gradyhealth.org under

cultural competence

Language Interpretive Services404.616.9626

• Trained & qualified staff medical interpreters – Spanish

• Telephonic interpreters - over 170 languages

• Agency interpreters in person as needed

• Video conferencing or agency interpreters forAmerican Sign Language

• Translated written documents

What makes an interpreter qualified?

A qualified interpreter must demonstrate:• Proficiency in English and the target language• Proficiency in medical terminology in both languages• Knowledge and use of interpreter roles, standards and protocols• Awareness of cultural issues, the significant role they play and how to

address them during a medical interpreting session• Interpreting skills that support the provider-patient relationship• Adherence to national code of ethics for interpreters

A qualified interpreter must complete:• At least one nationally recognized medical interpreter training• A nationally recognized medical interpreting test• Continuing education trainings in the field of medical interpreting

“Language Proficiency and Adverse Events in U.S. Hospitals:

A Pilot Study”

Adverse events involving some physical harm • 49.1%of Limited English Proficient (LEP) patients vs. 29.5%

of English speaking patients

Patients with moderate temporary harm to death• 46.8% of LEP patients vs. 24.4% of English speaking patients

Communication errors• 52.4% of LEP patients vs. 35.9% of English speaking patients

“Language Proficiency and Adverse Events in U.S. Hospitals: A Pilot Study” The Joint Commission Chandra Divi, Richard G. Koss, Stephen P. Schmaltz and Jerod M. Loeb

How to use an Interpreter

In Person? Over the Phone? Video?

Call 5-9626

IntroduceBrief Speak to Patient

Reasons To Use A Qualified Medical Interpreter

• Improve efficiency, customer service, and patient satisfaction

• Improve communication between staff, providers and patients

• Decrease risks of liability

• Comply with GHS policies

• To demonstrate that GHS is culturally competent

• Comply with federal and accreditation mandates:– Title VI – Executive Order 13166– Americans with Disabilities

Act (ADA) – Culturally and Linguistically

Appropriate Services (CLAS) Standards

– Joint Commission – HIPAA

• Increase safety of patients

The main reason is to communicate effectively with our patients

CLAS, Title VI, ADA, and The Joint Commission

• Effective and understandable communication• Cultural, linguistic, and learning needs assessment• Written materials based on patient communication needs• Interpretation and translation services• Staff competence (Qualified interpreters and translators)• Records of communication with patients• Patient involvement• Patients with comparable needs receive same standard of care• Hospitals provide services in accordance to laws and regulations

Key Cultural Competence Skills

• Awareness of one's own cultural worldview

• Value for diversity and cultural differences

• Knowledge of different cultural practices and worldviews

• Assessment of possible barriers

• Involvement of patients and families

• Respect for individuality while avoiding stereotyping

• Adaptation to diversity and cultural contexts of the populations served

•How do I determine the race/ethnicity of patients?Always ask the patient to self identify and explain benefits.

•What should I do if my patient is not willing to adhere to treatment?Assess for cultural needs or barriers that may exist. Call 5-4993 for assistance.

•What if a specific cultural practice is harmful to the patient?Talk to your patient and explain the risks. Negotiate when possible.

•Can I have family or friends support with the care?Yes, if this is the choice of the patient, having his/her person of choice is always recommended.

Frequently Asked Questions

Frequently Asked Questions

•When should I use a qualified medical interpreter?For any interaction with LEP or deaf patients.

•Should I document the use of an interpreter?Yes. Include interpreter’s name, code, date, time and subject.

•Can I ask the patient to bring his own interpreter for his or her next appointment?No. It is our responsibility to provide the interpreter to the patient.

•Can I use bilingual staff, volunteer, provider, family member or friend to interpret?No. The use of a qualified interpreter is required by mandates.

•What if the patient refuses to use an interpreter?Patients must first know that service is available, free and confidential. Refusal should be documented in chart. A waiver is available for patients to sign.

•What do I do if a staff interpreter is not available?Use our telephonic agency or video conferencing system for ASL. Interpreters can also be scheduled by calling LIS (5-9626) ahead of time.

•Is written information in the patient’s language enough to communicate with him/her?No. Written information should be provided in the patient’s language. It only supplements information given verbally. (This applies to LEP and English-speaking patients).

•If I am fluent in that language, do I still need to use an interpreter?No. If you are fluent you can speak directly to the patient, but cannot interpret unless you meet the required interpreter qualifications. Ask about the Bilingual Provider Assessment at 404 616-4993

Frequently Asked Questions

You can be culturally competent

• Remember the critical role of culture and language

• Address identified barriers to reduce impact in health status/adherence

• Learn about beliefs and practices of your patients. Ask when you do not understand

• Avoid stereotyping. Customs and culture vary from individual to individual

• Involve family when appropriate and work together in establishing goals

• Always use qualified interpreters. Never use children to interpret or ask patients to bring their own interpreter

• Use a normal tone of voice and become aware of your body language

• Verify understanding. Ask for summary with their own words

• Attend cultural competence trainings

For interpreters (in person, phone, video) or for translations 404.616.9626

For the Department of Multicultural Affairs - 404.616.4993

Additional Resources

Grady Health System Cultural Competence Trainings gradyu.gradyhealth.org

Grady Health System Language Access for Limited English Proficient (LEP) and for Deaf or Hard of Hearing Persons Policy gradynet.gmh.edu/PoliciesAndProcedures/LEPandDeafpatients

U.S. Department of Health and Human Services - Office of Minority Health –CLAS Standards http://www.minorityhealth.hhs.gov/

U.S. Department of Health and Human Services Office for Civil Rights – Title VI and Section 504 http://www.hhs.gov/ocr/

U.S. Department of Justice Americans with Disabilities Act www.ada.gov

Interagency Working Group on Limited English Proficiency www.lep.gov

The Joint Commission Effective Communication Resources http://www.jointcommission.org/

Bilingual Provider Assessment

Bilingual providers are encouraged to take the Bilingual Provider Assessment to: •Demonstrate bilingual skills•Be listed as bilingual (in assessed language)•Not be required to use interpreter to communicate directly with his/her patients who prefer using language assessed

For more information please contact Cesar Alvarado at

404 616-4993 or calvarado@gmh.edu