Improvement Stories

Ensuring Safe Care for All: Improving Care for Patients with Limited English Proficiency

The role of language barriers and their impact on adverse events is now receiving greater attention. Research suggests that adverse events that affect patients with Limited English Proficiency (LEP) are more frequently caused by communication problems and likely to result in serious harm, when compared to English-speaking patients. Language barriers also lead to longer lengths of stay and higher readmission rates. To address this, the Joint Commission has developed a set of standards on patient-centered communication that emphasize the importance of language, cultural competence, and patient-centered care. The following initiatives are being undertaken at MGH to prevent medical errors and address disparities between patients with LEP and English-speaking patients:

Training for MGH Clinicians

The Disparities Solutions Center, in collaboration with the MGH Institute of Health Professions, has developed an interprofessional curriculum to educate providers, frontline staff, and non-patient facing employees on providing safe and effective care for patients with LEP. The program consists of three e-learning modules that address the evidence of disparities and high rate of medical errors for patients with LEP, provide training on concrete skills for working with professional interpreters as integral members of the care team, and explore how systems of care can be improved. The training has reached a total of 6,046 MGH employees to date and is being adapted for broader roll-out throughout the Partners system.

Clinical Process Improvement Leadership Program (CPIP) on the Pediatric Floors

A team of pediatric nurses, physicians, and support staff was formed as part of the CPIP program to identify and address the needs of patients with LEP and their families. Based on feedback from a staff survey, two barriers to care were identified: the time required to locate and connect to offsite interpreter devices and for an in-person interpreter to arrive on the floor. In response, additional devices were obtained, which allows these resources to remain in each LEP patient room for the duration of a patient’s admission. In addition, education around accessing interpreter services and indications for placement of phones was provided. Through a series of PDSA cycles (Plan, Do, Study, Act), a trend toward an increased number of interpretations per day was identified. The team plans to share lessons learned with other areas of the hospital to help identify and address similar disparities. 

Rounding on Newly Admitted Patients with LEP

MGH Medical Interpreter Services is partnering with Volunteer Services to create a program to round on newly admitted patients with LEP. These visits are used to introduce patients to the language services available at MGH, provide materials in their language, and inform them of their right to a professional medical interpreter at no cost. The objective is to ensure that patients and families know that language assistance is always available in a variety of modalities and make it easy for clinicians to facilitate this interaction by ensuring that interpretation devices are readily available where needed.


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