Recognizing the Importance of Language Need in Healthcare:

The US Experience

Elizabeth A. Jacobs, MD MPPJohn H. Stroger, Jr. Hospital of Cook County

Welsh Language in Healthcare ConferenceCardiff, Wales

March 26th, 2010

Why Would I be Informative?

• Wales– Small Population– Homogeneous– National Health Care– Emphasis on Primary

Care– Welsh Language

predominant “other” language”

• US– Large Population– Heterogeneous– Mostly Private System– Emphasis on Specialty

Care– 303 languages spoken

at home

We Have the Same Problems

Although, Not Exactly

• Welsh Language Need– 20% speak Welsh– Code-switching – Especially when

communication important

• US Language Barriers– 20% speak English

“less than well”– Linguistic access

services are essential

Why Aren’t Language Needs Met?

• Lack of data

• Lack of planning

• Lack of awareness

• Attitudes

• Cost

• Lack of access to language resources

G. Roberts and Colleagues. Report of a Study of Welsh Language Awareness in Healthcare Provision in Wales . 2004

Data: Garbage In Garbage Out

• Need to ask (the right way)

• Need to record

• Need to use

Planning: “One More Thing?!”

• Data

• Dedication

• Diligence

Awareness?

"If English was good enough for Jesus, it’s good enough for Texas schoolchildren”

Attitude?

Awareness Attitude

• Data• Stories• Solutions

Why Should We Pay for This?

• We pay already

• It is cheap

• “Do no harm”

How Do We Do It?

• Bilingual providers

• Professional interpreters– Face-to-face– Telephonic– Video

• Dual-role interpreters

• Ad hoc interpreters

Your Stories?

How Do You Do It?

• Bilingual providers

• Professional interpreters– Face-to-face– Telephonic– Video

• Dual-role interpreters

• Ad hoc interpreters

But Are They Qualified?

Making it Happen

4 Critical Questions

• Who is my audience?

• What do they need to know?

• What is my ask?

• Who are my allies?

1. Who is My Audience?

1. Administrators 2. Clinicians

Power of Positive Intentions

• No one made the decision that all patients should communicate in English, regardless of language need

• They just don’t know:– The consequences– How to provide the appropriate services

2. What do They Need to Know?

• What happens when patients don’t have access to care in Welsh

• How do they provide care in Welsh

Providing Insight

Top 3 Tools

1. Stories

2. Stories

3. Stories

Providing Solutions

• Be the source

• Think about what you want them to do

• Then make and present a realistic plan as to how they can do it

3. What is My Ask?

• What do I want?

• What data do I have to support it?

• How will I support it?

4. Who Are My Allies?

• Doctors

• Patients

• Staff

• Administrators

• Board members

• Politicians

“I wanted to ask them about my illness. I couldn’t because there was no one to help me [communicate].”

ejacobs@rush.edu