Enforcement of Title VI – Voluntary Resolution Agreements

Recently, two medical facilities took action to improve their language assistance services after being investigated by the Office for Civil Rights in regards to Title VI of the Civil Rights Act of 1964. Shenandoah Memorial Hospital in Virginia and Memorial Health System in Colorado Springs signed a Voluntary Resolution Agreement to provide meaningful access to their Limited English Proficient (LEP) patients.

In the Voluntary Resolution Agreements, each facility outlines specific plans to provide meaningful access to LEP patients through language services. Such plans include:

• Appointing a language assistance coordinator
• Development of an LEP policy
• Assessment of linguistic needs
• Notification to LEP population of free language services
• Complaint procedure development
• Employee training
• Outreach

Title VI of the Civil Rights Act of 1964 prohibits discrimination in federally funded government agencies on the ground of race, color, and national origin. Title VI keeps federally funded agencies and activities accountable to provide committed and meaningful access to individuals including LEP persons.

Meaningful access may have different connotations to each facility. It is essential for facilities to evaluate their current resources to determine the appropriate measures taken to comply with Title VI and to improve accommodations for LEP populations.
Information on how to implement a strategic plan may be found at www.lep.gov.

http://www.hhs.gov/ocr/civilrights/activities/agreements/index.html

Industry Update: A National Certification Program for Healthcare Interpreters

The Certification for Healthcare Interpreter (CCHI) received an accreditation from the National Commission for Certifying Agencies (NCCA).

The CCHI is a professional certification organization acting in the public interest by establishing and enforcing education, examination, experience and ethics requirements for certification. The NCCA recognized and accredited the CCHI’s Spanish Healthcare Interpreter Certification for a five-year period. 

“NCCA Accreditation awarded to CCHI is an outstanding achievement, plus strong and clear recognition of CCHI’s leadership and a strong sense of equity in health care for all we are privileged to serve,” said Fred Hobby, CEO, Institute for Diversity in Health Management, and CCHI Commissioner from 2009 to 2011. He continued, “…CCHI is now the gold standard by which all other interpreter services programs will be measured.”

CCHI is the first organization certifying healthcare interpreters to receive NCCA accreditation.  The NCCA accredits certifying programs based on the highest quality standards in professional certification.  A valid and credible certification is an important milestone in the continued development of the language services industry.  We are excited to observe how these new standards will enhance the initiative to help bridge the language gap between individuals. 

Video Blog: “Reducing Recidivism with non-English Speakers” – a conversation with Jonathan Levy, CyraCom’s Director of Language Services

Starting October 2012, Medicare will cut hospitals’ funding by up to 1% if they have higher-than-expected 30-day readmission rates for patients with heart attack, heart failure, or pneumonia.[1]

In this video blog, Jonathan Levy, CyraCom’s Director of Language Services, discusses the challenges hospitals are facing concerning reducing readmissions rates for non-English speakers and proposes solutions for improvement.

 


[1] Patient Protection and Affordable Care Act, sections 3025 and 10309

CyraCom’s interpretation and translation solutions are exclusively endorsed by the American Hospital Association. With ISO 9001:2008 certified quality processes, US-based medically-trained interpreters, and a dedicated account management team, we are equipped to meet your patients’ language needs. 

6 Ways Language Services Assist in Patient Advocacy

With patient populations diversifying, language services are becoming an important aspect of the patient advocate’s job. At this year’s Society for Healthcare Consumer Advocacy’s annual conference, SHCA discussed its 9 Domains of Practice that have been identified as critical skills and knowledge for patient and consumer advocates.

Since CyraCom attended the event as a silver sponsor, we wanted to share with you how language services fit into 5 of the 9 domains:

 Image Source: SHCA Domains of PracticeTM

1. Patient rightsThe Right to Language Access

Patients have rights to receive healthcare provision in their native language, as outlined by federal mandates and Joint Commission standards. To meet these requirements, patient advocates should ensure that their organization has a Language Assistance Plan, which demonstrates a commitment to following language access procedures to auditors.

2. Measuring Patient Satisfaction - Measure Satisfaction by Language, Ethnicity

Certain minority groups are more likely to be dissatisfied with their healthcare, especially when compared to non-Latino whites (see this study for instance), so some health systems measure patient satisfaction by ethnicity and language preference. One way of doing this is to provide translated “Patient Satisfaction Questionnaires,” along with translated vital documents (consent forms, discharge instructions, etc).

3. Customer Service / Service Excellence - Language and Cultural Competency

Customer service initiatives that promote interpretation services and the hiring of bilingual staff bolster service excellence for non-English speakers. In addition to supporting the languages, all staff members can be educated on patient cultural competency.

4. Data Management - Keep a Language Record

The Joint Commission requires that patients’ preferred language be identified and tracked. Ask patients their preferred spoken language or use language identification cards. Afterwards, note the patient’s language in his/her medical record.

The American Hospital Association has found that leading hospitals are analyzing the language data they collect and are using it to provide better patient care. Some of the best practices that have emerged include using dashboards to track performance in quality areas, filtered by language, race and socioeconomic status; informing patients about and customizing language service offerings; and reviewing KPIs such as length of stay, admissions and avoidable readmissions.

5. Healthcare Management - Improve Hospital Bottom Line by Changing how Minorities are Served

Of the many challenges facing health leaders today, eliminating healthcare disparities among minorities is one of the most prevalent. Fortunately, through Affordable Care Act legislation, provisions have been made for making healthcare more affordable for underserved populations, developing community-based strategies to eliminate local health barriers, and improving the diversity of the healthcare workforce and making it more culturally competent.

At each of these steps, providing language services is a key element. If hospitals can communicate accurately with these groups, they can decrease medical errors, length of stays, and readmission rates.

Travis

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CyraCom’s interpretation and translation solutions are exclusively endorsed by the American Hospital Association. With ISO 9001:2008 certified quality processes, US-based medically-trained interpreters, and a dedicated account management team, we are equipped to meet your patients’ language needs. 

Providing Cost Savings, Excellence through Language Services: CyraCom and O’Connor Hospital

Saving our hospital clients money and providing them with exceptional service are two things we get really excited about. So we were thrilled to speak with Pamela Brotherton-Sedano, Vice President of Patient Safety of O’Connor Hospital in San Jose about their organization’s experience with us.

At one point, O’Connor was spending a lot on interpretation services. However, once a CyraCom account manager explained to them that they could save the hospital money and receive superior, medically-focused service, O’Connor decided to switch providers.

After using the service for some time, O’Connor saw tremendous results. “Within a year of changing providers, we saved over half a million dollars, which enabled us to invest more in the hospital,” explained Pam Brotherton-Sedano. “Our patients were also receiving better care because CyraCom’s interpreters are medically trained. It was a win-win: our patients continued to get excellent service and we were saving the hospital a lot of money in the process, which is almost unheard of.”

She continued, “It’s priceless to know you’re in good hands.”

Thanks for the compliments Pam. We’re glad to have been able to make a difference.

 Travis

* To learn more about O’Connor Hospital’s experience with CyraCom, download the case study, Providing Cost Savings, Excellence through Language Services

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CyraCom’s innovative language services have helped over 1,500 clients, such as O’Connor Hospital, attain excellence in their practices. Our ISO 9001:2008 certification and exclusive endorsement from the American Hospital Association for our interpretation and translation solutions demonstrate our commitment to quality.

Visit www.cyracom.com to learn more about our suite of language services.

4 Ways to Improve Cultural Competency in your Organization

Cultural competency is a strategy organizations can use to “to improve health outcomes, increase quality of care, and reduce health disparities especially among minorities.”[1] However, there are many obstacles hospitals face when trying to develop cultural competency programs, which include lack of staff diversity and poor communication, among other issues[2].

In trying to find practical solutions for these challenges, we came across a recent article, A Framework for Cultural Competence in Healthcare Organizations[3], which discusses four main improvement points. We break these down for you below:

1. Make Sure Staff Diversity Reflects Patient Diversity - When providing healthcare to diverse patient populations, it’s a good rule of thumb to have a workforce that’s equally as diverse, since “minority health care professionals are more likely to understand the needs of minority populations.”[4] For instance, if you serve a large Spanish-speaking population, staff should also reflect this racial makeup. This goes for nurses and other staff, as well as executive leadership and members of the board. Since Human Resources is generally responsible for hiring employees, the department should be proactively recruiting and hiring minority staff, as well as language services and diversity staff.

2. Make Sure Vision, Mission and Values are Centered on Cultural Competency - Cultural competency starts with an organization’s vision, mission and values. First, senior management should work with organizational governance to create a vision that is cultural competent and determine how to allocate resources to support that vision. Second, the organization should identify its target patient population, create a culturally competent mission, and develop strategies for carrying out the mission. And thirdly, in its values, the organization should “reflect its attitudes and emphasis on cultural competence and its commitment to providing culturally competent care.”[5]

* For more information on this topic, read “5 Ways to Put Meaning Behind your Hospital’s ‘Mission, Vision and Values,” and see how you can put cultural competency into the mix.

3. Create a Strategic Plan – To promote cultural competency, organizations should “establish a strategic plan that emphasizes the importance of cultural competence training to the overall organization, its employees, patients, and communities served.”[6] The planning process (and, ultimately, the plan itself) should include a discussion of goals and priorities, organizational cultural competency strengths, resources for supporting staff education and in-servicing, and how the plan’s processes can be maintained over the long term.  Once the plan is finalized and put into practice, it’s important to regularly evaluate if objectives are being met and whether or not changes need to be made – to this end, forming task forces and committees with the aim of monitoring progress is helpful.

4. Communicate -  To maximize the effectiveness of the cultural competency program, organization employees, as well as patients and the general community, should be communicated with about the program using a variety of methods. For instance, cultural competency policies and procedures can be published in employee handbooks, regular cross-organizational workgroups can be formed, and in-language support materials can be posted around the hospital for non-English speakers, along with other processes.

By following these steps, health organizations will be moving closer towards equal healthcare access for all people, as outlined in Title VI of the Civil Rights Act of 1964 and The Joint Commission’s standards for Patient-Centered Communication.
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CyraCom’s interpretation and translation solutions are exclusively endorsed by the American Hospital Association. With ISO 9001:2008 certified quality processes, US-based medically-trained interpreters, and a dedicated account management team, we are equipped to meet your patients’ language needs. 

[1] See footnote 3 for reference; p.208: Healthcare organizations are focusing more on cultural competence as a strategy for these key areas

[2] See footnote 3 for reference; P.208: Healthcare organizations face a number of challenges when developing cultural competency programs

[3] Castillo RJ, Guo KL, “A Framework for Cultural Competence in Health Care Organizations,” The Health Care Manager (2011): 205-214

[4] See footnote 3 for reference; P. 208

[5] See footnote 3 for reference; P. 211

[6] See footnote 3 for reference; P.211

Video: The AHA Extends its Exclusive Endorsement of CyraCom’s Interpretation and Translation Solutions

The American Hospital Association has extended its exclusive endorsement of CyraCom’s interpretation and translation solutions. “While many providers offer telephonic, video interpretation and translation services, CyraCom interpreters and translators have a medical focus and are able to understand unique terminology and nuances relevant to a medical environment,” explains Anthony Burke, President and CEO of AHA Solutions, Inc. “The solution proved its continued relevance and value to the health care field by promoting safer, more effective practices through accurate provider-patient communication.”

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CyraCom’s interpretation and translation solutions are exclusively endorsed by the American Hospital Association. With ISO 9001:2008 certified quality processes, US-based medically-trained interpreters, and a dedicated account management team, we are equipped to meet your patients’ language needs.

Making a Difference through Interpretation Services: CyraCom and St. Joseph’s Healthcare System

We are passionate about helping hospitals communicate with their Limited English Proficient patients. So, naturally, we like to hear our clients’ stories concerning how they have used our services to better serve their patients, promoting safer, more effective healthcare.

Recently, we spoke with Father Martin Rooney, Director of Pastoral Care and Mission services at St. Joseph’s Healthcare System about his organization’s experience with us. He explained:

“CyraCom provided all of the elements we were looking for in a language services provider: quick, easy-to-use, effective service and professional, medically-trained interpreters. We have CyraCom phones located throughout our healthcare system which enables our employees to communicate effectively and readily with our patients.”

Father Marty also praised CyraCom’s level of customer support.  “I find CyraCom to be a very attentive, customer-friendly company. They are helpful and always ready to assist,” he explained. “I told our account manager we are planning on building a new critical care tower and mentioned needing new phones and other services. The response was ‘whatever we need to do for you, we will work with you’ – that’s fantastic service.”

Stories like this are why we do what we do. Thanks for the compliments Father Marty.

Travis

* Read the case study ”Effective, Reliable Language Services” to learn more about St. Joseph’s Healthcare System and CyraCom.

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CyraCom’s innovative language services have helped over 1,500 clients, such as St. Joseph’s Healthcare System, attain excellence in their practices. Our ISO 9001:2008 certification and exclusive endorsement from the American Hospital Association for our interpretation and translation solutions demonstrate our commitment to quality. Visit www.cyracom.com to learn more about our suite of language services.

What you should Read: Informative Healthcare Language Services Articles of 2011

2011 was a productive year in healthcare language services research, and many pertinent topics were covered. The articles below discuss some of the issues I believe are most central to language services today. I hope the information presented will be of use to language services decision-makers in the healthcare space as they wrestle with these issues daily. Enjoy.

1. Interpreter Perspectives of in-person, telephonic, and videoconferencing medical interpretation in clinical encounters , Patient Education and Counseling. 2011 Sep 17 [Epub ahead of print]

What do professional medical interpreters think about the effectiveness of different interpretation methods (in-person, telephonic, video conferencing)? It’s a good question to ask, seeing as “Interpreters are uniquely positioned to address relative merits of in-person and remote modalities … given their broad interpreting experience.”

That’s what this article seeks to do – explore the effectiveness of different interpretation methods in hospital and ambulatory settings from the interpreter perspective.

After assessing 52 interpreters (a 73% response) concerning a range of medical scenarios, all interpretation modalities were deemed “equally satisfactory for conveying information.” However, in-person interpretation was preferred, over both telephonic and video conferencing interpretation, for situations involving more in-depth conversation and other scenarios.

2. A Framework to Identify the Costs of Providing Language Interpretation Services, Journal of Health Care for the Poor and Underserved. 2011 May 22(2): 523-31

While healthcare organizations are required to provide language assistance, allocating the funding to do so has been less prescribed. This paper is a must read because it “establishes a conceptual framework [for language services] that identifies program costs, can be used across health care entities, and can be understood by administrators, researchers, and policymakers to guide research and analysis and establish a common ground for informed strategic discussion of payment and reimbursement policy.”

3. A Framework for Cultural Competence in Health Care Organizations, The Health Care Manager. 2011 Jul-Sep;30(3):205-14.

Yes, we all know that cultural competency is important in healthcare. However, how does one go about making cultural competency a part of an organization’s fabric?

In this article, authors Richard J. Castillo and Kristina L. Guo take cultural competency from the theoretical to the practical, giving “a framework to guide health care organizations as they focus on establishing culturally competent strategies and implementing best practices aimed to improve quality of care and achieve better outcomes for minority populations.” A great read if you’re looking to improve your cultural competency program.

4. Examining Effectiveness of Medical Interpreters in Emergency Departments for Spanish-Speaking Patients with Limited English Proficiency: Results of a Randomized Controlled Trial, Annals of Emergency Medicine 2011 Mar;57(3):248-256.e1-4.

Does in-person interpretation improve communication satisfaction for patients and health providers? This study takes a fresh look at that question. After assessing numerous patients and health providers over a seven-month period, it was determined that the “… provision of professionally trained, in-person medical interpreters … greatly increased patients’ and providers’ satisfaction [in the ED].”

5. Patterns of Interpreter Use for Hospitalized Patients with Limited English Proficiency, Journal of General Internal Medicine. 2011 Jul;26(7):712-717. Epub 2011 Feb 19

Are interpreters being used appropriately in hospitals? Not quite, as this study indicates. At two urban hospitals that encounter a large percentage of Limited English Proficient (LEP) patients, 234 LEP patients were interviewed concerning interpreter usage. Of the patients interviewed, “57% reported that any kind of interpreter was present with the physician at admission, 60% with physicians during hospitalization, and 37% with nurses since admission.”

What does this show? Essentially, LEP patients are still receiving substandard access to language services, which can pose a variety of problems including misdiagnoses and other errors.

A limitation of the study is that it only examines two hospitals, and its results “may not generalize to other hospitals and settings.” However, the authors point out that “both sites in this study serve large numbers of patients with LEP and are located in a diverse area of the US … [so] It is likely that patients’ experiences may be worse in settings with less linguistic diversity or resources allocated to interpreter services.”

This article demonstrates an important point: while language access has improved for LEP patients, it is still not where it needs to be. The information presented in this study can serve as a wake-up call for organizations to re-evaluate their language access programs and identify areas of improvement.

Jonathan

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CyraCom’s interpretation and translation solutions are exclusively endorsed by the American Hospital Association. With ISO 9001:2008 certified quality processes, US-based medically-trained interpreters, and a dedicated account management team, we are equipped to meet your patients’ language needs.

Minority Doctors Needed? They’re on their Way

It’s a pressing concern: minority doctors are needed in healthcare.

According to the study Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, issued by the Institute of Medicine, and more recent data, Hispanics, African-Americans, and other minority groups receive poorer healthcare quality than non-minorities.  And one of the proposed solutions for dealing with this problem is creating a workforce of multicultural physicians – the idea being that physicians of different ethnic and linguistic backgrounds will be more culturally competent and give better care to minority patients.

There is some warrant to this concept, as minority physicians are more inclined to reach out to the communities they come from.  As Dr. Louis Sullivan, former secretary of the Department of Health and Human Services,  explains: “‘…  African American physicians and Hispanic American physicians are three to five times more likely to establish their practices in African American or Hispanic American communities.”‘

Minority doctors, being a part of these communities, also understand the patients better, which ultimately results in better health services. “‘What happens with the health outcome, depends upon good communication, the trust and credibility between the health professional and the individual seeking care, and an understanding of the patient’s culture, value system, so that one can develop, hopefully, a strong relationship or interaction between the health professional and the individual,’” says Dr. Sullivan.

However, while the idea of using a multicultural workforce to improve health outcomes for minorities may be sound, its realization has not been so simple.

In one of her first speeches, Surgeon General Dr. Regina Benjamin discussed the fact that minority doctors represent 6% of all physicians – the same number as a century ago – and called for stepped-up recruitment efforts. And in giving his outlook on the future of physician diversity, Dr. Louis Sullivan said, “‘It will be decades before our health care system truly mirrors the makeup of our general population.’”

Nonetheless, while the future may look bleak, there is hope on the horizon.

A growing number of Hispanic students are enrolling in medical schools nationwide, according to the Association of American Medical Colleges. Since 2004, applications from Hispanics have risen 22.9%, with nearly 6% of that growth occurring in 2010-2011, as indicated by a recent Chicago Sun-Times article.

“‘For 30 or 40 years there have been intentional efforts at trying to make sure that all underrepresented populations understand that medicine is a wonderful career,”‘ said Dr. Marc Nivet, Chief Diversity Officer of AAMC. “‘I think we are starting to gain some traction in the Hispanic population.”‘

While the numbers are still not adequate enough to support the growing US Hispanic population, they do demonstrate an emerging trend: more and more Hispanics are becoming involved in medicine, which can ultimately translate into improving healthcare for minority communities.

However, it is only a small piece of the pie, and the process of reform is, likely, going to take some time.

Travis

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CyraCom’s interpretation and translation solutions are exclusively endorsed by the American Hospital Association. With ISO 9001:2008 certified quality processes, US-based medically-trained interpreters, and a dedicated account management team, we are equipped to meet your patients’ language needs.