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Securing Staff Adoption and Adherence to Language Services Guidelines

Published on October 17, 2018 by Graham Newnum

Staff Adoption Guidelines Language Interpreter Services

Lee Health is the largest health system in Southwest Florida, caring for a diverse patient population in a variety of languages. Lee's System Director of Diversity and Patient Care Civil Rights, Yemisi Oloruntola-Coates, was kind enough to share insights with CyraCom on boosting staff adoption of language services:


Hospitals leading the way in language access make learning to use an interpreter a component of new hire training. Every new Lee Health employee receives this training during system orientation.

“Everybody learns about the resources - blue phones and video carts. Then nursing orientation and department heads get a more detailed language access training,”  Yemisi said.

Training goes beyond the mechanics of language services, including cultural competency to help staff understand patients from different backgrounds. This understanding may reduce avoidable errors and improve patient outcomes, and  Yemisi believes that Lee staff benefits from it as well.

“I tell my trainees ‘It's okay to be uncomfortable with the unknown, as long as you don't stay there,’” she recalled. “We do a training called Stepping Outside of your Cultural Comfort. When you’re willing to do that, you can learn something that can completely change your life.”


Organizations that are serious about ensuring every limited-English proficient (LEP) patient receives access to an interpreter should consider ongoing staff testing and retraining in using language services. Lee recently created a “Diversity Tracer” – a system-wide process for tracking language services usage.

“We survey nurses, techs, and physicians to ensure they have a baseline understanding of the resources: ‘How do you document that a patient needs an interpreter? What does the policy state? What are the resources available to you?’” noted Yemisi. “This gives us real-time readings on our staff's knowledge level, and we can break down the scores by hospital or interpretation modality.”

“It's extremely data-driven. If we notice that one department scores a 60% on knowledgeability, we can schedule retraining, set up periodic rounding to ensure compliance, and analyze the patient population they're seeing. It helps guide our work so we can be proactive rather than reactive. My whole approach is decreasing knowledge deficits and ensuring staff understands the resources available.”


Staff buy-in is crucial for a successful language services program, and for Lee, that meant overcoming objections to new technology.

“Some providers do prefer on-site interpreters,” Yemisi conceded. “But we’ve been able to explain the benefits that phone interpretation offers. We have people walking in speaking languages that neither on-site nor video can cover, whereas the blue phone has hundreds of languages available.”

“Education in how to use the phones is critical, and that's what's changed over the years. We do massive in-servicing now. CyraCom’s implementation team and our dedicated account manager collaborated with me, getting in front of leadership, reaching staff at multiple touch points, and ensuring the information is passed along and absorbed.”

“We've seen utilization increase as a result. We’re now in a place where departments are asking us to come and provide training, where before I'm banging on their door to get in and educate. Now they're requesting the training, and that makes a big difference.”


“Nudge theory” is a behavioral science concept which advocates positive reinforcement and indirect suggestion as a means of achieving non-forced compliance. In her time as Director, Yemisi has successfully implemented several of these nudges.

“One change we made was budgeting for interpreter services system-wide,” she explained. “We used to bill each department when they used the services, which created a perverse incentive not to utilize interpreters. Since the switch, utilization is up and department heads don’t feel pressure to manage usage.”

Another recent change involved adding a banner to the EPIC screen of every non-English-speaking patient. Anyone who pulls up the patient’s record gets a message - "Interpreter Needed" - and it stays there until the provider documents using one.

“It's an alert system,” Ms. Yemisi said, “a hard stop reminding them ‘Wait a minute, their primary language is Spanish. We need to provide an interpreter.’"

Now that you’ve read Lee Health’s techniques for securing staff adoption, download our full case study to learn more about the challenges of caring for LEP populations, and how Lee is partnering with CyraCom to overcome them.

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