Overcoming Language Barriers to Improve Health Literacy at Holy Name Medical Center

Health literacy, the ability to understand and participate in one's healthcare, is important for all patients. However, some patients, such as those who do not speak English as a first language, have more challenges than others in acquiring health literacy. To ensure patients understand their care regardless of their language, Holy Name Medical Center in Teaneck, N.J., offers interpreters. Jonathan Hirsch, director of guest services at Holy Name Medical Center, says the hospital's language services help not only patients who have limited English skills, but also the culture of the hospital.

Jonathan Hirsch is director of guest services at Holy Name Medical Center.Of patients at Holy Name Medical Center who do not speak English as a first language, approximately 72 percent speak Spanish, 20 percent speak Korean and 8 percent speak one of roughly 30 languages, including Bengali, Farsi and Tagalog in addition to sign language. Moreover, Holy Name is located on the turnpike near an airport. "The possibility of a tourist bus with foreign-speaking tourists overturning is there, and when patients arrive, we have to be able to take care of them," Mr. Hirsch says.

Language services
Holy Name Medical Center began offering an interpretation service through LanguageLine Solutions (formerly Language Line Services) in 1996. About 10 years ago, the hospital began using video interpretation, in which patients can see and interact with an interpreter through video, in addition to phone interpretation. Offering video interpretation has enabled the hospital to more effectively communicate with patients, which can improve health outcomes and patient satisfaction.

More information can improve outcomes
One of the barriers in communicating with patients who speak and understand a limited amount of English is getting a complete medical history. Beyond the practical language barrier, there is often a cultural difference in how people share personal information, according to Mr. Hirsch.

For example, there is a large Korean population in the community surrounding the hospital. In the past, when the hospital used only phone interpretation, providers had difficulty gaining information other than names and addresses from Korean patients. With video interpretation, through which patients can see the interpreter who speaks their language, patients are more willing to give complete information, according to Mr. Hirsch. "There's a certain level of comfort [with video interpretation]," he says. "They can see someone who looks like them on the screen, and they're more apt to give more information." Being able to obtain more comprehensive information from patients helps providers treat patients more effectively and safely.

In addition to a greater willingness by patients to share medical histories and other information, video interpretation helps interpreters learn more about patients through body language. A shrug of the shoulders or facial expression can indicate a level of understanding that the patient may not verbalize; by recognizing these signs, an interpreter can rephrase statements to ensure the patient understands everything, Mr. Hirsch says.

When "noncompliance" is really "lack of understanding"
Through interpreters, hospital personnel can help patients and their families better understand post-discharge instructions, which can reduce readmissions. "We're understanding better why patients are here and giving information on what they need to do to stay well and not return to the hospital," Mr. Hirsch says.

Effective interpretation can mean the difference between a compliant and noncompliant patient. Mr. Hirsch cites an example of receiving a patient transferred from a facility that did not have interpreters and being told the patient was noncompliant. After the video interpretation, however, the patient better understood his instructions and followed them. "The only reason he was noncompliant was that he had no idea of his plan of care because there was no interpreter at the last facility," Mr. Hirsch says.

Providing interpretation services can empower patients to engage in their own health. Patients who have greater health literacy can participate in shared decision-making with healthcare providers, which can improve patient satisfaction. "Communicating with patients is giving control back to the patients," Mr. Hirsch says.

Communication as part of the hospital's culture
Holy Name's interpretation services have become part of the hospital's culture, according to Mr. Hirsch. Physicians and staff learn the value of effective communication and improving health literacy beginning at orientation. During training, hospital leaders emphasize the need to understand patients' perspectives, earn their trust and meet their needs regardless of background.

This focus from leadership and the interpretation services have instilled more confidence in physicians and non-English speaking patients when they interact. In fact, physicians are spending more time with patients because they can communicate more effectively, according to Mr. Hirsch. In this way, communication is a key contributor to a patient centered culture at Holy Name.

More Articles on Health Literacy:

Patient Safety Tool: Always Use Teach-Back! Toolkit
Patient Safety Tool: AHRQ's Health Literacy Precautions Toolkit

Health Literate Care Model Supports Patient Engagement

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