Many patients from outside the U.S.
don’t have a concept of liability.
—Director, WakeMed Faculty Physicians Obstetrics/Gynecology, WakeMed Health and Hospitals • San Francisco General Hospital has developed several programs that use group
settings to educate patients and engage them in their own care. Projects such as Cancer Awareness Resources and Education (CARE), Centering Pregnancy, and the IDEALL Project (Improving Diabetes Efforts Across Language and Literacy) bring patients together to explore their health and health care. In addition to providing social support and education, the programs give patients more time with health care professionals than they would get during one-on-one visits.
Talk to patients. To create a welcoming environment for patients, it is important that staff members talk to them—even if they do not speak the same language.
• In one instance, a WakeMed Health and Hospitals patient said he wanted to leave the hospital before a scheduled surgery because he thought the staff hated him. None of his nurses had spoken to him because he did not speak English. After the nurses found out about this, they made a point to smile and speak to him in English, even if he didn’t understand. He appreciated their efforts and felt welcomed and comfortable.
• At Woodhull Medical and Mental Health Center, representatives from the patient relations department visit every hospital inpatient to discuss their rights and determine any communication or language needs.
• At Caritas Good Samaritan Medical Center, interpreters visit every inpatient with limited English proficiency twice a day. The hospital has, on average, 10 to 12 such patients at a time. When possible, nurses participate in these visits, giving them at least one opportunity per shift to communicate with their patients. Use technology. All of the hospitals use some
form of technology to improve how they
communicate with patients. Nearly all have access to telephone-based interpretation services. Several also use video-based interpreter services.
• When interpreters are on site, staff members can often arrange for a three-way call, between patients, interpreters, and health care providers, to take place immediately.
• For languages that are not available on site, hospitals typically have a contract with an off-site professional medical interpretation service, such as Cyracom, Language
Line, or Pacific Interpreters. Such services provide professional interpretation for languages that hospital staff rarely encounter or cannot identify.
• San Francisco General Hospital is beginning to use video medical interpretation. With use of a flat-screen monitor with an attached video camera, interpreters who are in the hospital or at another location provide interpretation. This method is similar to the DeafTalk video system used by Caritas Good Samaritan Medical Center and Sherman Hospital for sign language interpretation.
Other uses of technology include:
• MultiTerm: Sherman Hospital purchased terminology management software, designed for translators, to develop a common repository for translated words, phrases, and ideas. This ensures that in-house translations are consistent and helps interpreters document and share what they learn in their encounters.
• MedBridge Software: University of Virginia Health Systems recently introduced a computer program that allows staff members to communicate, on a temporary or emergency basis, with patients who do not speak English. Patients can read the questions they are being asked on a computer screen in their primary language as well as English. Staff members’ questions are also read out loud by the computer in the patients’ language.
• Visual Medical Schedules: San Francisco General Hospital’s anti-coagulation clinic uses a computer program to create a visual image of a patient’s weekly medication schedule.22 The schedule helps physicians and pharmacists communicate with patients about medication schedules by showing a picture of how much of each medication patients need to take each day.
• Automated Phone System for Diabetes Management: San Francisco General has developed an automated phone system to do diabetes education and surveillance with a sample of patients. Patients select their preferred language and receive weekly automated phone calls that provide basic educational messages and ask questions that require touch-tone responses.
Use patients’ experiences. Hospitals can get a lot of information from the questions patients ask and the feedback they provide. The only way to find out how well some communication programs are working is to ask patients. Patients can also be good resources for educating one another about hospital health care services.
• The Iowa Health System encourages its hospitals to ask patients to review hospital documents for clarity. Hospitals often use their own volunteers as patient reviewers or contact adult learning centers associated with local community colleges or high schools.
• As part of its Cancer Awareness Resources and Education (CARE) program, San Francisco General Hospital is planning to start a volunteer brigade. Graduates of the hospital’s CARE program will volunteer to help other cancer patients learn about and live with their illness.
PROMISING PRACTICE #6
Be Aware of Cultural Diversity
Patients’ cultural backgrounds can influence their interactions with the health care system and communications with hospital staff. The eight hospitals recognize that their patient populations come from diverse backgrounds. Many staff members at the hospitals view this diversity as an asset and try to find ways they can learn from the patients they serve.
In most cases, hospital leaders encourage a team-based approach to cross-cultural communication. With experience, staff members learn to recognize when a communication problem may have a cultural component. Staff members then call on their colleagues— including interpreter staff—from different disciplines, specialties, and cultural backgrounds to work together to find a solution.
When communicating with patients across cultures, hospital staff find that it is important to:
• recognize and understand the important influence of culture on health care interactions;
• create an environment that is respectful of and welcoming to patients, regardless of their cultural background; and
• use the experiences and strengths of staff members throughout the hospital, especially the interpreters.
Recognize the importance of culture. In many cases, staff members at these eight hospitals believe there is no such thing as cultural “competence.” Instead, they have adopted an attitude of continuous learning that focuses on cultural awareness. They are aware of their own cultural values and beliefs and seek to understand how patients’ cultural values and beliefs affect health care.