“[If he doesn’t understand English,] I [would use] some form of sign language [to] try to explain to him that he has severe pain in his abdomen and he probably needs an operation. The other thing I could show him is pictures of a surgeon where he probably has to open up the abdomen to perform the procedure.”
- Emergency Department physician
Health care is communication-dependent and involves multiple players across numerous disciplines and departments. All processes, including assessment, diagnosis, prognosis, informed consent, treatment, and education, rely on the interaction between patient and provider, and misunderstandings at the patient-provider level may contribute to poor quality care and adverse events. As the diversity of the U.S. population increases, health care organizations must recognize and consider the communication needs of their patient population(s) to provide safe, quality care.
Project Overview
One component of the HLC study was to complete a simulated “patient-centered assessment” at each institution in which clinical and support staff were presented a hypothetical patient case. This investigation, in collaboration with Elizabeth Jacobs, MD, MPP, at John H. Stroger Cook County Hospital and Rush Medical College, will examine the experience of Mr. Juan Lopez, a hypothetical limited English proficient (LEP) patient, as he navigates the health system at 60 hospitals across the country. The project promises unique insight into how a typical LEP patient is treated at different organizations, whether his treatment varies with hospital characteristics, and the hospitals’ orientation towards the provision of culturally competent care. Research findings will include implications for both hospital practice and policy and current Joint Commission standards.
Research Questions
- In what proportion of encounters did Mr. Lopez receive “appropriate” communication with his practitioner? Is it dependent on the type of staff he encounters?
- How did staff respond to Mr. Lopez’s cultural health beliefs? What percent of responses could be considered “culturally sensitive”?
- Do hospitals that met Mr. Lopez’s language needs and appropriately incorporated cultural beliefs into his care share any common characteristics?
- What does Mr. Lopez’s experience at these hospitals indicate about the need for further investigation of language services and cultural competency, especially in regards to the enforcement of Joint Commission accreditation standards?
For more information on Juan Lopez: One Limited English Proficient Man's Experience at 60 Hospitals, contact Tina Cordero at ccordero@jointcommission.org.