Building a High-Quality Language Services Program Toolkit Abridged Version: To view the complete toolkit, please visit www.rwjf.org. Building a High-Quality Language Services Program Toolkit By: Jennifer Trott, M.P.H. Catherine West, M.S., R.N. Priti Shah, M.P.T. Marsha Regenstein, Ph.D. Speaking Together The George Washington University Medical Center School of Public Health and Health Services Department of Health Policy May 2008 Getting Started What is this toolkit? This toolkit is a unique resource for building and maintaining a high-quality language services program. It provides the information and resources you need to: 1) Identify individuals, strategies and tools to build and improve language services in your organization 2) Evaluate and improve the quality of a language services program, including; I. The foundation of a high-quality language services program; and II. The tools necessary to embed high-quality language services into the health care organization 3) Generate ideas for measuring, monitoring and making improvements in the delivery of language services 4) Integrate advanced practices around language services into your organization. Who can use this toolkit? Anyone interested in facilitating patients’ language needs in a health care setting can use this toolkit. This information covers a wide spectrum of language services needs and will be useful to organizations that are building a new language services program or that are improving their current programs. While based on the hospital setting, this toolkit may be applied to other health care organizations. What should you know before reading this toolkit? Feel free to skip around to select chapters relevant to you. Depending upon the needs of your organization’s language services program, you may wish to select only a few chapters or you may wish to read the entire toolkit. Table of Contents Page I. “Nuts and bolts”: Constructing the elements of a language services program Chapter 1. Laying the Foundation for a High-Quality Language Services Program …………. 1 Chapter 2. Screening Patients for their Language Needs ………………………………………. 6 Chapter 3. Building a Language Services Workforce …………………………………………… 10 Chapter 4. Getting an Interpreter Service to the Patient …………………………………............... 16 Chapter 5. Documenting How Patients’ Language Needs are Met .……………………............. 22 Chapter 6. Meeting Patients’ Written Language Needs ………………………………………….......... 26 II. “Making it stick”: Embedding language services into the health care organization Chapter 7. Measuring and Improving the Performance of your Language Services Program... 30 Chapter 8. Educating Clinical Staff on Meeting Patients’ Language Needs ……………………….. 34 Chapter 9. Taking a Patient-Centered Approach to Meeting Patients’ Language Needs …… 40 Chapter 10. Working in Health Care Organization Teams …………………………………….............. 44 Chapter 11. Promoting the Value of Language Services in the Organization ……………………… 48 Appendices III. Tools to Help IV. Innovations that Work V. Glossary Acknowledgments Thank you to Jennifer Huang, M.S. and Melissa Stegun, M.A. for their advice and work on this resource. This toolkit could not have been possible without information and experiences from the hospitals that participated in Speaking Together, upon which much of the content in this toolkit was based. Bellevue Hospital Center Regions Hospital New York, New York St. Paul, Minnesota Cambridge Health Alliance UMass Memorial Health Care Cambridge, Massachusetts Worcester, Massachusetts Children’s Hospital & Regional Medical UC Davis Health System Center Sacramento, California Seattle, Washington University of Michigan Health System Hennepin County Medical Center Ann Arbor, Michigan Minneapolis, Minnesota University of Rochester Medical Center Phoenix Children’s Hospital Rochester, New York Phoenix, Arizona The authors wish to acknowledge the expertise and recommendations of the advisors that served on the Editorial Review Committee for this toolkit: Izabel Arocha, M.Ed. Beth E. Ebel, M.D., M.Sc., M.P.H. Cultural and Linguistic Educator Associate Professor of Pediatrics, Cambridge Health Alliance Children’s Hospital & Regional Medical Center Jeffrey L. Boyd, Ph.D. Director, Harborview Injury Prevention & Chief Clinical Psychologist Research Center, University of Hennepin County Medical Center Washington Irma Bustamante Juan Fernandez Manager, Language Services Translations Coordinator Phoenix Children’s Hospital Children’s Hospital and Regional Medical Center Connie Camelo Director of Interpreter Services Francesca Gany, M.D., M.S. UMass Memorial Medical Center Director, Center for Immigrant Health New York University School of Medicine Edith M. Davis, M.P.H. and Bellevue Hospital Center Senior Associate Director, TEMIS and Grants Development Michelle Harris, M.B.A. Bellevue Hospital Center Director, Interpreter Services University of Michigan Health System Editorial Review Committee (continued) Mary Lindholm, M.D. Elizabeth Nolan, M.S., R.N., A.P.R.N.-B.C. Assistant Professor of Family Medicine Director, Patient Education & Wellness and Community Health Resource Center UMass Memorial Health Care, UMass Cardiovascular Center, University of Medical School Michigan Health System Carol McCamy, R.N., C. Carleen Riselli, R.N., M.S.N., A.P.R.N. Inpatient Medicine Nurse Psychiatric Clinical Nurse Specialist Regions Hospital Cambridge Health Alliance Kathy Miraglia, M.S. Marbella Sala Manager, Interpreter Services Operation Manager, Center for Reducing University of Rochester Medical Center Health Disparities UC Davis School of Medicine Sally Moffat, R.N., M.S.N. Director of Community Outreach Services Sidney Van Dyke, M.A. and Language Services Director, Interpreter Services Phoenix Children’s Hospital Regions Hospital JoAnne Natale, M.D., Ph.D. Andrew Williams, M.D. Medical Director, Pediatric Intensive Care Assistant Professor of Medicine UC Davis Health System University of Rochester Medical Center © This toolkit is a product of the Robert Wood Johnson Foundation, created at the George Washington University School of Public Health and Health Services, Washington, DC, May 2008. All rights reserved. Chapter 1 Laying the Foundation for a High-Quality Language Services Program The Goal: To lay the foundation for a high-quality language services program. Why it’s important: A successful language services program begins with a strong foundation. Structuring policies, procedures and other elements to reflect and build on the organization’s priorities will lead to an integration of language services into the organization. How to build it: Language services programs vary in size, number of languages served, systems and modalities of interpretation provided. Before you build your program, ask several questions about your organization—Step 1 (below). Steps 2-5 detail what you need to do in order to build your program’s foundation. 1. Take a snapshot of language services within your organization 2. Develop a language services plan 3. Create a budget and monitor the financial performance of your language services program 4. Evaluate and assess your organization’s performance 5. Develop an improvement plan for language services delivery 1 1. Take a snapshot of language services within your organization • Review your current policies, procedures and structure for the provision of language services: ? What policies and procedures are currently in place? Do any require revision and updating? ? Do current policies and procedures reflect standards of practice for language services? ? Are language services policies and procedures reviewed by an organization- wide policy committee? ? Has your organization addressed language services in its strategic plan? If so, does the plan need to be updated? ? Where is the language services department physically located (i.e., at your organization or another facility in your system)? • Gauge the extent to which language services is embedded into clinical care and the overall organization: ? What is the relationship between language services and other departments, such as the quality improvement department? ? How do senior leaders support language services? ? Is the language services department represented on clinical teams and committees within the organization? ? Under which department is language services housed? • Determine whether your organization values language services: ? Do staff appear to understand the importance of language services? ? Are staff aware of policies and procedures around language services? ? Do staff actually use language services? How? • Conduct an organizational needs assessment to: Assess demand for language services, considering: • Languages spoken by your patient population • Geography of your service area • Areas of high demand within your organization • Times of high demand within your organization. Assess capacity, including internal and external resources available to meet demand: • Systems, staff and equipment currently supporting the delivery of language services, including internal and external resources • Translated materials and signage within the organization. Tip: See Chapter 3, “Building a Language Services Workforce,” and Chapter 4, “Getting the Interpreter Service to the Patient,” for information on the various types of systems, staff and equipment used to deliver language services in health care organizations. 2 2. Develop a language services plan • Form an interdisciplinary team to construct the language services plan, including: • Clinical leaders • Frontline