Communication Equals Understanding: The Effects of Increased Language Access for Patients

If the communication between people is poor or ineffective, there will be a concomitant level of misunderstanding. It may seem obvious, but this basic concept is not always fully appreciated. When it comes to the life and death decisions inherent in health care, the basic equation of communication = understanding is especially vital.

However, in patient care situations that occur daily throughout the United States, patients who speak little or no English are often not given access to the means for communicating with understanding when it comes to doctors, nurses and other care providers.

The law is clear on the requirements for effective health care communication between limited English proficient (LEP) people and English-speaking U.S. health care providers. What is also unequivocally clear is the wealth of data and analysis that confirms this simple truism – communication = understanding, especially important with health care decisions, treatments, and procedures.

The data points all agree that the communication equation is solved with qualified spoken language interpreters and translators. For additional confirmation, let’s look to the latest academic and quantitative data.

Does Language Access Improve Informed Consent?

The August 2017 edition of the Journal of Internal Medicine contains a study entitled, Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency.

This study examines whether the presence of a bedside telephone language assistance system would improve patient outcomes and informed consent procedures.

Hospitalized patients undergoing invasive procedures on the cardiovascular, general surgery or orthopedic surgery floors” of a hospital were studied. Patient rooms were equipped with “… interpreter phones at every bedside enabling 24 hour immediate access to professional interpreters.”

What Were the Results?

“We enrolled 152 Chinese- and Spanish-speaking patients with LEP (84 pre- and 68 post-implementation) and 86 English speakers. Post-implementation (vs. pre-implementation) patients with LEP were more likely to meet criteria for adequately informed consent (54% vs. 29%, p = 0.001) and, after propensity score adjustment, had significantly higher odds of adequately informed consent … as well as of each consent element individually.”

“A bedside interpreter phone system intervention to increase rapid access to professional interpreters was associated with improvements in patient-reported informed consent and should be considered by hospitals seeking to improve care for patients with LEP [limited English proficiency].”

Interestingly but not surprisingly, the study also found that the answer to the communication = understanding equation did not stop with LEP patients having 24 hour access to telephonic language assistance.

The communication “… improvements did not eliminate the language-based disparity. Additional clinician educational interventions and more language-concordant care may be necessary for informed consent to equal that for English speakers.”

For example, additional physician training about when to use and not use the telephone and when to use other language assistance methods instead of the phone is needed. Indeed, federal law specifies that, essentially, the more complex the communication topic, the likelier that an in-person interpreter will be the ideal, and compliant solution to the equation, communication = understanding.

What Does the Law State?

In addition, federal law (i.e., Section 1557 of the Affordable Care Act) specifies that the patient’s preferred communication method invariably must be the method used by the provider. For example, if the patient has an objectively reasonable cultural aversion to long telephone conversations, if the telephone connection is poor, or if the patient can better understand an interpreter with whom she can interact in person and can see, persisting in use of the telephone may well be legally inappropriate and problematic.

It is of course self-evident that solving the communication equation fosters and informs the best possible patient outcomes and choices. It is further axiomatic that the data, the studies, the analysis, and the law are all in sync – communication = understanding. To achieve this understanding, ALL data points agree that communication in the patient’s language is essential to the end result – communication = understanding.

Looking Forward

In 2017, we continue to witness unequivocal proof of the equation’s solution. “Twenty-five million people in the United States have limited English proficiency (LEP); this growing and aging population experiences worse outcomes when hospitalized…

Comprehensive language access represents an important, high value service that all medical centers should provide to achieve equitable, quality healthcare for vulnerable LEP populations,” concludes Convenient Access to Professional Interpreters in the Hospital Decreases Readmission Rates and Estimated Hospital Expenditures for Patients With Limited English Proficiency (Medical Care, American Public Health Association), yet another 2017 study, straight down the line in accord with its predecessors. The verdict is unanimous – (non-English language assistance access) answers the equation: communication = understanding.

**Read some of Bruce Adelson’s other blog posts to learn about more developments in language access law, and be sure to contact us if you’re interested in a consultation about your own organization’s compliance with federal language access law.

© Bruce L. Adelson, special for Bromberg.  2017 All Rights Reserved The material herein is educational and informational only.  No legal advice is intended or conveyed.

Bruce L. Adelson, Esq, CEO of Federal Compliance Consulting LLC is nationally recognized for his compliance expertise concerning many federal laws.  Mr. Adelson is a former U.S Department of Justice Civil Rights Division Senior Trial Attorney.

Mr. Adelson teaches cultural and civil rights awareness at Georgetown University School of Medicine in Washington, D.C.