Culturally Competent Health Care Starts with Improving Language Access

NYC Health Care System Launches Language Rights Awareness Campaign

A New York City health care system recently launched a Language Rights Awareness campaign to promote patient rights to language services and help eliminate barriers to care, improve patient safety and increase patient satisfaction.

New York City Health + Hospitals (NYC HH) is the largest public health care system in the nation serving more than a million New Yorkers annually in more than 70 patient care locations across the city’s five boroughs …. —all supported by 11 essential hospitals.

NYC HH’s effort tracks with current data and academic studies about the efficacy of language access for health care patients. Indeed, the data all reveal the ineluctable connection among high patient satisfaction, patient health and safety, alleviating barriers to care and legally compliant language access. For example, according to a 2018 study published in the Journal of Medical Internet Research:

“Cultural and language barriers keep patients and providers from building strong relationships, posing considerable obstacles to a positive patient experience, according to research published in the Journal of Medical Internet Research.

Culturally Competence Healthcare

In a changing healthcare landscape that emphasizes value, healthcare professionals are working to pinpoint the factors that constitute a positive experience for patients. These insights are especially important for community health centers (CHCs) that are transitioning to patient-centered medical home (PCMH) status.

Patients across all language proficiencies valued positive interactions with their providers. Confidence in one’s doctor, good staff- and provider-patient relationships, and active listening skills are all essential for rapport-building.

Additionally, patient-provider communication was strained when patients and doctors did not speak the same language. Patient trust fell by the wayside, and providers struggled to elicit patient activation.

Both Mien- and Spanish-speaking patients said that interpreters made the care encounter easier to navigate, and Spanish-speakers specifically stated that in-person interpreters were preferable.

Not speaking English also hindered self-efficacy related to engaging with the registration staff to understand the delay being experienced by the patient’s mother,” the team concluded. “This touches on another component of CHC—having ‘an enterprising disposition and a proactive stance toward health’ and one’s care.”

NYC HH operates in a city of more than 8 million people, serving more languages, dialects, cultures, and national origins among the city’s population than most cities and counties in the United States, especially when the relevant population is broadened to also encompass New York suburbs in New Jersey, Long Island, and Westchester County.

According to NYC HH:

“… [T]he health system’s ‘I Speak’ campaign features education and marketing materials in 16 languages aimed at promoting the wide array of interpretation services available to limited English speakers and showcasing the diversity among the health system’s workforce…

NYC Health + Hospitals invests approximately $10 million annually to provide 24/7 assistance in 200 languages and dialects through telephonic, video and in-person interpretation, including sign-language services, to ensure patients receive safe, quality care in their language. The health system responds to 1 million requests for interpretation services annually, which translates into more than 13 million minutes of interpretation services every year.

Language access services help close racial disparities and communication barriers that can lead to fewer doctor visits, avoidance of preventive health services, misdiagnoses and poor patient satisfaction,” said Mitchell Katz, MD, President and CEO, NYC Health + Hospitals.

“As a primary care doctor, I know well how important it is to understand and be understood by my patients. I speak Spanish and use it all the time with my patients at Gouverneur [Hospital]. It makes a huge difference. And I am grateful to have access to the amazing interpretation services we have available to help the many other limited English speakers I care for.

… The health system responds to 1 million requests for interpretation services annually, which translates into more than 13 million minutes of interpretation services every year.

NYC Health + Hospitals values diversity and our workforce prides itself on providing a safe, welcoming environment to all New Yorkers, irrespective of a person’s immigration status or language spoken,” said Matilde Roman, Esq., NYC Health + Hospitals Chief Diversity and Inclusion Officer. ‘One way we do this is by making language services available so that our patients can speak to their doctor or nurse in the language they feel most comfortable. We say, ‘diversity is our specialty’, and every day staff at NYC Health + Hospitals strive to provide culturally responsive services to meet our patients’ diverse needs.’

Language Access Tools for Health Care Providers

47 percent of Brooklynites speak a language other than English at home. Health care must be able to communicate in the languages of our patients in order for Brooklyn to truly be a safe place that raises healthy children and families, said Brooklyn Borough President Eric Adams.

‘Cultural and linguistic competence is key to ensuring patient engagement and safety,” said [New York State] Assembly Health Committee Chair Richard N. Gottfried.“As the largest public health system in the country, H+H is a leader in providing language-appropriate health care to New Yorkers regardless of immigration status.’”

The campaign features I Speak Cards such as:

The I Speak Cards also state the following:

  •  “Education materials in the top 16 languages spoken by NYC Health + Hospitals patients promoting the availability of free interpretation services;
  • “I Speak” cards to help patients communicate in their preferred language and request an interpreter in that language;
  • “I Speak” buttons for staff to wear that easily communicates to patients the languages they speak;
  • Video featuring diverse NYC Health + Hospitals staff saying “Your health matters” and “You have a right to receive health services” in multiple languages;

The cards also displays information for staff regarding the use of qualified medical interpreters by telephone, video, or in-person.

NYC Health + Hospitals offers patients and families the following types of free interpretation services:

  • Telephonic/over-the-phone interpretation: Uses a dual handset, wireless or mobile telephonic device to connect to a qualified medical interpreter.
  • Video remote interpretation: Uses a web-based portal (on a computer, laptop, tablet or mobile device) to access a qualified American Sign Language (ASL) medical interpreter, who helps the provider and deaf or hard of hearing patient communicate. This method also offers interpretation in select spoken languages.
  • On site medical interpreters: Qualified medical interpreters help (in person) the provider and Limited English Proficiency (LEP) patient communicate.
  • Language appropriate forms and education materials: NYC Health + Hospitals translates essential documents into the top 13 languages understood by LEP patients: Albanian, Arabic, Bengali, Simplified Chinese, Traditional Chinese, Haitian Creole, Hindi, French, Korean, Polish, Russian, Spanish and Urdu.”


In the end, it all comes down to communication. Using the appropriate language to fit each doctor-patient encounter facilitates the effective exchange of medically necessary information while ensuring health and safety and saving lives. NYC HH’s efforts are just part of seeing that all patients, regardless of language and national origin, receive the same quality of care required by law.

** Check out the blog, “Culturally Competence in Healthcare: An Imperative, Not an Option” for more on this topic.  

Read some of Bruce Adelson’s other blog posts including 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 2019, special for Bromberg, 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 is a Department of Family Medicine faculty member at Georgetown University School of Medicine where he teaches Implicit bias, cultural and civil rights awareness.

Beginning in June 2019, he will teach again at Cornell University.