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Health, Language and Culture. Imagine the experience of our culturally diverse patients. Language and cultural barriers A very different healthcare system.

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Presentation on theme: "Health, Language and Culture. Imagine the experience of our culturally diverse patients. Language and cultural barriers A very different healthcare system."— Presentation transcript:

1 Health, Language and Culture

2 Imagine the experience of our culturally diverse patients. Language and cultural barriers A very different healthcare system to navigate. Consider this: –The phrase “What brought you here today?”

3 Improving Communication with our Patients Interpreter Services provided by trained medical Interpreters helps improve patient outcomes, quality and satisfaction. It’s the Law Federal Laws preventing discrimination include language. Massachusetts Law mandates that we provide face to face Interpreter Services in the Emergency Department and Acute Psyche encounters in our most common spoken languages. Patients who are deaf and or hard of hearing are entitled to a Sign Language, or Sign Language and Certified Deaf Interpreter under the American Disabilities Act.

4 Working with Professional Medical Interpreters Interpreters are part of the care team for the patient. In addition to interpretation services, they can help providers understand cultural differences. Hold a pre or post conference with the interpreter for briefing or feedback. Very important for telephonic interpretation. Make sure the patient understands that interpreter services are free of charge. Document in the Medical Record Use of Interpreter Refusal of Interpreter Services

5 Can’t I just find someone to interpret? Clinical Information must be interpreter by a trained medical interpreter- consents, information about treatment, medications, discharge instructions…. For non- clinical information- you may use a family member or non-trained bilingual employee ONLY for non clinical situations such as registration, giving directions, ordering a meal, and informing that a medically trained interpreter is on the way. Minor children should NEVER be asked to interpret. It places too large a responsibility on the child. Also, adults patients are unlikely to be forthcoming with sensitive information.

6 Can I interpret? At Mount Auburn Hospital only medically trained interpreters interpret. Trained medical interpreters do not add, omit, distort, or change the register of the message. Many providers are fluent in other languages and choose to speak to their patients in those languages. Growing attention nationally. Some organizations have tested providers language skills. Reports cite a 30%-60% pass rate.

7 I-POP Interpreter Phone on Pole All inpatient and most outpatient units Quick access to 150 languages Will often stay in patient rooms Turn off between conversations

8 Any phone

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10 Interpreter Services Page # 6681 For scheduled appointments with more than 48 hours notice fax Request Form to x5091. Interpreter Services on Portal

11 Interpreter Services Page # 6681 For scheduled appointments with more than 48 hours notice fax Request Form to x5091. Interpreter Services on Portal Spoken Languages Monday - Friday 8:30am-5pm Staff Languages page: –Spanish: #6681, –Portuguese: #6852 –Armenian/Russian: #6692 All other languages – Use Phone After 5pm, weekends + holidays Spanish page #6681 Other Languages use phone I-POP

12 Interpreter Services Page # 6681 For scheduled appointments with more than 48 hours notice fax Request Form to x5091. Interpreter Services on Portal Spoken Languages Monday - Friday 8:30am-5pm Staff Languages page: –Spanish: #6681, –Portuguese: #6852 –Armenian/Russian: #6692 All other languages – Use Phone After 5pm, weekends + holidays Spanish page #6681 Other Languages use phone American Sign Language anytime Page #6681 I-POP

13 Interpreter Services Page # 6681 For scheduled appointments with more than 48 hours notice fax Request Form to x5091. Interpreter Services on Portal Spoken Languages Monday - Friday 8:30am-5pm Staff Languages page: –Spanish: #6681, –Portuguese: #6852 –Armenian/Russian: #6692 All other languages – Use Phone After 5pm, weekends + holidays Spanish page #6681 Other Languages use phone For special patient circumstances any time page #6681. American Sign Language anytime Page #6681 I-POP

14 Translation services arranged thru Interpreter Services JACHO requires we use certified translators Interpreters may translate one time, patient specific short documents. DO NOT USE TRANSLATION PROGRAMS SUCH AS Google Translator…

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16 People have more of a “culture” than their American neighbors if they were born in a foreign country and continue to honor family traditions. Everything considered to be “common sense” is determined by culture. Communication styles are rooted in culture and impact clinical interactions. To improve cross-cultural interactions, the first step recommended by experts is to understand the cultural values and beliefs of others. Cultural Quiz-What do you think? University of Toronto False True False

17 In every patient encounter there are at least 5 cultures involved. Patient Caregiver Biomedical Hospital American

18 Health Disparities Health Inequity

19 Institute of Medicine 2002 Even among the better-controlled studies, the vase majority indicated that minorities are less likely than whites to receive needed services. Although myriad sources contribute to these disparities, some evidence suggests that bias, prejudice and stereotyping on the part of healthcare providers may contribute to differences in care. Racial differences in patients’ attitudes, such as their preferences for treatment do not vary greatly and can not fully explain racial and ethnic disparities in healthcare.

20 IOM Report-Solutions Report highlighted no one cause of disparities and therefore no one solution. Culturally and Linguistically Appropriate Services (CLAS) Standards –Interpretation Guidelines –New JACHO guidelines Communication –Cultural Competency Education

21 Cultural Competence Respect Curiosity Empathy Cultural Humility

22 From good to GREAT: From Common Knowledge to Common Practice What is “common” is related to Culture.

23 “I think this would look great in my Living Room.” It is a Decoration “Let’s bring this back from our trip to India.” It is a Souvenir “I use this everyday when I pray.” It is a Place of Prayer People from different cultures will describe the same object differently.

24 Status A well decorated war hero. Status An expensive pampered pet. Status A wise elder. People from different cultures will describe the same word differently.

25 Cultural Passport Think about the answers to these questions: What words or phrases describe your cultural views of health and illness? If you loved ones were receiving in-patient treatment for serious illness, what should providers understand about your cultural view of medical care? What aspects of your cultural background do you feel could strengthen your interactions with and care for patients and their families?

26 “It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” Sir William Osler, MD

27 Worlds Apart Video Series

28 Explanatory Models Communication tools used to elicit increased understanding when those communicating have diverse cultural perspectives. The Explanatory Model-Kleinman –What do you think caused your problem? –Why do you think it started when it did? –What do you think your sickness does to you? –How serve is your sickness? Do you think it will last a long time, or be better soon in your opinion? –What kind of treatment do you think you should receive? –What are the most important results you hope to get from this treatment? The LEARN Model-Berlin, Fowles –Listen with sympathy and understanding to the patient’s perception of the problem –Explain your perceptions of the problem –Acknowledge and discuss the differences and similarities –Recommend treatment –Negotiate agreement

29 Thank You


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