Within Health Systems
Interpreter Services
Central to any medical service serving non-English speaking patients. There should be multiple modalities available to clinicians including contracts with agencies for in-person interpreters for elderly, hearing impaired, and mentally ill patients. Telephone contracts for rare languages or emergent access and video link systems when in-person is not feasible. In some cases complex patients will warrant navigation and case management when required. With these service systems must include:
- Interpreter training
- Certification
- Recruitment and retention
- Integrating interpreter services into provider and patient education
Administrative systems
- Recruiting from the community to have the work force reflect the communities
- Integrating cultural and linguistic codes into data systems such as diabetes tracking system and rehabilitation outcomes in order to assess outcomes by ethnic group
- Developing safety systems that include cultural information about names, pronunciations, and the name order by culture.
- Materials for appointments, procedures, and preps for procedures that are translated and culturally tailored
- Hospital schedules that minimize no show rates and reschedules by noting important holidays, feasts and fasts which will impact care of the ethnic groups served by the system
Financial systems
- Interpreted culturally sensitive interpretations that explain the concept of insurance, co-pay, sliding scale and the scope of charity care
- An explanation of the billing system and special attention to explain collections and how to work with the collection agency, how to work with the billing department
For Patients
Education about medical culture
- Education about the work-up, appointments, the role of specialty care
- Emergency services, Urgent Care, Primary Care, Specialty Care
- Pharmacy and formularies
- Advanced directives
- Giving bad news
- Palliative care, hospice, and the medical examiners requirements
- Disease specific topics for common diagnoses (TB, pneumonia, diabetes, cervical cancer, Hepatitis B)
- Routine procedures (colonoscopy, endoscopy, blood transfusions)
- Dietary changes for diabetes, hypertension, ischemic heart disease
- Pre-operative instructions and procedural explanations
Periodic Provider Training
Often left to medical schools or residency programs clinicians need an orientation to the interaction between culture and medicine. Obvious case studies vary by discipline but have to do with examples of how expectations in clinical encounters vary by culture, how common illnesses are constructed linguistically and culturally, how dietary patterns impact wound healing or illnesses like hyperlipidemia and diabetes that are affected by diet, and how religious life impacts end of life discussions and certain illnesses.
Health systems that can identify these elements within their array of services can say they have begun the steps needed to address disparities in care impacted by language and cultural difference.
