The road to equity in health care is paved by innovation, but it hasn’t always been smooth, nor is it finished. In 1980, when an 18-year-old Spanish-speaking boy named Willie Ramirez went to the hospital complaining of pain in his head, the South Florida hospital did not have an interpreter present. A miscommunication between doctors and Ramirez’s friends resulted in a delay of care that cost Ramirez the use of his arms and legs.
Ramirez’s story ― one that includes a multi-million-dollar settlement and a life spent advocating for language access services at hospitals around the country ― was a crucial inflection point in health care’s progress toward greater equity for all. But according to Elizabeth McCulloch, assistant vice president of diversity and health equity at Northwell Health, Ramirez’s story is just the beginning of language access services. For the last 11 years, McCulloch and the team at the Center for Equity of Care have been transforming language access services at Northwell, with some help from fellow Northwell employees, stakeholders and facility coordinators.
When Dr. McCulloch arrived at Northwell, she found a language access system that was fragmented and inefficient. She knew changes needed to be made.
“We can’t serve our population without effective communication,” says Dr. McCulloch, noting that Northwell’s patient population speaks a wide variety of languages ― 170 in Queens alone ― and for many, English is not even a second language. “Effective communication depends on language access and health literacy, two of the many important issues we’re addressing.”
LANGUAGE SUPPORT AND TRANSLATOR PROGRAMS
Innovation in Effective Communication Is Improving Health Equity at Northwell Health
"We can’t serve our population without effective communication. Effective communication
depends on language access and health literacy, two of the many important issues we’re addressing."
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Under the leadership of Dr. Jennifer H. Mieres, Northwell’s Chief Diversity and Inclusion Officer, language access services was centralized into the Center for Equity of Care, building from the ground up the structuralized system, policies and oversight that put a language access coordinator at each Northwell facility and expanded interpretation services usage by 800%.
“We needed a system as diverse as the patients we care for,” recalls Dr. McCulloch. “We can now provide assistance in more than 200 languages, 24/7, 365 days a year. People can connect with a qualified medical interpreter who speaks their language within 20 seconds or less.”
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In 2018, the Center for Equity of Care pushed the envelope of language access again, instituting Northwell’s Video Remote Interpreting (VRI) system. VRI has since revolutionized healthcare interpretation. Where previous systems relied on three-way headset interpretation between a patient, doctor and medical interpreter, VRI uses tablet technology paired with a specially designed app to put patients and clinicians face-to-face with an interpreter. The results, according to Dr. McCulloch, have been nothing short of “game changing.” VRI is available at all of Northwell’s inpatient and select
Northwell Health Paramedic Danielle Conigliaro calls up a LanguageLine translator via an app on an iPad.
ambulatory facilities and in the health system’s ambulances, providing interpretation in 41 languages.
“Both patients and clinicians love VRI,” says Dr. McCulloch. “It makes such a difference for patients to be able to see someone who looks like them and understands their culture.”
Understanding a patient’s cultural identity is a major component of effective communication. Along with language access services, effective communication uses the tenets of health literacy, an approach to patient health that considers all of a patient’s cultural components and communicates health information in a way patients can understand. The idea behind effective communication is for a patient to better comprehend their health and taking an active participatory role in decision making. When utilized effectively, a patient should leave a health care consultation with the ability to clearly explain their condition and necessary medications to a family member.
“Health care should be collaborative,” says Dr. McCulloch. “We want to provide the same quality care experience to every patient, no matter what language they speak.”
In solving the challenge of health equity, language access is one piece of a larger puzzle. According to Dr. McCulloch, the Center for Equity of Care’s next big priority is increasing the accurate collection and use of patient’s demographic data, such as race, ethnicity, preferred language and sexual orientation and gender identity. Without accurate health data, systems and programs cannot be properly designed to address health disparities. Conversely, when research and health experts accurately understand an individual’s social determinants of health ― the conditions in which people are born, grow, live, work and age ― they can design programs and systems that solve the challenges presented by a patient’s socioeconomic status, education, neighborhood and physical environment, employment, social support networks and access to health care.
“The future of health care is using data to link equity with quality,” explains Dr. McCulloch. “We need better information in order to understand where the disparities exist.”
This is easier said than done. Not only is collecting accurate info in a high-stress environment like an ER difficult, but many non-English speakers are wary of providing personal information out of fear it will be leaked to law enforcement or immigration or used to bill them for interpretive services. That’s why diversifying Northwell’s employee population to better reflect their patient population has been a key initiative of Dr. McCulloch’s team. An employee population who understands the cultural nuances of their patients can reliably communicate that interpretive services are free and that the personal information being gathered will only be used to provide better care, not to get patients in trouble with any authoritarian body. Furthermore, developing more interpreters from within Northwell’s diversified staff will be key to pushing language access forward.
Northwell is also pushing for more in-house medical translators.
“Oftentimes when we talk about language access, interpretation and translation get blurred together,” Dr. McCulloch says.
Northwell has two distinct programs to develop language access partners from current staff ― one for interpretation and one for translation. Medical translators are qualified translators able to translate health system documents. But it’s not as simple as just knowing a second language; translation is never a one-to-one proposition. To address the written language gap in health equity, medical translators must understand the culture of native speakers. Northwell’s program to develop translators in-house aims to do just that.
Medical translation has many applications. For example, a urologist at Northwell noticed that sometimes just communicating simple phrases like “the doctor will be with you soon” or “would you like a glass a water?” was frustratingly hard. To communicate with such a diverse population, a pocket guide of common translations was proposed and is being developed.
Northwell also developed “I Speak” cards that provide patients a way to show staff
which language they speak. Staff can then easily access qualified interpretation services for the patient. The “I Speak” cards have been successful as both a collaboration between the community and employees in the field and as a tool to increase the quality of care in Northwell facilities.
“It’s gratifying to see the support our language access services have throughout the organization, and we’re super grateful for it,” says Dr. McCulloch. “It’s our clinicians who have been lobbying and fighting for these services, and that’s because the need is so great. They know having our language access services is the only way they can effectively communicate and do right by their patients.”
Dr. McCulloch knows there’s more to do. She’s confident Northwell will continue to use innovative, data-driven approaches to make health care equitable for all.
Under the leadership of Dr. Jennifer H. Mieres, Northwell’s Chief Diversity and Inclusion Officer, language access services was centralized into the Center for Equity of Care, building from the ground up the structuralized system, policies and oversight that put a language access coordinator at each Northwell facility and expanded interpretation services usage by 800%.
“We needed a system as diverse as the patients we care for,” recalls Dr. McCulloch. “We can now provide assistance in more than 200 languages, 24/7, 365 days a year. People can connect with a qualified medical interpreter who speaks their language within 20 seconds or less.”
"We can’t serve our population without effective communication. Effective communication
depends on language access and health literacy, two of the many important issues we’re addressing."
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