Interpreters Help Overcome Linguistic and Cultural Barriers

Case Management Monthly , May 11, 2010

Nearly half of U.S. physicians say language and cultural barriers are at least minor obstacles to providing high-quality patient care, according to a study released by the Center for Studying Health System Change, a nonpartisan policy research organization located in Washington, DC.

The study highlights the need for healthcare providers to address non-English-speaking patients, especially as the percentage of non-English speakers rises.

The latest U.S. census data, collected in 2000, says 47 million residents over the age of five (18% of the total population) speak a language other than English at home. In 1990, 31.8 million residents (14%) reported they did not speak English at home, and in 1980, 23.1 million residents (11%) did the same.

Considering communication is at the heart of what staff members do, staff leaders should treat solving the problem of language and cultural barriers as a top priority.

Such obstacles "can lead to wrong clinical paths and poor outcomes, even disastrous outcomes," says Barbara Bogomolov, RN, MS, BSN, manager of refugee health and interpreter services at Barnes-Jewish Hospital, a member of BJC HealthCare, in St. Louis.

Use interpreters to bridge communication gaps
Patients rely on staff—such as nurses and case managers—to explain forms such as the Important Message from Medicare, provide instruction on performing post-discharge tasks, and ensure their concerns are met. However, many facilities lack resources to address non-English-speaking patients, says Bria Chakofsky-Lewy, RN, supervisor of Community House Calls/Interpreter Services at Harborview Medical Center in Seattle.

Harborview has used its Community Health Calls program to help bridge linguistic and cultural barriers for 16 years.

Originally established to serve the county's East African and Cambodian refugees, the program has since expanded to provide services to patients that speak Spanish, Vietnamese, and Somali.

Harborview employs 50 state-certified medical interpreters that speak 26 languages and serve a patient population that speaks 80 languages. Harborview had more than 100,000 interpreter encounters in 2009.

When Harborview has a patient that speaks a language that is not in its medical interpreters' repertoire, it gets help from an outside interpreter service agency. Facilities that do not have interpreters on staff should at the very least have access to a strong telephone interpreter service, says Bogomolov. Facilities should never rely on a patient's family members or a bilingual staff member in another department to provide interpretive services. "There are issues of bias, performance, patient safety, and confidentiality," she says.

The National Standards on Culturally and Linguistically Appropriate Services (CLAS) do not allow a patient's family members to interpret medical instructions unless the patient specifically requests that they be allowed to do so.

For more information on the CLAS standards, visit the U.S. Department of Health and Human Services' Web site at

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