Overcoming language barriers in healthcare

Thanks to value-based care and the effective work of patient advocates, the healthcare industry has significantly enhanced its focus on addressing the social determinants of health (SDOHs). Payers and providers now collaborate to bridge gaps in transportation access, food and housing stability, and patient-centered education in an effort to improve access, adherence, and patient outcomes.

Among the most challenging barriers, however, is limited English proficiency (LEP).  Approximately 8 percent of all the people living in the United States self-identify as speaking English “less than very well,” a number that is predicted to increase rapidly alongside the growing immigrant population. In some counties, up to a third of the population has limited proficiency, exacerbating health disparities and leading to measurably worse health outcomes.

For example, a new study from Mass General Brigham (MGB) found that non-English speakers comprised close to 30 percent of hospital admissions during the first wave of the COVID-19 pandemic and had a 35 percent greater chance of dying or requiring intensive care unit (ICU) support during that time.

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The study adds to a long legacy of research tying language barriers to miscommunications with providers, reduced patient satisfaction, lack of follow-up, and worse clinical outcomes for both acute and chronic conditions.

Healthcare organizations are required by law to take “reasonable steps” to provide language-related services for their patients, but the reality is that many patients do not get adequate help with understanding their care.

How can providers close the gaps in the care that stem from language barriers to improve patient experiences and bolster clinical outcomes?

Appropriately document the need within the community

While Spanish is the most common non-English language spoken in the United States, immigrants from all over the world bring their own languages and cultural norms to their new communities. Deaf, hard-of-hearing, and other patients who speak American Sign Language often need interpreters, too, a fact which is sometimes left out of the discussion around language needs.

Providers will need to develop a clear understanding of the unique makeup of their catchment area and document this information alongside other SDOH data in a standardized, actionable way.

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By analyzing this information and integrating the results into SDOH programming, providers will be able to take proactive steps, such as preparing educational materials in commonly spoken languages and making a concerted effort to hire bilingual staff who can offer culturally competent care.

Increase investments in live interpreters and tech-driven solutions

However, multilingual staff members cannot and should not take on the entire burden of communicating with non-English speakers. Nor can providers rely on family members to act as interpreters. Patients may feel uncomfortable sharing sensitive details with their relations, while family interpreters may not be able to accurately convey the patient’s words to the provider – or the provider’s words to the patient.

To make the most of contracts with interpreter services, executive leaders should choose a company that offers enough skilled translators for their primary languages of need. These interpreters should provide video and/or audio services as well as the ability to translate written documents.

Meanwhile, all clinical care providers and administrative staff should be equipped with tablets and/or smartphones to use for video and audio calling at the point of care. They should also be familiar with tools like Google Translate, which can help inform and reassure patients while waiting for a proficient speaker.

Partner with the community to offer holistic language support

Just like with other SDOH initiatives, providers need to think outside of the four walls of the clinic to truly address patient needs.

Health systems should consider working with community-based organizations, including faith-based groups and social service providers, to learn more about the language-based barriers to care in their regions. Working with community entities can increase trust and reduce frustrations or stigma that may come from trying to communicate across language barriers. 

Providers may also work with these partners to offer English as a Second Language (ESL) classes with a specific healthcare focus. A team of researchers from Harvard Medical School and Brigham and Women’s Hospital notes that community-based ESL classes can help individuals with some English proficiency improve their general health knowledge in just one three-hour session.

These efforts may make LEP patients more confident about interacting with the healthcare system and more likely to remain adherent to treatment for the long-term.

Language barriers may be among the most challenging social determinants of health, but there are ways to empower patients and providers to communicate more effectively. By investing in interpreters and other language resources, providers can improve care and offer better experiences to their patient populations.

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry. Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.