CKHS Introduces Measures to Make Non-English Speaking Patients More Comfortable
Experts agree that it is vitally important for every patient and his or her family members to receive detailed instructions about the patient's diagnosis, treatment options and prognosis. However, in the United States - particularly in Delaware County and its surrounding areas - a growing immigrant population means that non-English-speaking residents may have difficulty understanding their physicians and other caregivers.
Crozer-Keystone Health System (CKHS) has taken another step toward making its five hospitals more accommodating toward its non-English speaking patients and visitors by installing dual-handset telephones that allow the patient and his or her caregiver to speak directly to an interpreter at the same time.
The telephone system, which is contracted through Phoenix Language Services of Bucks County, Pa., allows the patient and his or her family members to communicate freely with his or her caregiver. Both the patient and his or her physician can pick up one of the telephone's receivers to be immediately connected to a professional medical interpreter through Phoenix Language Services, which represents 150 different languages.
"Delaware County is a very diverse community, and we are committed to making sure we provide the best possible care for our patients," says Gene Zegar, vice president of Human Resources for CKHS. "Part of being a good neighbor and a good provider of medical services is being able to communicate with our patients. We aim to be sensitive to the diverse needs and the diverse population of our area."
The new interpreter service phones are being placed in high-utilization areas of each hospital, such as the Admissions offices and emergency departments. Staff members are directed to use the telephones whenever they need to communicate with a patient with a limited knowledge of the English language.
"It is vital for our staff members to use the interpreter services to ensure that we provide our patients with the best quality of care," says Tonya Yao, Human Resources manager for Taylor Hospital. "An interpreter can help the doctor or nurse find out where the patient's pain is, thus eliminating the need for unnecessary testing or subjecting the patient to procedures he or she does not necessarily need."
Studies have shown that using a non-trained interpreter - such as an employee who speaks several languages - to relay information to patients is harmful for both the patient and employee. Turnover rates for employees who are asked to interpret for patients are high as a result of the employee's worries about getting his or her required job duties done and about the reliability of the information he or she provides to the patient. Using a family member to serve as an interpreter has similar drawbacks, as relatives may be hesitant to give a patient bad news or may try to shield him or her from some details of an upcoming treatment or procedure.
Interpreter services have already proven to be popular among CKHS employees and patients. A total of 5,904 hours were logged by employees and patients utilizing the service from July 2001 through July 2002. Of those hours, 3,629 (61.47 percent) were spent speaking with Spanish interpreters, followed by Vietnamese (384 hours; 6.52 percent), French (263 hours; 4.45 percent), Russian (225 hours; 3.82 percent) and Arabic (217 hours; 3.69 percent).
The telephone system is the latest in a series of CKHS initiatives aimed at making it easier for patients to control their own health care options.
A booklet used at all CKHS hospitals, entitled "Talk to All People" (TAP), allows patients to identify their native language. The booklet outlines the phrase "I speak..." in 28 different languages, and patients can point to their own language, allowing caregivers to connect the patient with an appropriate interpreter. Interpreters can then speak with the patient and his or her caregiver over the phone, or can arrive on-site at any of Crozer-Keystone's hospitals within 30 minutes to speak face-to-face with the patient, his or her family, and his or her doctors and caregivers, according to Bill Martin of Phoenix Language Services.
The TAP book also lists some common phrases used by hospital caregivers - such as "Take your medicine," "Are you hungry?" and "Where is your pain?" - along with a pronunciation guide that helps the caregiver vocalize the statements in the patient's native language.
According to Leslie Mickles, nursing education manager for Crozer-Chester Medical Center, staff members are also using the interpreter services available to them to learn more about individual patients' cultural customs and beliefs, which helps the patient and his or her family become even more comfortable with the care he or she is receiving.
"Certain cultures have certain beliefs," Mickles says. "For example, in some cultures, touching a person on the head is equivalent to cursing him or taking away his spirit, which causes a great deal of distress to the patient and his family. The interpreter services help us to understand those beliefs and accommodate them."
In addition to the use of interpreter services and TAP books, Delaware County Memorial Hospital has installed signage around the building that provides hospital information and maps in a variety of languages.
"People really seem to like both the TAP books and the signs," says Valerie Voluntad, coordinator of DCMH's Diversity Outreach program. "They come in very handy in certain circumstances. It's calming for both the caregiver and the patient."
Bradley Baldia, project coordinator of DCMH's Cultural Connections Collaborative, agrees.
"One of our priorities at DCMH is to make our patients, their families and our visitors feel comfortable," he says. "That includes families with limited English proficiency. The directories at DCMH make it easier for them to find the areas of the hospital that they need to get to."
The signage is expected to be installed in the system's other hospitals within the next few years.
"Here at the Crozer-Keystone Health System, we realize that communication is a vital part of good health care," Zegar says. "By developing these initiatives, we can ensure that all people, no matter their background, culture or language, can benefit from an open dialogue with their doctors and caregivers."
CKHS Adjusts to Growing Diversity in Delaware County
According to U.S. Census figures, the population of Delaware County is growing more ethnically diverse. For example, from 1990 to 2000, the number of people of Chinese descent in the county grew by 141 percent, the number of Vietnamese people grew by 86 percent, and the number of Mexican people grew by 55 percent.
Crozer-Keystone Health System (CKHS) has responded to this growing diversity among its patients – and its workforce – in a number of ways. These efforts range from implementing new technologies and policies to efforts aimed at introducing employees for a range of different cultures.
“Crozer-Keystone recognizes and celebrates the diversity of the communities served by our hospitals. We continue to develop ways to meet and exceed the expectations of our patients and families. We are proud of our diverse workforce and their competency in caring for our diverse community,” says Joan K. Richards, chief operating officer of Crozer-Keystone Health System and president of CKHS Hospitals.
In 2002, for example, the health system implemented the use of dual-handset telephones that allow a patient and his or her caregiver to speak directly to an interpreter at the same time. Through the system, both the patient and caregiver are immediately connected to a professional medical interpreter through Phoenix Language Services of Bucks County, Pa., which provides interpreter services for the health system. Crozer-Keystone employees and patients log about 6,000 hours of interpreter services each year in more than 30 languages.
In the spring of 2002, cultural diversity fairs were held at each Crozer-Keystone hospital. The fairs exposed employees to various cultures through vendors, interactive displays, entertainment, education and food. In addition, large maps were placed in public areas at each hospital, and employees were encouraged to use pushpins to show their families’ country of origin.
“Exposing employees to the rich cultural backgrounds of our patients - as well as the people they work with every day - leads to greater understanding and, in the end, better employee satisfaction and patient care,” says Eugene Zegar, CKHS vice president of Human Resources.
Toward that end, the health system uses the “Talk to All People” (TAP) booklet to identify patients’ native language. The booklet outlines the phrase “I speak …” in 28 different languages, allowing caregivers to connect the patient with an appropriate interpreter. The booklet also lists common phrases that may be used by health care employees, as well as a pronunciation guide.
Representatives from the Cultural Connections Collaborative at Delaware County Memorial Hospital also created a cultural diversity handbook that was distributed to departments throughout the health system. The handbook includes information about health care beliefs and customs for a range of different ethnic groups. Employees can reference the handbook to learn, for example, how patients from these various groups may traditionally regard such relevant topics as child-rearing, dealing with pain, and death and dying.
The Cultural Connections Collaborative is funded through Pew Charitable Trusts and administered by the Delco Memorial Foundation of Delaware County Memorial Hospital (DCMH), in collaboration with the Upper Darby School District, Lutheran Children and Family Service, ChesPenn Health Services and the Pennsylvania Department of Health.
The collaborative has been active in training Upper Darby School District staff members to help them deal more effectively with the health, mental health and social issues that hinder the success of recently immigrated children. The collaborative helps recently immigrated students through such activities as coordinating immunizations, organizing book and magazine collections, and planning an annual “multicultural health and learning fair.”
Delaware County Memorial Hospital, which is located in one of the most diverse areas of Delaware County, has also taken additional steps to reach out to its patient population. For instance, in the past two years, the hospital has introduced hospital maps in eight different languages, as well as placed the word “welcome” in the same languages on windows near hospital entrances. The hospital also hosts English as a Second Language classes, which are regularly packed with local residents from dozens of different countries.