The Joint Commission will be releasing new standards for hospitals surrounding language, culture, and communication in the January 2011 hospital manual.
The standards, announced in the January 2010 Perspectives on The Joint Commission, will be accompanied by a Web-based, downloadable guide, which will be released in late May. Hospitals will be able to view the standards at this time, and although they will be included in the 2011 hospital manual and part of a survey, they will not be factored into a hospital's accreditation at that time, said Paul Schyve, MD, senior vice president at The Joint Commission, who spoke on a Webcast entitled New Joint Commission Standards to Improve Patient-Provider Communication on April 16.
"We realized that there were more barriers to effective, safe care and communication than just culture, and just language," said Schyve.
To develop the standards, The Joint Commission put together a technical expert panel (TEP) of people involved in many different areas of healthcare, as well as other areas of society. The panel addressed three areas:
- Effective communication—Identifying needs and providing language services for those patients who need them.
- Data collection and use—How to collect demographic data of patients and using it for performance improvement.
- Address specific patient needs—Ensuring patient and family involvement, equitable treatment, and addressing cultural and spiritual beliefs.
Specifically, new to the standards will be requirements involving identification and documentation of oral and written communication needs of a patient, and the patient's preferred language for discussing healthcare. This goes beyond language, and includes glasses, hearing aids, and communication boards for intubated patients. Additionally, the patient's and his or her advocate's preferred language should also be documented in the medical record.
"Think broadly about the different barriers to communication and how you might need to address them for any specific patient, and be prepared with any equipment and so on for patients with that particular kind of problem," said Schyve.
Other additions include the need to formally train interpreters, as not all people who are bilingual are trained in medical terminology. These qualifications must be evaluated and met through assessment, education, training, and experience, as deemed acceptable by the facility.
The new standards also heavily emphasize the effect on a patient's well-being that having a family member, close friend, or other individual present during care can have. The hospital will be required to allow this type of person, regardless of relationship to the patient, to stay at a patient's side for emotional support throughout his or her care. This will align with President Obama's memorandum last week stipulating that hospitals that participate in Medicaid or Medicare afford patients the right to have visitors of their choice, regardless of their relationship (familial or not).
"Those that were on the TEP pointed out that in patient-centered care, it's become clear that patients are much more comfortable when they're in the hospital if they can have a friend of family member with them on a much more continuous basis," said Schyve.
Many of the new requirements are additions to some existing standards in the Rights and Responsibilities of Individuals, Record of Care, Treatment, and Services, and Human Resources chapters.
The road map will help guide facilities in complying with these standards and incorporating their concepts and intent into everyday care, said Amy Wilson-Stronks, MPP, CPHQ, project director in the Division of Standards and Survey Methods at The Joint Commission and principal investigator on the Hospitals, Language, and Culture study.
"I think it's really important for folks to think about this in a broader context," said Wilson-Stronks. "In order to address disparities, there really needs to be an integrated effort at multiple levels, and it needs to be an ongoing process, integrated into both patient safety and quality improvement initiatives."
Heather Comak is a Managing Editor at HCPro, Inc., where she is the editor of the monthly publication Briefings on Patient Safety, as well as patient safety-related books and audio conferences. She is also is the Assistant Director of the Association for Healthcare Accreditation Professionals. Contact Heather by e-mailing hcomak@hcpro.com.