The Joint Commission and the Department of Health and Human Services last week released a 30-minute series of videos titled Improving Patient-Provider Communication. The videos, designed for organizations and healthcare providers, spell out what is required by The Joint Commission and by federal law in terms of effective communication and language access, and how the intent of the law can be met.
Those hospitals that accept federal funding are required to comply with Title VI of the Civil Rights Act of 1964, which prohibits discrimination based on race, color or national origin. This includes providing a translator for those patients who are not proficient in English. Similarly, Section 504 of the Rehabilitation Act of 1973, which protects the rights of individuals with disabilities, requires healthcare organizations that receive federal funds to provide effective communication for patients who are deaf or hard of hearing.
The videos are part of a larger Joint Commission research study called Hospitals, Language, and Culture, undertaken with funding from the California Endowment. The goal of the study, which has been ongoing since 2003, is to better understand the issues of culture and language and how they play out in patient populations in hospitals. The Joint Commission has already published a few reports from study findings and plans to publish more in the future.
"We were interested to know how these issues were identified, what was challenging to hospitals about addressing these issues, how they were meeting the challenges, and looking at promising practices for meeting those challenges," says Amy Wilson-Stronks, MPP, project director in the Division of Standards and Survey Methods and principal investigator for Hospitals, Language and Culture study at The Joint Commission.
The research component has mostly focused on racial and ethnic health disparities and the role that culture and language may play in that issue, says Wilson-Stronks. However, as the study has evolved, the issue of effective communication between patients and providers relating to quality care for all patients has stood out as the primary safety imperative that is inherent in any discussion about cultural and ethnic healthcare disparities.
A different, but related Joint Commission project aims to take the lessons learned from the Hospitals, Language, and Culture study and revise and update the existing Joint Commission standards concerning effective communication, cultural competence, and patient centered-care. This 18-month grant was funded by The Commonwealth Fund and the funding runs through January 2010.
"As we've considered how to actually implement what we've learned from that, we realize we have to look at these issues in a broader context and really believe that patient and family-centered care is a little more encompassing and probably better reflects that concept of meeting patient needs as a way to improve quality and safety," Wilson-Stronks says.
An expert multidisciplinary advisory panel has also been working together to provide input on what should be included in the proposed requirements. The board represents many parties, including patients from many cultural backgrounds, patients with disabilities, and patients who are gay, lesbian, bisexual, and transgendered.
"We're looking at this idea of culture more broadly, and communication more broadly, as we're looking at the role of the standards," says Wilson-Stronks.
The Joint Commission expects to announce a set of proposed requirements concerning cultural competence, effective communication, and patient-centered care in January 2010. Hospitals will not be responsible for implementing them until January 2011 at the earliest, says Wilson-Stronks.
In addition, the Joint Commission will be producing an implementation guide that will focus on what the new standards require, focus on promoting effective communication and culturally competent care, and provide some examples to help organizations meet the standard, says Wilson-Stronks.
Overall, Wilson-Stronks says addressing linguistic and cultural needs in the context of healthcare communication is not just an issue for a minority population. Understanding the need for open lines of communication and removing any barriers to a trusting patient-provider relationship are key in any healthcare scenario.
"In some ways, I think this is a misunderstood issue," says Wilson-Stronks. "We often think of diversity and cultural competence and language access as what is needed to provide care to a subset of our population. But we really realize that it's not just a nice thing to do to be respectful of patients' values and beliefs, that it's important because we want to make sure our health system is responsive to those needs because they do indeed have an impact on physical quality of care and safety."