More than 66.6 million American's speak a language other than English at home. As the U.S. population grows in linguistic diversity, it's important to understand the nuances surrounding the varying levels of English proficiency, including the impact it has on equitable access to care.
In healthcare, government and other essential services, most are familiar with the compliance requirements set forth with the intention of ensuring equal access. What often goes overlooked, however, is that depending on an individual's level of English proficiency, there may be additional considerations.
Patients with limited-English proficiency are more likely to be admitted to the hospital, receive unnecessary tests, and experience delays in diagnosis due to misunderstanding of the patient's symptoms and medical history. Understanding the different levels of language support your patients may need can help you to provide the best possible care to each individual.
What is Limited-English Proficiency?
Limited-English proficiency is defined as the limited ability to speak, write, read, or understand English. Title VI of the Civil Rights Act of 1964 states that entities or programs that receive Federal financial assistance must make programs accessible to people with limited-English proficiency — this means ensuring interpretation or translation is available as needed to ensure equal access to healthcare and other vital services.
From a compliance perspective, fully bilingual staff who can communicate with patients in their native language can play a vital role, but both interpreting and document translation require additional technical skills and knowledge beyond competence in two or more languages. Ensure you're prepared to provide patients with translated documents (intake forms, discharge instructions) in addition to on-demand interpreting and translation as required.
Not everyone whose primary language is not English is considered to be limited-English proficient. Respecting each patient's English proficiency level is vital to protecting their dignity and ensuring that they receive high-quality care.
Levels of Proficiency
English proficiency, or proficiency in any language, is categorized in a six-level system, from zero to five. Determining where a particular patient's proficiency lies can ensure that you provide the appropriate language access resources.
Level 0: No Proficiency
People with this level are unable to communicate in English beyond a few words. Services will need to be provided entirely in their native language or another language in which they are fluent.
Level 1: Elementary Proficiency
Elementary proficiency is the level commonly considered limited-English proficient (LEP). People with this level of English proficiency can ask and answer simple questions but cannot hold conversations or read and write in English, and will need significant language support throughout the entire patient journey.
Level 2: Limited Working Proficiency
At this level, people can communicate reasonably well in English on a relatively simple basis. They can hold conversations and may be able to read and write at a basic level, but will need significant language support when dealing with complex topics such as healthcare.
Level 3: Professional Working Proficiency
People with this level can speak at an average speed with an extensive vocabulary. They can generally read and write in English. However, they likely need some language assistance to fully understand their healthcare needs and options.
Level 4: Full Professional Proficiency
Patients with English proficiency at this level likely need little language assistance in a healthcare setting. They may speak with an accent or make minor mistakes, but they are generally fluent and able to read, write, and speak on advanced topics. It's a good idea to have language services available to them if their healthcare needs are very complex to ensure there are no misunderstandings.
Level 5: Native/Bilingual Proficiency
At this level, the person has been speaking English so long that fluency is equal to that of a native speaker. There is typically little to no accent and no need for language assistance.
Addressing the Lack of Access to Quality Care
People who are not fluent in English, especially those with limited-English proficiency, face real barriers to quality care. Research shows that when medically qualified interpreters are not available, healthcare facilities tend to rely on patients' family and friends or hospital staffers who are bilingual but not trained in interpretation or translation. In many cases, patients' young children end up acting as interpreters, as their English proficiency may be higher than their parents.
Unfortunately, this lack of access to trained and skilled linguists can hamper the availability of quality care. Of medical errors caused by interpretation difficulties, 77% are made by interpreters who are not medically trained. Those with limited-English proficiency are also more likely to be admitted to the hospital and to receive unnecessary tests, and there can be delays in diagnosis due to health professionals' misunderstanding of the patient's symptoms and medical history.
A professional, trustworthy language solutions provider can help your facility guard against these issues. Having highly skilled translators and interpreters standing by ensures that your patients get the quality care they deserve without language barriers standing in the way.
Extending Access (and Empathy) During Difficult Situations
Unfortunately, not all healthcare visits yield good news. Whether someone is facing a disease diagnosis or a risky surgery, difficult situations can bring heightened emotions, and even native English speakers may have trouble following exactly what healthcare providers are telling them. For those with a non-native level of English proficiency, immediate access to medically qualified interpreters and translation services is imperative to make sure the message is clear.
At times like these, it's also important to ensure your language solutions team possesses a high degree of empathy. In addition to providing a clear and accurate statement of what is happening medically, an empathetic interpreter will also be able to convey the warmth and concern that your entire team extends to patients.
Meet the unique needs of all patients.
Understanding your patients' levels of proficiency can enable you to provide better access to care and services -- for everyone. Set your patients and providers up for successful outcomes by verifying their preferred language ahead of time and preparing to have an interpreter ready for a wide range of scenarios. Taking these steps can help improve health outcomes and will ensure providers are equipped with the tools needed to provide adequate care.
Don't let language barriers get in the way. Be prepared to provide equitable care to your multilingual patient community -- whenever, wherever. Download our free Guide to Designing Your Ideal Language Access Plan to get started today.
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Want to learn more about equipping your organization with the right language access resources? Get in touch today.