Communicating Effectively With Patients Who Have Limited English Proficiency

Patient Safety & Risk Solutions

August 17, 2021

Reading time: 3 minutes

Patients who have limited English proficiency (LEP) often do not understand the health information conveyed to them by healthcare providers. For these patients, inadequate comprehension can result in many negative outcomes, including delayed diagnoses, misunderstanding of care plans, medication errors, lack of follow-through, misuse of health services, and lack of trust and confidence in healthcare providers.1

Because of the far-reaching effects of poor comprehension, healthcare leaders, providers, and staff should proactively identify and address language barriers.

Implementing strategies to improve patient comprehension can help organizations provide optimum care for patients who have LEP and reduce the risk of misunderstandings that could potentially lead to adverse outcomes.

  1. Ask all new patients to indicate their preferred language, and determine whether an interpreter is needed to properly assess language preferences and language assistance needs. Document these preferences in the patient’s health record.
  2. Match patients with qualified bilingual clinicians or staff members, or request an interpreter for patients who do not speak English very well or who appear to have difficulty understanding English.
  3. Display signs in your waiting and reception areas announcing the availability of interpreting services. Note: The Affordable Care Act requires covered entities to post notices of nondiscrimination and taglines that alert individuals who have LEP to the availability of language assistance services.
  4. Use acceptable language assistance services to help your patients who have LEP. Acceptable services include bilingual healthcare providers or staff members, staff trained as interpreters, onsite trained medical interpreters, and telephone or video medical interpreting services.
  5. Do not have healthcare providers or staff who are not trained or certified serve as medical interpreters. Also, for privacy reasons, do not use a patient’s family or friends, including minor children, as interpreters.
  6. Be certain that all healthcare providers, staff, and interpreters use plain language when communicating with patients who have LEP.
  7. Provide written materials in patients’ preferred languages. If unable to do so, secure the assistance of interpreters trained in sight translation. Additionally, obtain multilingual health education materials to distribute to your patients who have LEP to support comprehension and adherence to treatment.
  8. Research whether Medicaid or the Children’s Health Insurance Plan in your state pays for interpreter services. Healthcare providers are reimbursed for providing interpreting services in some states. In others, the state contracts directly with interpreting services.
  9. Contact community organizations to determine whether they can provide volunteer trained medical interpreters.
  10. Consider sharing language interpreting services or developing collaborative contracts with local healthcare organizations to use telephonic or online interpreting services.
  11. Assess your staff’s efforts in meeting language assistance needs. Explore new approaches to address any weaknesses identified.
  12. Routinely conduct a review of the health records of patients who have LEP to ensure that their language assistance needs are being documented and assessed. Ensure that qualified individuals are providing language assistance.
  13. Develop procedures for your office staff to respond to calls from patients who have LEP. If possible, use bilingual office staff or onsite interpreters to respond to these calls.
  14. Reserve blocks of time for patients who have LEP to schedule appointments, and arrange for interpreters to be available during those times.
  15. If your organization provides care to a significant number of patients who have LEP, record answering machine messages in more than one language with prompts. If using an answering service, consider contracting with a service whose language capacity supports your patient population.



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