Introduction
In America’s 2021, 25.7 million people (8%) over the age of 5 have Limited English Proficiency (LEP), including many limited english proficiency patients! Among whom Spanish is the most common (63%), Chinese is next (7%) and at last is Vietnamese (3%). With 81% of America’s LEP citizens born outside, they experience the “healthy immigrant effect!” Thus, the LEP community still lacks translation resources, leading to healthcare issues ranging from faults to disasters.
Who Are Patients with Limited English Proficiency (LEP)?
Patients with limited English proficiency (LEP) are those who cannot speak proper English in a medical setting, where they should. Therefore, they enjoy no effective communication as translation, if provided, might not convey what they really wish conveyed. In addition, poorly trained translators might not reflect the culturally appropriate terminology and understanding of a case, which is essential for patient-centered care.
With little online medical content in various languages, patients with LEP find it difficult to fully understand critical information!
Have you faced a similar situation? Let us tell you about one!
In a small Brooklyn shop, Maria, an immigrant from Peru, who speaks Quechua scribbled with sticks her chest pain onto a napkin, handed it to her daughter, as she screamed for help. Her daughter translated poorly it for the 911 operator. But later, paramedics would wrongly understand Maria’s heart attack as “indigestion!” Long story short, Maria survived; but her napkin sketch continues a mission hanging in a Manhattan clinic as part of a training program for Emergency Medical Technicians (EMT).
Maria was lucky, but many others were not! Such a scene is a daily reality for millions of limited English proficiency (LEP) patients in English-speaking countries.
Such reasons and others of the same nature led to 35% higher readmission rates for limited English proficiency patients and 2.3x increased ER misdiagnoses. So how exactly are non-English-speaking patients suffering? Find out more as you read on…
Is Limited English Proficiency Considered a Disability?
Many countries blame migrants for not learning their dominant languages. But they are negligently burdening those individuals and obstructing their access to timely care. This pushed them to live below 200% of the federal poverty level (compared to only 12% of the English-proficient). In addition, 68% of the LEP elders face issues managing their chronic diseases.
Does that really make LEP a disability?
On the contrary, studies and the Americans with Disabilities Act (ADA) view LEP as a health disparity with a grave impact on care access and quality and not a disability.
Unfortunately, limited English might cause LEP patients surgical delays and errors in their paperwork, that amount to 58% when no professional interpretation takes place.
Accordingly, employment protections (Title VII) mandate that an employer deploys LEP employees if her/his work is linked to national origin discrimination. Moreover, education rights mandate that schools provide language assistance under Title VI, ensuring LEP students can access equal educational opportunities.
The Impact of Language Barriers on Healthcare Quality
The Impact of language barriers on healthcare quality is greater than imagined. Taking the story in the introduction, there are many more everywhere. Language barriers contribute to misdiagnosis, less-than-average treatment, worsening outcomes, and premature discontinuation.
Providers often misinterpret the culture as well, leading to undertreatment and thus risking their legal stance and reputation. That’s how 17% of malpractice handling LEP cases were cited (as communication failures).
From a healthcare professional’s side, the medical processes for LEP patients take 20–40% more time and effort than English-speaking citizens. Thus, 63% of clinics in rural areas rely on uncertified bilingual professionals, risking miscommunication.
Why would you face all that?
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Challenges Faced by Healthcare Providers When Treating Limited English proficiency patients
Challenges in this field are many and unexpected. No matter how heavily healthcare professionals trained, they still cannot wholly have control over LEP challenges in healthcare.
However, here are some of them:
- Information Gathering: Obtaining complete and accurate medical records, symptoms, and preferences hinder accurate diagnosis and personalized treatment plans.
- Building Rapport and Trust: Communication barriers significantly impact the ability to build trust, reducing patient satisfaction and adherence to treatment.
- Ethical Informed Consent and Decision-Making: It becomes extremely complex when patients do not fully understand the procedures or treatment plans.
- Explaining Complex Information: Medical terminology, treatment options, benefits, and risks are often difficult to convey accurately.
- Time Constraints and Resource Limitations: Limited time and access to qualified interpreters hinder effective communication.
- Variability in Translation Quality: Inconsistent translation can compromise the accuracy and effectiveness of communication.
Healthcare Policies for Managing Patients with Limited English Proficiency
Despite officials’ ongoing efforts to improve policies in this area, significant challenges remain, and stronger oversight and accountability are still needed. However, important strides have been made, including:
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Title VI of the Civil Rights Act (1964): Requires healthcare organizations to provide language access services for individuals with limited English proficiency (LEP) (U.S. Department of Health & Human Services).
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Section 1557 of the Affordable Care Act: Strengthens language access protections by mandating the use of qualified and certified interpreters.
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2023 Health and Human Services (HHS) Proposal: Suggests mandatory use of video remote interpreting (VRI) to improve telehealth access.
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Affordable Care Act (ACA): Requires free interpreter services for insured patients and prohibits discrimination based on language.
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National Standards for Culturally and Linguistically Appropriate Services (CLAS): Sets the framework for culturally and linguistically competent healthcare delivery.
Notably, California passed Senate Bill (SB) 223 in 2024, which penalizes hospitals for using minors or family members as interpreters, ensuring professional interpretation standards are upheld (California Legislative Information).
What Is an LEP Plan in Healthcare Institutions?
A well-devised limited English proficiency patient’s plan starts with a thorough assessment of each patient’s language needs, taking into account demographics, language preferences, and communication barriers.
Such a plan details how a language service ought to be provided including its medium (on-site, remote, telephone) as well as the training and expertise needed, including communication techniques, level of collaboration, level of cultural sensitivity, and even the electronic health records (EHR) computer system to be used.
Moreover, it stretches to consider engagement strategies with LEP patients to understand their needs better; and outlines evaluation criteria for the effectiveness of services, collecting feedback, and continuous improvement.
It does not stop here, an LEP plan also supervises adequate resources and allocations are in place, in terms of translation services, training, and constant evaluation as well as supporting community partnerships.
The Importance of Training Medical Staff to Work with Limited English proficiency patients
Talking about the importance of training your medical staff to work with LEP patients, we find it too vast to be defined. To start, it is better to lay out some of the results achieved in this direction:
- Reduced Errors: At the University of Washington, after 8-hour training, ICU medication errors were cut by 40%!
- Cultural Competency Training: Improves patient trust and adherence to treatment.
- Duke University Model: That welcomed “Language champions” )bilingual volunteers( to help with medical interpretations and cut limited English proficiency patients’ waiting time by 70%.
- Enhancing Communication Skills: Training helped with smoother, clearer, and more effective communication with limited English proficiency patients, using visual aids and other tools.
- Increased Safety: Reducing medical errors, misdiagnosis, and adverse outcomes associated with language errors.
- Increased Satisfaction: Translations that consider the cultural and linguistic sides of the Limited English proficiency patient’s mother languages improve the patients’ experience, trust, and satisfaction.
- Better Outcomes: Foster treatment adherence.
- Reduced Disparities: Addressing LEP populations’ health issues through equitable access to healthcare.
- Ethical and Legal Compliance: Ensuring compliance with federal regulations such as Title VI of the Civil Rights Act, which mandates language access for LEP individuals in healthcare settings, protects institutions from legal risks and promotes patient-centered care.
Social Factors Related to English Proficiency: Education, Employment, and Income
Is it fair or logical to have the average income of LEP families at 35k while it is 65k for English-proficient ones? That only adds to the LEP life challenges. However, now with the AI revolution, 40% of LEP workers are fearing going jobless! So how much more critical would English proficiency be for their career resilience?
Besides, LEP has long been associated with lower education. That is what the huge body of research proves. Moving ahead, such language barriers continue to limit employment opportunities and even earning potential, contributing to socioeconomic gaps and disparities.
From a social lens, LEP populations fall in isolation, which is a normal result of restricted access to information about health, education, and community resources. Much worse, it gradually paves way to acculturation and identity loss across newer generations, leading up to more isolation and overall dispersion.
Official Government Resources and Guidance on LEP
With all efforts called for and governmental endeavors, the Department of Health and Human Services (HHS) and the Office for Civil Rights (OCR) cannot cease improvements of LEP healthcare experience.
Some of those endeavors, for example, are the HHS tracking of Title VI compliance and upholding state-specific guidance. Moreover, there is the Centers for Disease Control and Prevention – CDC’s Checklist – that was used by over 1,200 clinics during COVID-19 to streamline language access. Another one is the Department of Justice – DOJ Enforcement – that fined 14 hospitals in 2022 for failing to provide translated consent forms.
These are all great steps that aim to ensure equitable healthcare experience for all, but will they ever be enough?
Frequently Asked Questions
Who Are Patients with Limited English Proficiency (LEP)?
They are all patients who happen not to speak English very well in an English-speaking country. Those patients require special services and management all through and even after their medical journey. In America’s 2021, 25.7 million people (8%) of the U.S. population over the age of 5 have LEP!
Is Limited English Proficiency Considered a Disability?
It is not. Limited English proficiency is merely a description of the English knowledge a person possesses.
According to the Americans with Disabilities Act (ADA), LEP is viewed as a health disparity with a grave impact on care access and quality and not a disability.
What are the Impacts of Language Barriers on Healthcare Quality?
There are many grave impacts LEP has on healthcare. Some of them are:
- 35% higher readmission-to-hospital rates
- 3x increased emergency room misdiagnoses
- No effective communication, leading to misdiagnosis, undertreatment, and poor outcomes
- Limited online medical content
- 58% increase in surgical delays and paperwork errors
- Premature treatment discontinuation is common
- Risks and legal and professional issues
- More time and effort
- Reduced healthcare access, safety, and quality
What Is an LEP Plan in Healthcare Institutions?
It is a well-devised personal plan for LEP patients. It starts with a thorough assessment of each patient’s needs, taking into account demographics, language preferences, and communication barriers.
Such a plan details how, where, and by whom a language service ought to be provided, including. It also defines the level and strategies of collaboration, level of cultural sensitivity, and even the electronic health records (EHR) computer system to be used.
Moreover, it outlines evaluation criteria for the effectiveness of services, collecting feedback, and continuous improvement. It goes beyond that by supervising adequate resources and allocations are in place.
Conclusion
For generations, language has been an obstacle. It weighed down on people’s lives, health, image, and education. We have heard hundreds of stories of how languages hindered proper healthcare, research, and more.
But now with AI, will we now be closer to cross-language, error-free communication?
Let’s hope for that but meanwhile, healthcare institutions, primarily, should trust expert language service providers that comply with national and international standardization, keep risks to a minimum, and help save lives.
At ClickTrans, we do not localize texts only, we scavenge for idioms, gestures, and even silences that have meanings. Let’s shake hands on better and more effective healthcare services that are made available in all languages you choose.
Don’t let language barriers risk your patients’ health or your clinic’s reputation. Get a free quote from ClickTrans today.
