Communicating Effectively with Patients Who Have Limited English Proficiency

Patients who have limited English proficiency (LEP) often do not understand the health information that they receive from their 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 their clinicians.¹

Because of the far-reaching effects of poor comprehension, healthcare providers and staff should proactively identify and address language barriers. Doing so can help optimize care and prevent misunderstandings that may lead to adverse outcomes.
The following strategies offer guidance for improving communication with and comprehension for patients who have LEP.

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 a qualified interpreter for patients who do not speak English very well or who have difficulty understanding English.
3. Provide patients with a notice of nondiscrimination and a notice of the availability of language-assistance services and auxiliary aids. Display information on your website and in prominent physical locations about the availability of interpreting services. (Note: These are requirements under Section 1557 of the Affordable Care Act.²)
4. Use acceptable language-assistance services, such as 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 members 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. When patients prefer to use their own interpreters, ask them to acknowledge in writing (in their preferred language) that they are declining to use the practice’s interpreter.
7. Request that all healthcare providers, staff members, and interpreters use clear, concise, and easy-to-understand language when communicating with patients who have LEP.
8. 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 give to your patients who have LEP to support comprehension and adherence to treatment.
9. 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.
10. Contact community organizations to determine whether they can provide volunteers who have received training as medical interpreters.
11. Consider sharing language-assistance services or developing collaborative contracts with local healthcare organizations to use telephonic or online interpreting services.
12. Routinely review the health records of patients who have LEP to ensure that providers/staff members are assessing and documenting their language-assistance needs. Make sure 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.

Resources

Agency for Healthcare Research and Quality: Health Literacy Universal Precautions Toolkit, 3rd Edition: Address Language Differences: Tool #9

Agency for Healthcare Research and Quality: Improving Patient Safety Systems for Patients With Limited English Proficiency

American Academy of Pediatrics: Addressing Low Health Literacy and Limited English Proficiency

MedPro Group: Risk Q&A: Interpreters and Auxiliary Aids

MedPro Group: Risk Tips: Working With Medical Interpreters

The Joint Commission: Quick Safety 13: Overcoming the Challenges of Providing Care to LEP Patients

U.S. Department of Health and Human Services: Guidance to Federal Financial Assistance Recipients Regarding Title VI Prohibition Against National Origin Discrimination Affecting Limited English Proficient Patients

U.S. Department of Health and Human Services: Limited English Proficiency (LEP)

Endnotes

1. Agency for Healthcare Research and Quality. (2012, September). Improving patient safety systems for patients with limited English proficiency: A guide for hospitals. Retrieved from www.ahrq.gov/health-literacy/professional-training/lepguide/index.html
2. 89 Fed. Reg. 37522- 37703 (May 6, 2024), www.federalregister.gov/documents/2024/05/06/2024-08711/nondiscrimination-in-health-programs-and-activities; U.S. Department of Health and Human Services. (2024, April 26). HHS issues new rule to strengthen nondiscrimination protections and advance civil rights in health care. Retrieved from www.hhs.gov/about/news/2024/04/26/hhs-issues-new-rule-strengthen-nondiscrimination-protections-advance-civil-rights-health-care.html; Dawson, L, Sobel, L., Pestaina, K., Kates, J., Artiga, S., & Burns A. (2024, May 15). The Biden Administration’s Final Rule on Section 1557 non-discrimination regulations under the ACA. Kaiser Family Foundation. Retrieved from www.kff.org/affordable-care-act/issue-brief/the-biden-administrations-final-rule-on-section-1557-non-discrimination-regulations-under-the-aca/