Dawn Mangine

    Approximately 57 million people in the United States, or about 20 percent of the population, speak a language other than English in their homes. Another 25 million people, about 8.6 percent of the population, are considered to have limited English proficiency (LEP). The Pew Research Center estimates that by the year 2021, 50 percent of newly insured patients will be minorities and less likely to speak English as their primary language.

    Culture, Language, and Patient Safety

    Despite the best efforts of healthcare practitioners, hospitals are not as safe as they could be. Even in the era of robust patient safety and quality care practices to identify and mitigate risk, some populations are still falling through the cracks of the systems. Emerging evidence is revealing that patients with minority cultural and language backgrounds are significantly more at risk of experiencing an adverse event than the majority population.

    “Language barriers significantly impact safe and effective health care,” according to a Quick Safety article by the Joint Commission. In a study that surveyed six Joint Commission accredited hospitals, an analysis of 1,083 adverse-incident reports found the following regarding LEP patients compared to English-speaking patients:

    • 49.1 percent of LEP patients experienced physical harm (compared to 29.5 percent of English-speaking patients)
    • The higher levels of physical harm ranged from moderate temporary harm (46.8 percent) to death (24.4 percent)

    When professional interpreters were not used at admissions or discharge, LEP patients have:

    • Longer hospital stays
    • Greater risk of line infections, surgical infections, falls, and pressure ulcers
    • Greater risk of surgical delays
    • Greater chance of readmission

    Communication is vital to patient safety and quality care, and without the proper understanding in place, patients will suffer. In addition, the legal consequences for healthcare organizations that do not provide professional interpretive services for care and consent can be significant.

    As important as interpretation is, it is also vital to remember that effective communication extends beyond words.

    “What is not always understood in regard to the issue of providing interpreting services to people of diverse cultural and language backgrounds in that intercultural communication requires not just an exchange of words (spoken sounds and conventional symbols) but also an exchange of shared meanings, which, in a clinical encounter can be very difficult…. [To] be effective, interpreters and bilingual staff must not only ‘translate words’ but establish and verify ‘shared meaning’.”

    Steps to Take in Education

    The top ten most common languages spoken in the United States are: English, Spanish, French, Chinese, German, Tagalog, Vietnamese, Korean, Italian, and Russian. The cultural diversity represented by these languages clearly presents challenges for healthcare providers in the United States. One way to address language and cultural obstacles is to create simulation scenarios dealing with them, and to continue to integrate diverse populations into healthcare education and careers.

    • Create simulation scenarios that incorporate different cultures, languages, and communication methods
    • Have students fill out at cultural competence self-assessment awareness checklist (here’s an example)
    • Create a supportive classroom culture for the safety of diverse patient populations
    • Instruct on communication methods that incorporate communication boards
    • Teach students the importance of seeking out organizations with professional interpreters, bilingual or multilingual employees, and translated written materials


    “Overcoming the challenges of providing care to LEP patients,” Quick Safety Issue 13, Joint Commission, May 2015.

    Johnstone, M. J., and Kanitsaki, O. “Culture, language, and patient safety: making the link.” Division of Nursing and Midwifery, RMIT University, Bundoora, Melbourne, VIC, Australia. International Journal for Quality in Health Care, 2006; Vol. 18 No. 5: pp. 383-388.