Over 24 million individuals in the United States speak English "less than very well" and are considered limited English proficient (LEP). Due to challenges inherent in patient-provider interactions with LEP patients, LEP individuals are at risk for a wide array of negative health consequences. Evidence suggests that having an interpreter present to facilitate interactions between LEP patients and health professionals can mitigate many of these disparities. This article presents the results and lessons learned from Speaking Together: National Language Services Network, a quality improvement (QI) collaborative of the Robert Wood Johnson Foundation to improve the quality of language services (LS) in hospitals. Using five LS performance metrics, hospitals were able to demonstrate that meaningful improvement was possible through targeted QI efforts. By the end of the collaborative, each of the hospitals demonstrated improvement by more than five percentage points on at least one of the five recorded quality metrics. Lessons learned from this work, such as the helpful use of quality metrics to track performance, and the engagement of physician champions and executive leadership to promote improvement can be utilized in hospitals across the country because they seek to improve care for LEP patients.

'Caring for him at home was such a sad, challenging but rewarding and special time ... we wouldn't have wanted him to die anywhere else ... things improved after the syringe driver was started as he seemed more at ease and was not suffering anymore ... the twinkle returned to his eyes for a while ... it made such a positive difference and allowed us to carry on at home until the end.' These words from the family of a dying patient recently cared for by the author remind us of how special the care given at the end of life is.

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