Culture, language, and patient safety: making the link

Abstract

It has been well recognized internationally that hospitals are not as safe as they should be. In order to redress this situation, health care services around the world have turned their attention to strategically implementing robust patient safety and quality care programmes to identify circumstances that put patients at risk of harm and then acting to prevent or control those risks. Despite the progress that has been made in improving hospital safety in recent years, there is emerging evidence that patients of minority cultural and language backgrounds are disproportionately at risk of experiencing preventable adverse events while in hospital compared with mainstream patient groups. One reason for this is that patient safety programmes have tended to underestimate and understate the critical relationship that exists between culture, language, and the safety and quality of care of patients from minority racial, ethno-cultural, and language backgrounds. This article suggests that the failure to recognize the critical link between culture and language (of both the providers and recipients of health care) and patient safety stands as a 'resident pathogen' within the health care system that, if not addressed, unacceptably exposes patients from minority ethno-cultural and language backgrounds to preventable adverse events in hospital contexts. It is further suggested that in order to ensure that minority as well as majority patient interests in receiving safe and quality care are properly protected, the culture-language-patient-safety link needs to be formally recognized and the vulnerabilities of patients from minority cultural and language backgrounds explicitly identified and actively addressed in patient safety systems and processes.

A piece of the puzzle — the role of ethnic health staff in hospitals

“…[8][9][10] In Australia, barriers to care for migrants were formally acknowledged in the early 1970s 11 prompting the establishment of two nationally funded programs -the Health Care Interpreter Service and the Ethnic Health Worker programdesigned to ameliorate some key factors impeding care.…”

Alterations in Medical Interpretation During Routine Primary Care

“…In one study, communication problems contributed to adverse events at a much higher rate among LEP patients (52.4%) than English speakers (35.9%), with 49.1% of adverse events rising to the level of clinical significance in LEP populations, compared to 29.5% in English-speaking populations. 3 Many studies have shown that LEP patients tend to have lower rates of preventive screening and higher rates of hospitalization and drug complications 2,3,9,[11][12][13][14][15] . Lack of discussion and poor understanding of treatment plans, including medication side effects, are likely reasons for these concerning rates, as such factors can lead to patient dissatisfaction and reduce adherence to physician recommendations [16][17][18] .…”

Accès aux services sociaux et de santé en français : l’expérience des Franco-Manitobains

“…Un accès limité aux services de santé en français, situation rapportée par plus de la moitié des francophones en situation linguistique minoritaire (FCFA, 2001), constitue une barrière ayant des effets négatifs sur les résultats des traitements et la satisfaction des patients (Forgues, Doucet et Guignard Noël, 2011). On constate que la capacité de communiquer dans sa langue avec les professionnels de la santé encourage l'usage de mesures préventives et peut favoriser la justesse des diagnostics et l'observation des consignes (Bowen, 2001 ;Johnstone et Kanitsaki, 2006 ;Manson, 1988 ;Woloshin, Schwartz, Katz et Welsh, 1997). De plus, une bonne communication assure le respect de la confidentialité du patient et l'obtention adéquate d'un consentement aux soins (Bowen, 2001).…”