The organization’s public-facing internet pages and the organizational intranet are your best tools for promoting proper language support in your institution. As the Language Program Manager, you can guide the organization by designing the Interpreter Services intranet pages and by collaborating deeply on the patient-facing internet pages and on the patient portal.
The language program manager must be or become proficient and proactive in designing and updating web pages, and knowledgeable about the portal and other digital pathways that patients are expected to interact with the organization, and ensure that language support and disability accommodation information is accessible.
The organizational structure of healthcare systems has made it very difficult make sure that staff and patients have easy access to language support and disability accommodation information. The Language Program Manager can open up the necessary pathways by working with several specific departments which are normally not alert to patient language support or disability accommodation issues.
Health organization websites are controlled within silos that generally exclude most operations managers. Most managers have to put in a ticket to IT to get updates made to their internal departmental web page. IT has templates for departmental web pages which are minimal in content. Marketing usually controls the external public-facing web pages, and Marketing operates with no organic connection to patient care operations. This silo situation means that the Language Program Manager has to be assertive about using the powerful tool of custom-designed department web pages to provide information related to language support and disability accommodation.
The language program manager can make the best case for creating and controlling her departmental web pages by following the lead of the Infection Control department. In most hospitals and clinic systems, the Infection Control department posts policies, procedures, information on how to find and order protective equipment, short videos on correct usage, stats on what projects and alerts are going on around the organization, and goals for improving response to patient care illness of various sorts. Staff and providers know to go to the Infection Control page whenever they have a question on how to proceed.
The Language Access Program internal website should be structured similarly. The most commonly needed language support and disability accommodation information for staff and providers is listed by topic on the front page, so that it takes only seconds to find what is needed. All detail should be on linked pages. Here are suggested topics to list on the front page, each a link to full information on a separate page:
Request language support for your patient
Request or find disability accommodation for your patient
Request written translation of materials
Guide to working with an interpreter
Ask the patient what language support and disability accommodation she needs
Our policy on FREE and 24/7 language support and disability accommodation
Tips on providing appropriate language support in your unit
Contact info for Language Program Schedulers and Manager
Request consultation on language support and cultural competence
Tell your patients about these navigation aids to get things done in our system
Link to list of available written translations
Information about our language communities
Policies and procedures related to language support and disability accommodation
How to become qualified as a bilingual provider or staff person
(Keep internal department affairs off of this set of web pages. Manage that through a protected share drive for your staff, just like the share drive that all nursing units have to manage staffing and internal staff training.)
As you develop the supporting information on separate pages linked to the headers, remember to include, on the appropriate pages, these topics which staff and providers are famously ignorant about, and make the information easily printable:
Fact that language support is required for all patients, family members, and members of the public who request it for effective communication with the care team and all other sections of the organization (cafeteria, gift shop, info desk, finance office, patient relations, advice nurse at 2 am, birthing tour, etc.
Fact that language support is provided at no cost to the patient.
Fact that qualified interpreters and translators are required—use of family members to interpret is not OK, use of non-qualified staff to interpret is not OK, doctors must be linguistically assessed before practicing in a second language, use of Google Translate for care instructions is not OK, etc.
Different means available on the units for providing language support: Address by type of unit because staff and providers think of themselves this way: inpatient floors, ED, procedure areas, outpatient clinics, ancillary care and imaging (pharmacy…)
Guide to decide what modality or mix of modalities to use for a particular patient based on his situation today.
Steps to get the language support, be that through a centralized internal request system or by contacting agency directly.
Steps to get the devices needed for language support and disability accommodation.
Reminder to make sure that language designators are correct on the EMR: Staff should have the correct questions to ask the patient to specify and verify what she needs in terms of accommodation or language support. Give examples of how to use the different designators and variables. A short video on how to ask the questions.
Public-facing Internet Pages
With respect to the public-facing internet pages of the organization, the language program manager can carry out two important objectives:
First, there must be specific information about the fact that the organization does provide language support and disability accommodation, with a few basic facts about that and a link to the Language Program Manager for questions.
Second, the entire public-facing website should have some information at the very least translated and presented in audio and in ASL-interpreted format.
The link provided here presents a survey of WA State hospitals’ public-facing web pages with respect to language access to those pages. It would be interesting to know how these data would appear for other states.
It is very helpful for the Language Program Manager to have someone in Administration direct Marketing to work with them to guide Marketing on what is needed. Because of the silo structure of healthcare organizations, the specialists responsible for Patient Access or Disability Accommodation may not have undertaken the necessary work on the external web pages. The important thing is for you to provide the patient-centered vison to Marketing and their embedded IT specialists to make the information on the external web pages accessible to all readers.
Rather than simply adding legally required captions or screen navigation tools, which Marketing IT programmers will certainly have installed, move through the external web pages walking in the shoes of a person with limited English and then in the shoes of a Deaf and blind person.
Which menus are confusing?
Is there a welcome to patients with need for language support and disability accommodation, in their languages, audio, and ASL video, on the landing page of the organization’s website?
If there is, put a well-marked pathway to a full page with more information on how to access information:
Pathways should be indicated for people who want more specific information on content that will never be translated into that detail or into all languages: For example, the reader may be invited to contact Interpreter Services, Information Desk, or Patient Relations and ask for an interpreter in their language, then ask for the specific information that they need from the live staff person.
Advertise all language support mechanisms that are in place, such as any translated phone menus, availability of interpreters when calling the 24 hour advice nurse, availability of translated patient education materials in such and such languages, availability of free interpret support in almost all languages during the business week, assurance of assistance from staff in filling out forms, availability of certain forms in key languages for establishing care, consenting for surgery, applying for financial aid.
Discuss how to deal with phone calls in and out of the facility, reminder calls, after-hour calls for urgent matters, and the portal.
Add detailed disability accommodation information and how to request it.
Which titles, menu items, and navigation buttons should be translated and maybe audio-recorded to help people find the correct page they are looking for?
Build consistent visual markers and buttons to click on each page for translated or audio-visual versions of the info. Remember that many native-born Americans are functionally illiterate and appreciate being able to listen to the information in audio format.
Would it be more effective to have entire key pages translated? Would it be more useful to have title translations pop up by hovering the cursor over the English?
The Patient Portal
Patients are increasingly required to access the Patient Portal in order to contact anyone in their clinic or hospital system. This works well for many patients, but it is a formidable barrier to care for those with physical or sensory disabilities, those who speak English but do not read English fluently, those who do not speak English, and those who do not have easy access to a computer.
The most responsible policy around portal use would include provisions for those who cannot use it, as well as provisions for those who can use it accommodations and language support within the portal are supplied.
Modifying the portal itself may be very difficult even for IT. However, there may be add-ons of text, audio, or visual material that can be set into the portal on all key pages. Here it is again important for the Language Program Manager to get access to the portal and to walk through the functionality pretending to need language support or disability accommodation. Just getting access requires persistence, as only patients and direct care staff have access to the portal attached to their user profiles.
Family practice doctors and staff are the strongest advocates for diverse patient access to the portal. The Language Program Manager is encouraged to form a collaboration with them to identify the most difficult aspects of portal access and request IT efforts to circumvent these barriers.
Please let us know if your organization has welcoming and effective and accessible public-facing web pages or portal!