Policy-making processes enable organizations to not only improve upon productivity and efficiency, but to avoid breaching rules and regulations. Without it, there will be no guide when it comes to decision making and achieving desired outcomes. In relation to healthcare, they set the foundation for the delivery of safe and cost-effective care. The gateway to providing standardization in healthcare can only be achieved by implementing and enforcing policies. The combination of strategies and policies together form a larger process that aims to align country priorities with the real health needs of the population to enable all citizens to live longer healthier lives and have access to quality health care as a result.
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Language barriers within the healthcare industry increase the risks for adverse effects and events. A new study has found that “patients who have Limited English Proficiency (LEP) are at greater risk than English-speaking patients for experiencing effects that result in harm during a hospital stay” (Arevalo, n.d.). With today’s growing diverse population, there is a need for hospitals to develop strategies that break down language barriers to improve the safety and quality of care for their LEP patients. Hospitals and organizations alike need to start by being culturally aware. Being culturally aware of the population around them will bring forth an inclusive and welcoming work environment that will not only enable employees to understand and respect one another; it will also lessen the odds of excluding groups that are different than theirs.
- Executive Summary
The issue I’ve chosen to discuss is language. “Proper diagnosis is difficult when doctors, nurses and other healthcare advisors are unable to communicate with their patients” (“The importance”, 2018). Whether it is a language barrier or that a patient struggles with health literacy, patients need to be given the opportunity to have an accurate understanding of how to manage their own health and improve outcomes. “It’s been estimated that there are more than 300 languages spoken in the United States and more than 90 million Americans have low health literacy” (“Facts about”, 2017). This represents the number of patients who have difficulties in using and understanding health related information. The context and language in which patients receive and perceive information can ultimately affect their outcomes. In an effort to help promote access to quality health care services, the workforce has to be able to understand and interact with different groups. Therefore; it is imperative that individual understanding and language needs are incorporated in patient-centered communications.
Key stakeholders will bring about “cultural competence to effectively deliver health care services that meet the social, cultural, and linguistic needs of patients (“Cultural competence”, 2004, para. 1). Being culturally aware will encourage sharing of knowledge amongst stakeholders whilst transforming engagement to break down language barriers. “Section 1557 of the Affordable Care Act mandates that hospitals provide qualified interpreters to help facilitate communication between clinicians and patients” (“The importance”, 2017). Recommendation for a course of action on the issue is to implement translation services appropriate enough for the population and their needs. With the help of the qualified medical interpreter’s, patient rights can be honored, and malpractice risks can be lowered.
- Factual Overview
Language is a “system of arbitrary vocal symbols, used to express communicable thoughts and feelings, while enabling members of a social group or speech community to interact and co-operate” (Shah, 2014). To improve the overall health of patients and communities, language must be considered. In an effort to meet the needs of patients who communicate in languages other than English, “Section 1557 of the Affordable Care Act mandates that hospitals provide qualified interpreters — using qualified staff or via phone and video — to help facilitate communication between clinicians and patients” (“The importance”, 2017). By meeting these requirements, chances are that patient preferences and their language needs will be met. Furthermore, barriers that increase the risk of delayed care, missed appointments and longer hospital stays for example; can be significantly reduced. Ultimately, language will be the long lasting foundation to building stronger community relationships and reducing health disparities.
The key organizational stakeholders involved in the issue are the directors of human resources and revenue cycle. As the director of human resources, Mr. Carp recognizes the shortage of certified medical interpreters and Spanish speaking caregivers. For employers who want to develop a diverse workforce, effective recruiting strategies must be used to build that reputation of valuing differences, by attracting the right people to bring forth that same appreciation. Director of revenue cycle Mr. Flounder mentions the hospitals reimbursement mix of one third Medicaid, Medicare and commercial (“The health”, n.d.). Understanding your hospitals reimbursement mix helps to measure strengths and weaknesses. Organizations can measure and track performance levels and without it; “health systems will be at a disadvantage if they do not work to improve the quality of care they provide” (Brown, n.d.).
Other stakeholders involved in the issue who were not mentioned in the article are the providers and the governing board. Providers provide advocacy, control costs and see to it that patients receive the proper care. The governing board such as the CFO and the CEO influence the way care is delivered through the development of strategic initiatives. The key stakeholders in the article shaped health law and policy by strengthening their workforce to move more towards health. For example, by mandating that at least 30% of a hospital’s caregiver workforce speak Spanish; the understanding that this will bring about positive outcomes, improve and protect health for their population is evident (“The health”, n.d.) There is a connection to the community to foster an optimal consumer experience for all patients to reinforce the value of health.
Potential legal risks and malpractice issues that apply in this scenario include: medical -negligence, uncoordinated and low-quality care, improper practices and liability to name a few. For example, given that Hospital Bass does not survey its patients, chances of decreased satisfaction are higher; there is the potential of increased malpractice lawsuits and the loss of investment/ business. Example two is the resistance of paying more for certified medical interpreters. This can cause complications, misdiagnoses, longer hospitals stays, incorrect treatments and worst case scenario; death. Example three is the addition of continuing education requirements for cultural competency (“The health”, n.d.). Cultural competency allows employees to be educated on how to accept social, ethnic and political differences for the betterment of working together as a team.
The one conflict among the key stakeholders is opposing the bill. From an HR point of view, example one shows that the hospital cannot afford to hire and recruit more caregivers. Example two shows that some caregivers are unionized and some are not (“The health”, n.d.). Given the amount of Spanish speaking patients who utilize Hospital Bass’s services, it would be in their best interest to hire employees that exude cultural awareness and open-mindedness to better improve organizational culture. Caregivers want to be rewarded for their services, and a voice to communicate any and all frustrations and dissatisfaction. With unions come better job security, equal workplace opportunities and a set standard for better working conditions.
a. Stakeholder 1: Director of revenue cycle, Mr. Flounders’
The knowledge and expertise brought to the table by Mr. Flounder ensures a framework where a process in set in stone to help the organization get paid for services as quickly as possible, in full. He is considered the “jack of all trades” when it comes to how he communicates with his staff and how he is able to provide them with the necessary tools and resources to maintain financial stability. When a program is developed carefully and managed, a well-managed revenue cycle ensues. The organization reaps the benefit of reflecting best use of regulations to further increase patient and doctor satisfaction, grow the business and lastly, heighten the ability to retain and receive revenue.
By helping identify various opportunities that will improve the efficiency of Hospital Bass, Mr. Flounder has to pay close attention to administrative functions that deal with claims processing, revenue generation and forms of payment. If this is not checked upon, it can cause all sorts of problems such as; denials and or claim rejections. The only way for Hospital Bass to remain financially fit is to address problems in workflow, training and communication. If there is a lag between delivery of care and payment, it makes it harder for the hospital to be able to stay on the right track of keeping accounts receivable moving and managing their funds responsibly.
b. Stakeholder 2: Director of human resources, Mr. Carp
Mr. Carp wants effective communication and collaborative teamwork from everyone employed with Hospital Bass. Effective communication has positive effects on staff and protects any chance of misunderstandings. For example, communication errors between coworkers can result in administering wrong medications or patient harm if important information is not passed along in the right way from one employee to the other. Communication at the hospital has to be transparent, structured and purposeful. Employees should be trained in making sure that messages are communicated at the right time to ensure patient safety. In the end, “sharing a singleness of purpose to deliver highly reliable healthcare to all and maintaining a peak level of transparency with effective communication must be an enterprise mandate” (Marcus, 2016).
Hiring the right people for key roles is the only one to shape the future of Hospital Bass. In their case, a diverse mix of employees is required. When dealing with diversity in the workplace, we must also consider inclusion because both components go hand-in-hand. By having an inclusive workforce, organizations can grow and thrive exponentially due to the many different insights at their disposal. Furthermore, an inclusive and welcoming work environment lessens the odds of excluding other groups. This will also help the hospital close any cultural gaps and “ultimately unites people in spite of — and sometimes because of — their differences” (Hughes, 2016).
“Title VI of the Civil Rights Act of 1964, ensures that federal money does not support providers who discriminate on the basis of race, color, or national origin. The U.S. Department of Health and Human Services (HHS) and the courts—including the U.S. Supreme Court—have interpreted Title VI to protect national-origin minorities who do not speak English well” (Youdelman, 2008, p. 425). This act realizes that without effective communication with patients whose primary language isn’t English, it can be quite difficult to provide quality care. In addition, lack of enforcement and knowledge of this act will leave this specific population unable to receive the same quality of care received by English speaking patients. Executive Order 13166 issued in 2000 by President Clinton requires agencies to develop and implement a system to provide services to those with limited English proficiency. This order makes it a point to take all reasonable steps to provide meaningful access to their services for LEP persons. And lastly, “the HHS Office of Minority Health promulgated standards for Culturally and Linguistically Appropriate Services (CLAS) in health care, which states that health care organizations must offer and provide language assistance services, including bilingual staff and interpreter services, at no cost to each patient/consumer with limited English proficiency at all points of contact, in a timely manner during all hours of operation” (Youdelman, 2008, p. 425).
1. Cost vs. savings
Stakeholders invest in projects to ultimately reap one and only benefit, money. Hospital Bass is unable to recruit more caregivers who speak Spanish. The hospital wants to continue on with the way things are, however; reality is that the situation is not ideal. Approximately 40% of the patients who use Hospital Bass’s emergency department on an annual basis self-report that Spanish is their primary language. Being that the percentage is so high, it is important for the stakeholders to unite and understand the importance of caregivers. If patients are unhappy with their caregivers or unable to communicate freely with them, it will end up costing the hospital more than what they are trying to initially save. Continuing education requirements for cultural competency to state licensure requirements are another pushback the stakeholders will face. This will cost the organization money but, complying with laws and maintaining licenses should be the ultimate goal for all. Supporting continuing education and certification is essential retaining caregivers because from that comes high job satisfaction, and the unlikelihood of changing jobs. With the complexity of health care, everyone involved benefits from certification as they are better prepared to make informed decisions, committed to career development and dedicated to patient care in a constantly changing environment.
2. Protection of minority population
Disparities of care within the minority population not only impose a tremendous burden on the individuals and their communities, it also accounts for increasing health care costs. With escalating health care costs wreaking havoc on federal and state levels, consequences of disparities could be the driver we have been waiting for to constitute the right change towards improving quality of care. For example, if an opportunity was presented to reduce health disparities and improve care particularly in the areas of diagnosis and prevention, the results most likely, over time will be improved outcomes that may result in long-term cost savings and reduced premiums. The savings generated could then be used to sustain or develop new programs to reduce disparities in care (Angeles & Somers, 2007, p. 2).
Legal and Malpractice Issues
Potential ramifications associated with language include financial hardship. For example, incurred losses, damages in settlements and or legal fees. Health care providers and patients alike must have ready access to competent language services to avoid risks to patient safety. If a patient is unable to understand medical instructions; it can result in numerous return visits and failure to take the proper steps to treatment. Subsequent return visits and misdiagnoses take up valuable time for both the provider and patient however; had the provider been able to communicate clearly with that patient the first time, proper treatment would have been given and the possibility of a lawsuit would be alleviated. “It is imperative that providers know and understand these federal laws in order to ensure compliance and avoid any malpractice lawsuits. Healthcare professionals must additionally familiarize themselves with their state’s specific laws if they want to avoid future lawsuits” (“Language in”, 2018).
A course of action at Hospital Bass is patient advocacy. Their strength should lie in providing a united voice for the vulnerable patient populations. Through this voice, they will be able to achieve the greatest possible impact and ensure the rights of those it serves are not only respected but, protected as well. In order to measure quality and calculate value, there needs to be a combination of patient-reported outcomes and patient engagement. Patient-reported outcomes capture the process of care that providers will need to use when treating individuals and the population. Patient engagement involves the patient’s willingness to be actively involved in their own health care planning; for example, treatment plans to managing chronic illnesses and conditions and so forth. In addition, the hospital needs to have their own unique identify, stand out from its competitors when it comes to diversity in the workplace. By having an inclusive workforce, they can grow and thrive exponentially due to the many different insights at their disposal. When teams are built on a strong foundation that encompasses a variety of backgrounds and experience, employees and organizations are automatically placed on the right path of success.
Reconciling stakeholder needs, and interests will involve a strategy that reduces service fragmentation and improves the coordination of services and effectiveness. There is the possibility of one-track mindedness that causes a stakeholder or multiple stakeholders to zone in on one aspect which often leads to them not realizing that what is good for one individual, may not be best for all. Adding a voting element will allow everyone the opportunity to voice choices and opinions. In the end, the decision making should and will be guided by a framework where no matter the goal; short or long-term, has the potential to provide numerous benefits for the hospital, clinicians and their patients.
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Legal risks and potential malpractice issues are real when patient care is comprised due to a language barrier. Language barriers tend to affect the delivery of adequate care through misunderstanding of physician instructions, poor information exchange and loss of important cultural information to name a few. Since hospital Bass would have to recruit more caregivers who speak Spanish, there is pressure to acquire, secure and maintain funding sources to ensure continued operations. As a result of this, the organization should consider seeking private funds elsewhere to close the gap. If and when funding is secured to hire more caregivers, there needs to be careful administration of expenses and reporting practices to better secure funding in the future.
Financing practices that impact stakeholders will be handled through a communication strategy that encourages existing funders to help with navigating the economy, whether it comes in the form of fundraisers to gain additional funds or the introduction to other potential donors. Potential conflicts will be resolved through collective action with different services, sectors and community groups. Collaboration is key when given the responsibility to debate on services that directly influence people’s health. Therefore, utilizing data from these types of population groups can help identity what population would benefit from what. The stakeholders can be of influence by shaping the way healthcare and health outcomes join forces to achieve a high performing system. They also have the basis understanding that they carry the bulk of the power and the drive to put the organization in a position where they can be successful. Population health outcomes can be improved by the stakeholders through implementing a quality improvement approach. Without it, they are unable to make adjustments surrounding the various opportunities for improved population health.
In closing, Hospital Bass should change the way in which health care is being delivered. The Spanish speaking patients want the same processes as others that will not only improve quality, limit cost increase but also, make health care more efficient. The relationship between the financial well-being of the hospital and that of their patients is that, their lasting impressions will be strained patient-provider communication. Patient experience will also diminish as well as create inequities within their organization. Spanish speaking caregivers are a must because they will serve as cultural brokers who bridge the language barrier gap.
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