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Dome - Not lost in translation

January 2011

Not lost in translation

Date: January 5, 2011

Training in cultural differences helped our Medicaid managed-care organization better serve its growing Hispanic members


Emily Boulin and Megan Ginsberg were part of an effort in Priority Partners to help staff understand their own biases and cultural differences to better serve a growing Hispanic membership.
Emily Boulin and Megan Ginsberg were part of an effort in Priority Partners to help staff understand their own biases and cultural differences to better serve a growing Hispanic membership.

“Many faces, one need” reads the slogan for Priority Partners, Hopkins’ managed-care organization (MCO) that serves 185,000 low-income Marylanders. Yet when that slogan was written in Spanish to accommodate the group’s growing Hispanic membership, the message got lost in translation.

Phrases that seem clear in English “may have a different, nuanced meaning” to Latinos, explains Emily Boulin, a senior bilingual community health advocate at Priority Partners.

She says Hispanic members were puzzled by the slogan because “many faces” in Spanish “refers to a person’s various facial expressions.” They were confused about the group’s purpose.

That revelation came out of a cultural competency training session initiated by Priority Partners President Robert Neall last year. He wanted managers and frontline staff to improve their interactions with Hispanics, who constitute 12 percent of the MCO’s patients.

That session proved to be an eye-opener. “We found we needed to increase our sensitivity to material we produce in the Spanish language,” says Victoria Fretwell, senior director for marketing and communications.

“We had been translating the English-language brochures, our website and health care information word for word into Spanish,” Fretwell adds. “We didn’t realize until then this was inadequate and often misrepresented our products and services.”

An advisory panel was formed to help Priority Partners reassess customer service, marketing and outreach efforts geared to Hispanics.

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The same words can be interpreted in markedly different ways by individuals from Central America, South America or the Caribbean.

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A slightly different Spanish-language slogan was adopted that more effectively delivers the desired message: “Your health. Our priority.” (Tu salud. Nuestra prioridad.)

Boulin thinks the new wording accurately conveys the MCO’s purpose while resolving another translation garble: In Spanish, the words “Priority Partners” have individual meanings, but in combination “they imply nothing,” she says. By using “priority” in a slightly different context and linking it to the word “health,” the new slogan becomes readily understandable to Hispanics.

A second cultural-awareness session took place in September, with statistical presentations, discussions, videos and group exercises. A similar event is planned for next year.

The cultural-awareness sessions, organized by Maura Walden, director of corporate training and organization development for Johns Hopkins HealthCare, has made a difference, she says. The staff who deal directly with Hispanics “look at things differently. Now they understand their own biases and differences in cultures. They are asking the question, What do I need to know about Hispanic members so I can better serve them?”

Priority Partners has increased its bilingual customer service staff and will be creating a separate Spanish-language Consumer Advisory Board next year. Revamping the MCO’s Spanish-language material and telephone scripts, however, proved more complicated.

“Certain English words can have very different meanings in Spanish or multiple meanings, depending how they are used in various situations,” Boulin observes. Additionally, the same words can be interpreted in markedly different ways by individuals from Central America, South America or the Caribbean.

For instance, a bilingual customer service representative with a Central American background may be speaking with a Priority Partners member from South America and address the caller as “tu”—the more intimate form of “you,” reserved for close friends, relatives and children—instead of the more formal “usted.” The caller may take this as a sign of disrespect and hang up without getting her health concerns addressed.

It also is common in Hispanic cultures to start conversations by socializing. Boulin says it might take 10 or 15 minutes before a member discusses the reason for the call. Hispanics regard a “let’s-get-right-to-work” approach as “pretty rough treatment,” according to Neall.

That poses a problem in evaluating bilingual customer service staff, says Fretwell, since they take far longer than their English-language colleagues to handle calls.

When Priority Partners managers studied the data, though, they found  that this cultural adjustment helps resolve caller problems and results in fewer follow-up calls.

This led to new metrics for staff evaluations that allow for longer telephone conversations with Hispanic members.

Priority Partners’ cultural awareness program is part of a long-term process to make everyone in the organization better attuned to members from different backgrounds, Neall says. “It is an investment you make in your workforce so they can deal with the real lay of the land.”

—Barry Rascovar

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