Breaking the Language Barrier to Quality Care

Language Training for bilingual staff at Johns Hopkins Medicine ensures high-quality medical communications.

Published in Dome - Dome January/February 2020

When Vivian Gibson, a radiation oncology nurse at Sibley Memorial Hospital, speaks Spanish to her patients, she says she’s often met with “absolute gratitude.” In medical conversations, “Sometimes you’re lost even if you speak the same language,” she adds.

Across each of Johns Hopkins Medicine’s campuses, all patients and their families — regardless of English language proficiency — have the guaranteed right to understand and be understood during medical discussions, as outlined in an enterprisewide language services policy.

To ensure safe, effective communication in every patient interaction, Johns Hopkins Medicine trains and certifies providers and staff members at three levels:

· Qualified medical interpreters are highly proficient in at least two languages and have the appropriate training and experience to provide accurate medical interpretation, whether it’s in person, over the phone or remotely via video.

· Qualified bilingual staff interpreters have the linguistic skills and understanding of medical terminology and concepts that allow them to interpret between staff and patients within their clinical setting and professional role.

· Qualified bilingual staff speakers can use their language skills to engage in direct conversations with patients and families within their clinical setting and professional role.

In her work at Sibley, Gibson sees many pediatric cancer patients whose families do not speak English, so she chose to take the assessment and training to become a qualified bilingual speaker. The process is simple: After receiving their manager’s approval, staff members who are interested in the program submit a request through the Language Access Services portal.

They then take a 45-minute, over‐the‐phone assessment with a live person to determine their level of proficiency in both English and one of 16 target languages, including Arabic, Farsi, Hindi, Mandarin, Russian and Spanish. Johns Hopkins recognizes its staff members are incredibly busy and offers the assessment 24/7.

This assessment is required for all staff, even native and fluent speakers of other languages. Panagis Galiatsatos is a pulmonologist at Johns Hopkins Bayview Medical Center who grew up in Baltimore’s Greektown with parents who speak only Greek. He attended six years of Greek school in the United States and travels to Greece often.

However, Galiatsatos says that during his assessment, “I quickly realized my conversational Greek is great, but I definitely had gaps in my ability to communicate more formally, especially on medical topics. … There’s a difference in being able to transfer medical insights in a way the patient can understand.”

Raquel Hernandez, a pediatrician and director of the healthy weight initiative at Johns Hopkins All Children’s Hospital, was thrown a similar curveball, despite being a bilingual Spanish speaker. “I think that even if someone is conversational and comfortable in another language, they will likely be challenged by this test, but that’s because it’s a totally different set of terms,” she says. “Even when I’m talking to my family, it’s difficult to describe complex terms like pernicious anemia.”

Hernandez says, “For many bilingual providers, language is a sense of our identity, but when it’s used as a health care tool, there has to be a different lens to it. I’m now a bit more humble about my own language proficiency skills, and fortunately, I had the chance to review and bridge any gaps so I can show my patients that their language is important and that they’re in the right hands.”

Galiatsatos continues to expand his fluency in Greek medical terminology and also plans to retake the assessment. “I’ve witnessed how language becomes a barrier to appropriate care. Now as a physician, I understand that communication is one of our most valuable skills to ensure our patients understand what we’re thinking and what we’re encouraging them to adopt in regard to medical management.”

Once participants pass the assessment, they then complete an online myLearning course that covers standards of practice for using their language skills.

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Ensuring High-Quality Medical Communications

“Communicating with patients in their preferred language is obviously a big part of this initiative, but we also want to ensure our qualified bilingual staff members understand the legal and ethical ramifications of interpreting conversations between colleagues and patients,” says Kimberly Chmiel, a training specialist with Language Access Services. “Our online training also addresses regulatory requirements, cultural competency and diversity, and other topics to ensure high‐quality medical communications.”

Following the assessment and training, staff members receive designation as either a qualified bilingual staff speaker or interpreter.

Gibson emphatically encourages caregivers across Johns Hopkins to participate in the qualified bilingual speaker program: “Being able to do the course over the phone and online makes it attainable for more staff, and it’s such an important thing to do for our patients.”

So far, more than 1,400 employees across the health system have completed the program.

“Linguistically and culturally appropriate communication is central to providing high-quality health care and improving patient outcomes,” says Kim Norman, Language Access Services program manager. “This assessment and training initiative ensures the highest level of medical communication for patients across each Johns Hopkins entity, no matter what language they use.”

Register for the qualified bilingual speaker program to use a second language for medical conversations at Johns Hopkins Medicine. Johns Hopkins Community Physicians staff members should contact Human Resources Manager Beth Wilson to register. Questions? Email [email protected], or read more about language services.