Families who don’t speak English well are less likely to express worry about their child being in the hospital
Medical errors are known to be caused by communication breakdowns, which are more likely to occur when there are language problems.
A new study led by Alisa Khan, MD, MPH of Boston Children’s Hospital surveyed patients and family caregivers at 21 children’s hospitals across the United States and found that many who do not speak English feel less comfortable asking questions and speaking up during their hospital stay. The findings were published in JAMA Pediatrics on June 13th.
“As clinicians and hospitals, we need to do a better job of collaborating with families that have language problems,” Khan adds. “Families should be encouraged to ask questions and speak up, and we should provide a safe environment for them to do so.”
Families are the best experts on their children, and their observations are invaluable. Every encounter must also include the use of qualified interpreters. Although these expenditures take longer, they can pay off in terms of patient safety, quality, and equity. “
The researchers recruited 813 hospitalized pediatric patients and families who spoke Arabic, Chinese, Spanish, or English at random. Investigators urged them to complete a survey in their native language with the help of interpreters. Adolescent patients aged 13 and up were asked to complete their own questionnaires.
According to the results of the survey, 75 (14%) of the 608 patients and caregivers who agreed to take part spoke little or no English, and 132 (25%) knew little or nothing about health.
To varying degrees, all 21 hospitals had interpreters available in person, via video, or over the phone. Despite this, survey respondents with a limited command of the English language were:
- less likely to strongly agree that they would “freely speak up if I see something that may negatively affect my/my child’s care” than respondents who were proficient in English (57 vs. 82 percent).
- less likely to strongly agree that they would “feel free to question the decisions or actions of health care providers” (37 vs. 71.5 percent).
- less likely to strongly disagree that they would be “afraid to ask questions when something does not seem right” (39 vs. 64 percent).
“We knew that our hospital systems aren’t necessarily set up to encourage patients to speak up, but the extent of the disparity based on language competency startled us,” Khan adds. “This difference could have safety concerns,” says the author, “since when relatives speak up, care is considerably improved.”
Participants with a lower level of education and insufficient health literacy were also less likely to dispute judgments. When these and other factors—relationship to the patient, age, gender, color, ethnicity, and economic level—were taken into account, individuals with limited English proficiency:
- were one-fourth as likely as English-proficient participants to say they would freely speak up about something that may adversely affect the child’s care
- were one-fifth as likely to say they would question providers’ decisions or actions
- were less than half as likely to say they would be unafraid to ask questions when something does not seem right.
Medical errors and language difficulties
In a preceding 2020 study, which guided the current research (harm due to medical care), Khan and colleagues discovered that hospitalized children whose families were unfamiliar with English were twice as likely to encounter negative events as children whose parents were familiar with Based on their new findings, Khan urges hospitals to:
- invest in additional interpreter resources (including video and in-person interpreters)
- create policies that require the use of certified interpreters for every encounter
- encourage clinicians to build rapport with non-English-proficient families, to invite families to speak up and ask questions, and to solicit their expertise about their child’s condition
- create a culture that allows more time for encounters with non-English-proficient families
- hire more bilingual staff (beyond just interpreters)
- invest in implicit bias and cultural humility training.
“Every interaction, beginning with admission, is an opportunity for families to speak up and maybe prevent a medical blunder,” Khan says. “We must ensure that families that do not speak English have an equal opportunity to express themselves.”
The study’s principal investigator was Christopher P. Landrigan, MD, MPH, chief of Boston Children’s Division of General Pediatrics. The Patient and Family Centered I-PASS Safer Communication on Rounds (SCORE) Study Group worked together on it.
“In everything we do in health care, families are critical partners,” Landrigan says. “Healthcare systems must find ways to make sure that the voices of all patients and families are heard and acted on, no matter what language they speak, how much schooling they have, or what race they are.”
