The Goal:
To screen all patients for their language needs in order to determine true demand for language services.

Why It’s Important:
Providing appropriate language services depends on a health care organization’s ability to accurately screen for language needs among its patients and to identify patients’ preferred language for health care encounters. The use of standardized practices to collect this information will provide the hospital with an accurate assessment of the need for interpreter services, translated materials and signage. 

How To Do It:
Registration and scheduling staff are typically the first to communicate with incoming patients and have the first and most important opportunity for collecting patient language data. The following five steps emphasize the importance of coordinating with registration/scheduling in hospital settings and outpatient clinics: 

1. Develop a relationship with registration/scheduling staff.

• Become familiar with registration/scheduling department staff, structure and mechanisms for communication. For some organizations, registration/scheduling are decentralized and use different information systems.
  
• Assess the relationship between registration/scheduling and language services:
  • What questions related to language are asked at point of registration/scheduling? 
  • How confident are you that these questions are being asked of every patient?
  • What information related to language needs is recorded at registration/scheduling?
  • What policies and procedures around collecting patient language data exist? Are registration/scheduling staff aware of these policies and procedures?

2. Give registration and scheduling staff the tools they need to screen for language needs.

• Determine which questions related to language would best capture demand for language services, including at a minimum, “In what language would you prefer to receive your care?” Screening patients for their language needs does not replace the need to collect information on race, ethnicity and primary language.

Tip: Many hospitals struggle with whether to ask for preferred language versus primary language. Ideally hospitals should ask both questions of their patients and should keep in mind each question is designed to solicit different types of information. While primary language provides demographic information on a patient, such as the native language or language spoken at home, knowing the preferred language of a patient can help anticipate demand for language services. A patient’s primary language may not necessarily be the language that they prefer to receive their health care in. Additionally, a patient’s preferred language for oral communication may differ from their preferred language for written communication.  

• Develop a script and offer related staff training and education to ensure that
  registration/scheduling staff ask the same questions of all patients and are prepared to address questions and concerns from patients regarding language information. Developing a good tool requires the involvement of the people who will use it. Ask registration/scheduling staff to assist in the script development process.
  
• Establish mechanisms for resolving the language needs of patients who cannot communicate with registration or scheduling staff. Examples include posting a language identification poster in the registration/scheduling area to identify the patient’s language and providing patients with an "I speak" card.

3. Work with registration/scheduling, information technology and leadership to develop policies and procedures around the collection of language needs data.

• Designate a location within the registration/scheduling screen or form for patient language information.
  
• Develop a list of languages to choose from that reflects your patient population and revise the list as needed.

Tip: For organizations serving communities with distinct dialects (e.g., European Portuguese, Brazilian Portuguese), educating registration staff on these distinctions can help reduce error rates at registration/scheduling.

• Establish mechanisms to ensure that registration/scheduling staff record language data. These mechanisms might include implementing required fields or using pop-up reminders.
  
• Determine points in a patient’s care at which language information can be verified. At many hospitals, this information is verified during the nurse assessment or during other points of care.  This process can be particularly useful during a patient transfer, such as from the emergency department to the ICU.
  
• Find a way to get patient language data collected at registration/scheduling to the clinical provider or other staff member who is responsible for requesting language services for the patient.

4. Evaluate and assess your organization’s language needs screening process.

• Assess the rate of patients being screened for their language needs in the organization. If language screening information is not readily available across the organization, try starting in two clinical areas within the hospital.

Tip: The use of data is a powerful way to make change.  Share this information with registration/scheduling staff and hospital leadership to illustrate how your organization’s screening process performs.

• Take advantage of opportunities to double-check patient language information and detect errors.  For example, some language services programs cross-check a list of patients with language needs generated daily from registration with their own schedule of patients needing an interpreter service.
  
• Shadow and meet with registration/scheduling staff to determine:
  • Whether the same language-related screening questions are being asked of all patients
  • Whether current practices are preventing registration/scheduling staff from recording language data.  Staff often consider it awkward to ask a patient about language needs, particularly when a patient’s language preferences appear to be obvious. Be sure to explain the importance of following the procedure, even if the staff believes the answer is obvious, to reduce errors and ensure quality. Address errors made at registration on a case-by-case basis or through group trainings and refresher courses. Clear explanations of hospital policy, examples of “what not to do” and telling real-life stories of what can go wrong can help make a strong case. 

Tip: Assess barriers or reluctance toward screening for language needs through focus groups with registration/scheduling staff or by attending a registration/scheduling staff meeting.  Improvements in screening are most likely to occur if these staff are involved in designing and testing new changes.

5. Develop strategies to improve the language needs screening process.

• Work with registration/scheduling and leadership to revise policies around language data collection as necessary.
• Modify the screening process for exceptions including:
  • emergencies in which the patient is not screened at registration/scheduling
  • patients who are clinically unable to speak
  • caregivers who speak a language other than English.

Tip: One hospital addresses differences in language preference between minors and their parents by also asking the preferred language of the caregiver. 

• Talk regularly with registration/scheduling to ensure that all staff are up to date on the policies and procedures of language data collection and to confirm that the tools used to collect this data meet their needs. In some organizations, registration/scheduling departments experience high turnover. In these cases, plan on more frequent refresher courses and training sessions.

Tip: Consider the following forums for getting your message across:  regular meetings with the department head or entire registration department and regular internal communications (e.g., an internal newsletter). 

• Develop a process for reporting errors to the registration/scheduling departments.