Diversity Equity and Inclusion: Equity: The Impact of Language, Culture & Accent Bias

Prevention requires providers’ dedication to quality communication.

Communication plays a vital and often underappreciated role in the healthcare equity equation. The literature has clearly demonstrated that language, culture and accent bias can negatively impact the quality of communication patients have with their providers, which ultimately impacts their outcomes.

Telling examples

When we talk about communication, we already know that significant gaps exist between providers — and all the specialized jargon inherent in the healthcare industry — and the public when it comes to healthcare literacy. That gap is only widened when you factor in patients’ linguistic diversity, which includes everything from pronunciation, expression and word choices to regional variations in dialect and language. Let’s look at how biases surrounding language, culture and accent can negatively impact patient care:

• Language. Studies show that patients with limited English proficiency have lower patient satisfaction. Why is that? There are plenty of reasons. To start, these patients often have a decreased comprehension of the critical healthcare instructions they are given. Not understanding and therefore not adhering to these instructions can lead to increased morbidity and mortality rates. It also increases the patient’s psychological stress in a healthcare environment, which often creates its own series of unnecessary barriers. But it goes even further with language problems. When the problems surrounding a linguistic gap are exacerbated by a lack of institutional support, more frequent and medically significant communication errors (i.e., preventable errors) often occur.

• Culture. There are several ways in which cultural differences or perceptions of differences impact patient care. When it comes articulating pain, certain cultures may be more expressive, while others tend be more stoic. Unfortunately, these discrepancies have created glaring inequities. For instance, research shows us that compared to their white counterparts, patients of color are less likely to be given pain management medication and, when they were given pain meds, they were given lower quantities.

• Accent. Multiple problematic biases surround accents for both patients and providers alike. Research shows that accented English speakers report receiving differential treatment in the healthcare setting. For example, in certain North American primary care settings, the cultural and linguistic backgrounds of immigrant patients were unable to be accommodated and led to difficulties with diagnosis and treatment. These unfortunate experiences led to discomfort, frustration and the silencing of vulnerable communities. People who speak with non-native accents are also often perceived as less competent, less trustworthy and, on the provider side, less capable of providing quality care. This bias impacts the patient/provider relationship and presents a significant barrier in a provider’s ability to achieve professional development and advance their career.

Change starts here

Like most institutional changes, preventing language, culture and accent bias starts at the top. Facilities must commit to healthcare equity and make it a leader-driven strategy. Once you have that backing, it’s much easier to build a structure that implements culturally and linguistically appropriate services. When it comes to building a culturally competent workplace (or strengthening an existing one), there’s no need to reinvent the wheel. Facilities can simply look to the Culturally and Linguistically Appropriate Services (CLAS) standards created by the Office of Minority Health at HHS (See “National CLAS Standards”). These national CLAS standards essentially provide a clear framework for supporting patients’ linguistic and cultural needs.

With the proper organizational framework in place, the goal then is to foster an inclusive and equitable workplace. On a day-to-day basis, this includes integrating professional language services into your workflow. For instance, we have a variety of translation and interpretation services available for our Limited English Proficiency or LEP, visually impaired, deaf or hard-of-hearing patients at our multiple locations at no cost. If patients need a language service, they communicate that need to their care team. We have Spanish interpreters who can come directly to the room, phone interpreters for more than 240 languages and video interpreters for 33 languages. While smaller facilities and freestanding ASCs may not have a budget for such comprehensive language services, there are plenty of free and low-cost resources out there to prevent the types of issues outlined earlier. Of course, one of the most effective ways to become a culturally competent organization is simply to have an increasingly diverse workforce with a firm understanding of the needs and challenges faced by the communities they serve in place.

It doesn’t matter how surgical facilities become culturally competent organizations dedicated to equity; what matters is that they commit to doing something. Providers must be trained appropriately and equipped with culturally and linguistically appropriate services and resources to bridge ever-present information gaps. Disparities related to language, linguistics or a lack of cultural awareness are unwanted, unjust and utterly unacceptable. Quality communication is something every patient deserves from their provider. OSM