Workforce Language Services

An interesting statistic from the National Health Law Program’s survey of 260 members of the National Association of Community Health Centers:

“Eighty-one percent of general internists treat LEP patients frequently — 54% at least once a day or a few times a week,” Hitov said.

The article in which this statistic was quoted also provides insight into the multiple issues that arise when attempting to provide quality medical services to a population that speaks a wide range of languages.  The following excerpt highlights the issues, how some health care facilities are responding to these issues, and a plan for moving forward:

Referrals to specialists who do not offer interpreters was cited as a major problem by Stevens. Another is family members who wish to serve as interpreters but also interfere with the clinical process and insert their own views.

The Fairfax center found similar solutions to those used in in the district. All health care professionals are bilingual, and there are language service lines in all exam and interview rooms, Stevens said.

To guide the way toward a world in which there are more health centers like the two featured in the briefing, the AMA and other organizations developed in 2001 a set of principles for providing health care access to people with limited English proficiency.

They include offering language assistance at no cost at all points of contact and in a timely manner; providing both verbal and written notice of the right to receive language services in a patient’s preferred language; and assurances that the language assistance is competent.

In addition to Spanish-language radio and television spots, Chase is also rolling out new services to make banking easier and more accessible to Hispanics.  These include a Spanish-language website, documents in Spanish at local branches, and more bilingual tellers. 

As Rebecca Vargas, head of multicultural segments at Chase, says:

“It’s not just a matter of talking to Hispanics in a culturally relevant way, which these ads achieve. But it’s a matter of having the bilingual employees in the branches, the products they need and being in the places in where they live.”

The article also briefly mentions that the needs of Spanish-speaking customers differs from those of the general population, and Chase hopes to provide more fiscal guidance and assistance in attaining financial goals to Latinos.  This is part of Chase’s long term strategy to serve more Hispanic customers in their own language.

Though details on 2008 ad spending weren’t disclosed, Vargas noted that Chase has committed to better serving the Hispanic market and expects to come back in 2009 with additional marketing programs.

“We’ve always spent a significant amount of money for Hispanic marketing, but this year we are changing the media mix a bit, maybe spending a little more on radio without forgetting TV,” Vargas said. “We’re also doing more grassroots activities, festivals and looking at things that we can do to serve Hispanics in their language of choice.”

This terribly sad story needs no preface:

Before Teresa Sanchez and her brother Omar Aquino were shot and killed in their Mountain View home, Sanchez is believed to have made a desperate call for help.

Investigators believe she called 911 from her cell phone, whispering to the CHP dispatcher someone was breaking into her home, but before the dispatcher could confirm the address, the call ended.

“From what they could tell, she said she lived on a street that sounds like Clemon Street. We don’t have a Clemon Street or anything that remotely sounds like that here in Mountain View. So at that point we spent time repeatedly, the dispatchers and officers trying to call back the number in hopes of getting her back on the line,” said Liz Wylie with the Mountain View Police Department.

Dispatchers tried to pinpoint exactly where the call was made from, but unfortunately they received word that shots were being fired before they could ascertain where she called from.  Even more unfortunately, the victim disconnected before the number appeared on the dispatcher’s GPS unit. 

While this tragedy strengthens the reasons for having multilingual services for 911 calls, I still wonder if, in this case, there would have been time to access a Spanish-speaking person to get the correct address.

Cultural competency.  Diverse workforce.  Practicing inclusiveness.  All buzzwords sounding throughout various industries.  But how to make sure that your organization, company, or industry is really putting these words into practice?

An article in Nurse.com opens with a definition of culturally competent health care from the Office of Minority Health:

culturally competent health care [is defined as] services that are respectful of and responsive to the health beliefs and practices and cultural and linguistic needs of diverse patient populations.

The article also includes a comprehensive set of questions from University of Delaware scholar Larry Purnell which will help health care practicitioners and managers assess whether their institution’s practices reflect the definition of culturally competent health care.

While industry specific, the questions can also assist other industries in orienting themselves toward putting cultural competence into practice.

To read the entire set of questions, click here.

Some companies strive for a diverse workforce because they think it’s the right thing to do.  Other companies grudgingly do so because of Equal Employment Opprotunity mandates.  Still others find that having a diverse workforce all through the ranks is a smart business decision. 

A recent piece in Business Week makes the case for the third reason for crafting a diverse workforce.  Companies want to sell their products or services, right?  Authors G. Michael Maddock and Raphael Luis Viton urge companies to create a workforce that mirrors their target audience to sell more and continue to create innovative products and services.

They offer a three part argument for sustaining a competitive advantage:

1. Understanding. If your workforce mirrors the diverse demographics and cultural aspects of your customers, you are bound to have a better understanding of your audience. (Providing you encourage all those unique voices to contribute. If all you are doing is counting heads—”let’s see we employ 53% women, 11% blacks, 16% Hispanics…yep, we’re covered; now let’s have the same old people at the top make all the decisions as they always have in the same old ways”—you have not gained a thing.)

2. Credibility. If your workforce looks like the people you are trying to reach, you increase the odds of closing the sale. Let’s use a simple example to make the point. From whom would 22-year-old guys want to buy their $85 athletic shoes? A 63-year-old grandmother or a 22-year-old guy?

3. Connectedness. And if your workforce is the same as the people you are trying to reach, you are bound to be closer to them at all times, which give you a leg up on the competition.

Of course, simply mining diverse talent for ideas isn’t enough, and that’s where cultural competency training comes in.  A company won’t be able to sustain this competetive advantage if it doesn’t take into account the need to integrate diverse employees into the overall business structure.  A company won’t be successful if it doesn’t stress inclusiveness and understanding into its policies and management practices.

Cultural competency training will enable your business to not only sustain sales to diverse populations, but will also allow you to keep the employees you seek to include, thus bolstering sales and increasing employee buy-in.

The higher rate of workplace deaths for Latinos than for all other racial and ethnic categories has been well-documented.  But South Carolina has the highest rate of workplace deaths in the nation, 23 workers out of 100,000.  Compare this to Oklahoma’s death rate, which is second highest with 10 Latinos out of 100,000 losing their lives on the job.

The disparity is attributed to the newness and explosive growth of the Spanish-speaking immigrant population:

Hispanic workers’ growing presence in the workplace has likely led to a communications and training disconnect, making workplace conditions more treacherous than in other states, Lacy said.

“There’s a lot we have to learn when we move somewhere new,” she said. “Imagine moving to a different country and having to learn (different workplace rules), with everything in a different language.”

States with a longer history of immigration likely have a better, safer workplace system in place, Lacy said. In California, for example, Hispanic workers who work alongside more experienced Spanish-speaking workers might find it easier to learn how to operate a piece of machinery or the safest way to climb a ladder, Lacy said.

Also, Hispanic workers who are migrating to South Carolina are coming mainly from southeastern Mexico, a part of the country where, traditionally, fewer residents have crossed the U.S. border for work, Lacy said. Since the concept of immigration is newer there, that might also lead to a disconnect.

“If you’re coming from an area of Mexico that doesn’t have a long history of immigration, you’re not going to have a lot of information about working or living in the U.S.,” Lacy said.

To read more about this unfortunate phenomenon and steps taken to remedy the situation, click here.

More hospitals are offering Spanish classes alongside traditional classes teaching clinical skills in major New York hospitals for their resident physicians.  The move toward providing doctors with training in Spanish is both practical (it can be difficult to find interpreters during certain shifts and patients prefer to speak directly with a doctor that speaks their native language) and cultural. 

One of the Spanish instructors at Yeshiva University’s medical school stressed the importance of cultural sensitivity in patient care as well as the need to beware of using slang terms with patients:

Still, according to Ms. Marzan, of Einstein, stressing cultural sensitivity is also key. For example, some immigrants take herbal supplements to treat their ailments. Patients might also describe symptoms in a way that doctors are not accustomed to. For example, describing pain as being felt everywhere might mean the patient feels a lot of pain, and pain that is described as moving from the stomach to the chest to the face may be a reference to nausea.

Slang should also be taken into account. During the language lesson at NewYork-Presbyterian, students were taking turns naming parts of the human form when one doctor mistakenly used a casual word for buttocks. Laughing, Mr. Shane corrected him. “‘Culo’ is basically ‘ass,’” he said. “You would never say that to a patient.”

To read the full article, click here.

An article in the Chicago Tribune and another in the Washington Post detailed increasing unemployment rates for Latinos working in the construction industry.  Both articles shared stats found in a recently released report from the Pew Hispanic Center. 

Despite the rise in unemployment, Hispanic immigrants did not appear to be returning to their native countries in significant numbers. Those who have lost their jobs tend instead to seek other work in the United States, the report said.

“For now, at least, we do not find any signs that they are discouraged enough to go back home,” said Rakesh Kochhar, associate director of research at the Pew Hispanic Center and author of the report. “They are remaining active.”

The Washington Post article also mentions that Latinos are not sending as much money to their home countries as they once were, and currently only 50 percent of those surveyed were able to regularly send money home as opposed to 73 percent two years ago.

An Arkansas man who was tried for a DUI signed a court waiver translated into Spanish with a very different meaning.  Last February, his lawyer challenged the court’s decision because what he signed wasn’t what the court intended he sign.  How did this happen?  Because of a bad translation, one that was never caught, even though the waiver had been in use for years:

“We all just assumed the waiver was correct,” Rogers lawyer Doug Norwood said. “I did, the judge did, everyone did. Now, come to find out we’ve been stumbling around in the dark for years, and the thing is hideously wrong.” Norwood said the waiver was translated years ago by a court clerk who wasn’t certified by the state, although she spoke Spanish.

The issue is with the word assume.  Many monolingual language speakers simply assume that a document is correctly translated, when in fact, if a certified, qualified translator isn’t used, the exact opposite can be the case.

A certified court interpreter was quoted in the article:

“You would never say ‘crimen’ for a misdemeanor,” Simmons said. “Now, you’re raising a misdemeanor to a felony.” The word “annual,” can be mistranslated to “anus” if an accent mark isn’t placed over the letter “n,” she said. “If all you do is pick up a dictionary or go online to translate, the meaning can be lost,” she said. “A literal translation can mean nothing like what it should.”

To read the complete article, which includes the court’s take on the situation, click here.

In Mesa, Arizona the police department has turned to volunteers to assist monolingual 911 dispatchers when Spanish-speakers call in.  The reasoning for suspending use of the Language Line (a for-profit interpretation service) is the budget crisis that so many municipalities are facing:

In 2006, Mesa spent $118,000 to translate calls that weren’t in English. And in the first four months this year, the city has spent $28,000. Most of the calls were in Spanish.

With only five certified Spanish-speaking operators out of 120, the communications center often relies heavily on a program called Language Line.

The program allows dispatchers to connect with translators for most of the world’s languages. However, as the need for translation services rises and the city faces tighter budgets, new ideas — like using volunteers — are becoming necessary.

“During lean times, it’s the creative ideas that are working,” said Cari Zanella, public safety communications administrator. “For us, it’s a perfect fit. Volunteers want to help and our 911 center can use the help.”

Police Chief George Gascón came up with the idea for the volunteer program after department analysts figured out how much translation services were costing the city.

I’m a bit torn over this move.  There’s an obvious need for translation services for 911 calls, and I do understand that something’s got to give when there are budget cuts.  But I can’t help but wonder why, in a major metropolitan area in a state with huge numbers of Spanish-speakers, only five out of 120 dispatchers speak Spanish?  I don’t think that moving towards use of volunteers is necessary, as the article states, but I do think that recruiting more bilingual paid employees is necessary.

To read the entire article, including quotes from one of the volunteers, click here.