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The Impact ofCommunicationChallengeson the
Delivery of QualityHealth Careto
Minority LanguageClients & Communities
A Position Papersubmitted by thePEI French Language Health Services NetworkIn collaboration with the Société Santé en français
ACKNOWLEDGEMENTS
The Prince Edward Island French Language Health Services Network would like to thank all those whohave contributed to the production of this position paper.
Research and report writing: HRA Consulting FirmPatsy MacLeanConstance RobinsonKay Lewis (Quest Hospital Planning Solutions)
Advisory Committee: Joanne Donahoe Lizanne ThorneMelissa Doucette Garth WaiteJulie G. Gilman (Chair)
Resource person: Caroline Currie
Collaborators: Société Santé en français
Translation: Acadian and Francophone Affairs Division, Government of P.E.I.
Graphic design & layout: TechnoMedia
Printing: Kwik Kopy
The production of this position paper has been made possible through a financial contribution fromHealth Canada through the Société Santé en français.
The views expressed herein do not necessarily represent the views of Health Canada.
For more information, please contact:
The Prince Edward Island French Language Health Services Network48 Mill Road, P.O. Box 58Wellington, PEC0B 2E0Tel: (902) 854-7441Fax: (902) 854-7255Email: info@santeipe.caWeb: www.santeipe.ca
A production of the Prince Edward Island French Language Health Services Network
MARCH 2007
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INDEXMessage from the Co-Chairs of the Prince Edward IslandFrench Language Health Services Network.................................................................................................2
Message from the Société Santé en français Board Chairand President and Executive Director..........................................................................................................3
HistoryofthePEIFLHSN............................................................................................................................4WorkofthePEIFLHSN...............................................................................................................................4PEIFLHSNPositionStatement.....................................................................................................................5RecognitionofthePurposeofCCHSA..........................................................................................................5CommunicationChallenges&QualityofCare..............................................................................................6WhyCommunicationIsImportant................................................................................................................6 Access.......................................................................................................................................................7 Prevention................................................................................................................................................7 Consent....................................................................................................................................................8 ProfessionalCodeofEthics.......................................................................................................................8 QualityofCare.........................................................................................................................................8 Patientsafety............................................................................................................................................9 MedicalErrors........................................................................................................................................�0 HospitalAdmissions...............................................................................................................................�� DiagnosticTesting..................................................................................................................................�� PatientFollow-Up..................................................................................................................................�� MentalHealthCare................................................................................................................................�� Safety......................................................................................................................................................�� Outcomes...............................................................................................................................................�2 PatientSatisfaction.................................................................................................................................�2 PatientCompliance................................................................................................................................�2 ResearchContinues................................................................................................................................�2Language&Standards.................................................................................................................................�4Conclusion...................................................................................................................................................�5References....................................................................................................................................................�6
APPENDIX ACCHSAStandardsRelatingToLanguageAccess..........................................................................................�9LeadershipAndPartnership.........................................................................................................................�9Environment................................................................................................................................................22HumanResources........................................................................................................................................23InformationManagement............................................................................................................................24AcuteCare...................................................................................................................................................25AmbulatoryCare..........................................................................................................................................29CommunityHealthServices.........................................................................................................................33CriticalCare.................................................................................................................................................38HomeCare..................................................................................................................................................43Long-termCare............................................................................................................................................47Maternal/Child............................................................................................................................................52MentalHealth..............................................................................................................................................56Rehabilitation...............................................................................................................................................60
APPENDIX BLanguageAccessResources&Tools.............................................................................................................65
APPENDIX CEvidenceForMonitoringCommunicationChallenges.................................................................................67
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Message from the Co-Chairs of the Prince Edward IslandFrench Language Health Services Network
ThePrinceEdwardIslandFrenchLanguageHealthServicesNetwork,incollaborationwiththeSociétéSantéenfrançais,ispleasedtosubmitthispositionpapertotheCanadianCouncilonHealthServicesAccreditation(CCHSA).
WhentheP.E.I.FrenchLanguageHealthServicesNetworkdevelopeditsAction Plan for the Delivery of Primary Health Care Services in Frenchon Prince Edward Islandin2006,oneofitsrecommendationswasthatfromanationallevel,theSociétéSantéenfrançaisbeincited“…toconsiderusingtheexistingAccreditationFrameworkoftheCCHSAasawayofencouraginghealthcareorganizationstoimprovethedeliveryofFrenchlanguageservices”asitisrecognizedthatlanguageandcultureimpactqualityofcare.Thispositionpaperisinresponsetothisrecommendation.
Onceagain,ourcollaborativeapproach,whichunitestheNetwork’scommunityandprovincialgovernmentpartners,hasprovedsuccessful.WeareconfidentthattheCCHSAcanusethisnewtooltocontinuetoraisethebarforqualityinhealthservicesandmeetitscommitmenttobealeaderinimprovingpatientsafety.WelookforwardtoacontinuedcollaborationwiththeCCHSAsowemaymeetourjointgoalofimprovingqualityofcareforminoritylanguageclientsandcommunities.
DonaldDesRoches ClaudeBlaquièreGovernment Co-Chair Community Co-Chair
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Message from the Société Santé en français Board Chair, President and Executive Director,
WeareverypleasedtoannouncethattheSociétéSantéenfrançaisisteamingupwiththePrinceEdwardIslandFrenchLanguageHealthServicesNetwork(PEIFLHSN)tosubmitthepositionpaperThe impact of communication challenges on the delivery of quality health care to minority language clients & communitiestotheCanadianCouncilonHealthServicesAccreditation(CCHSA).
Inthispaper,weaccuratelypointouttheinevitablecharacterofcultureandlanguageassystematicparametersforassessingthequalityofservices,withinthescopeofaccreditinghealthcareinstitutions.
AvastreviewofCanadianandinternationalliteratureonthesubjecteloquentlysupportstheimportanceofintegratingqualitystandardsforcommunicationbetweentheinstitutions,stakeholdersandtheFrancophonecommunitiestheyserveintoaccreditationprocesses.Inthisregard,thePEIFLHSNisproposingverypromisingsolutionsthatarein-linewiththeperspectiveoftheCCHSAorientations.TheSociétéSantéenfrançaisfullysupportsthePEIFLHSN’sworkonbehalfofallitsaffiliatednetworks.Weareconvincedthatthiscollaborativeeffortwillinevitablyresultinimprovedqualitystandardsforpatientcareandsafety,whichinturnwillleadtobetteraccesstoFrench-languageservices,improvedefficiencyofinterventionsandgreatersatisfactionamongusersoftheseservices.
Dr.BrianConway HubertGauthierBoard Chair President and Executive Director
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History of the PEI FLHSN
TheGovernmentofPrinceEdwardIslandadoptedFrenchlanguageserviceslegislationinApril�999.Whiletheprovisionswhichwouldappreciativelyimpacthealthserviceshaveyettobeproclaimed,thecurrentlegislationdoeshaverepercussionsonthedeliveryofhealthandsocialservices.ThepartialproclamationoftheFrench Language Services ActillustratestheProvince’sintenttoimproveaccesstoFrenchlanguagehealthandsocialserviceswhileprovidingservicesofcomparablequalitytoEnglish-languageservicestobenefittheAcadianandFrancophonecommunity.
WhiletheProvincehasacknowledgedtheprincipleofincreasedprovisionofservicesinFrench,thereisaneedtodeterminehowthiscanbeachieved.Todothis,theAcadianandFrancophonecommunityincitedtheMinisterresponsibleforAcadianandFrancophoneAffairsandtheMinisterofHealthandSocialServicestoestablishajointgovernment-communitynetworkdedicatedtothetaskofproposingpracticalsolutionsforthedeliveryofFrenchlanguagehealthandsocialservicesinPEI:thePrinceEdwardIslandFrenchLanguageHealthServicesNetwork(PEIFLHSN). ThePEIFLHSNisnotuniqueinitswork.Itispartofanationalnetworkofsimilarorganizationsineachprovinceandterritory:theSocietéSantéenfrançais(SSF).Provincial,territorialandregionalnetworksandtheSSFworkincollaborationtoimproveaccesstoFrenchlanguagehealthservicesforFrenchlanguageminoritycommunities.
The PEI FLHSN vision is: ToensurethatAcadiansandFrancophonesofPrinceEdwardIslandhaveaccesstoacompleterangeofFrenchlanguagehealthandsocialservicesofcomparablequalitytothoseprovidedinEnglish.
ItseekstoachievethisvisionbyproposingsolutionsthatincreaseaccesstoFrenchlanguagehealthandsocialservicesthroughworkinginpartnershipwithotherorganizationsandthecommunity.
Work of the PEI FLHSNInarecentPEIFLHSNreport,Action Plan for the Delivery of Primary Health Care Services in French (a.k.aSetting the Stage, 2006),theassessmentoftheexistinglevelofserviceconcludesthatcurrentFrenchlanguageservicesareinadequate,poorlyplannedandpoorlydistributed.Itobservedthat,todate,theimplementationoftheFrench Language Services Acthasbeendisappointingintheareaofprimaryhealthcareservices.IntheentireprovinceofPrinceEdwardIsland,onlyonefamilyhealthcentreactivelyoffersFrenchlanguagehealthservices.Elsewhere,peoplewishingtoaccessFrenchlanguagehealthservicesmustaskfortheserviceand,giventhefewbilingualemployeesspreadacrossthesystem,thereisnoguaranteethatsuchaservicewillbeprovided.Only0.9%ofpositionsinthehealthandsocialservicessystemaredesignatedbilingualwhile3.�%ofemployeesclaimedsomelevelofknowledgeofFrenchwhenlastsurveyed;thiscomparesto4.4%ofthepopulationwhichreportedFrenchastheirfirstlanguageinthe200�Censusand�2.�%ofIslanderswhoclaimtheycanspeakFrench.
ThePrinceEdwardIslandDepartmentofHealthiscurrentlyworkingtorespondtotheSetting the Stage report.Its Departmental Strategic Planhasadoptedasoneofitsgoals:
To improve access to health care: access for linguistic and ethnic minorities
Operationally,theDepartmenthasalsotakenstepstoaddresscommunicationchallenges,butthisprocesshassignificanthumanresourceimplications,andwilltaketimetoresolve.
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The Setting the StagereportrecommendedthatthePEIFLHSNencouragetheSociétéSantéenfrançaistoconsiderusingtheexistingAccreditationFrameworkoftheCanadianCouncilonHealthServicesAccreditation(CCHSA)asameansofraisingawarenessofhowcommunicationchallengesaffectthedeliveryofhealthcareservices.Becausecommunicationchallengesnegativelyaffectthequalityofhealthcareandcreatesanunacceptablelevelofrisk,thisisanissueofconcernforallhealthorganizationsacrossthecountry.
ThePEIFLHSNfollowedthisrecommendationbydirectingthatapositionpaperbeprepared.ThisdocumentwaspreparedunderthedirectionofthePEIFLHSN,byHRA,aCharlottetown-basedhumanresourceconsultingfirm.JulieGilman,FLHSNCoordinator,oversawtheworkperformedbyHRAconsultantsPatsyMacLeanandConstanceRobinson,inassociationwithKayLewisofQuestHospitalPlanningSolutionsInc.
PEI FLHSN Position StatementThePEIFLHSNbelievesthattheAccreditationFrameworkusedbytheCanadianCouncilonHealthServicesAccreditation(CCHSA)isanexistingmechanismwithinthegovernancestructureofthehealthsystemwhichcanbeusedtoimproveaccesstoFrenchlanguagehealthservicestotheFrancophonepopulationandreduceriskswithinthesystem.
ThePEIFLHSNtakesthefollowingposition:
That the CCHSA should continue to increase awareness of the impact of communication challenges on those accreditation standards that consider how health institutions respond to the language needs of the linguistic minority communities, clients and families through the following actions:
• AspartoftheircontinuingeducationCCHSAsurveyorsshouldbeapprisedoftheresearch regardingtheimpactofcommunicationchallengesonaccessibilityofqualityofcare,andshould beadvisedtoaddresstheseissuesintheiraccreditationwork;• Strengthenguidelinesforstandardsandcriteriaonhowtoaddresscommunicationchallenges;• Includelanguageaccessindicators,orothermeansofevidence,forreportingthatanorganization is“linguisticminorityfriendly”;• ProvidetheSelf-AssessmentTeamswithanopportunitytodetermineiftheteammembership reflectsthediversityofthecommunityitserves.
Recognition of the Purpose of CCHSA
ThePEIFLHSNrecognizesthattheCCHSAplaysauniqueroleinthedeliveryofhealthservicesbyassistinghealthserviceorganizationsacrossCanadaexamineandimprovethequalityofcareandservicetheyprovidetotheirclients.AreviewoftheCCHSAstandardsandcriteriatoidentifyareaswherecommunicationandlanguagearealreadypartoftheaccreditationprocessisattachedinAppendixA.Itillustratestheintegralrolecommunicationsplayinthedeliveryofqualityhealthcare.
BecausetheCCHSAmissionisdrivenbyqualityofcareissuesratherthanrights,thispaperfocusesonhowlanguagebarrierissuesimpingeonqualityofcare,andtheimportanceofheighteningthisfactorintheaccreditationprocess.Thispaperprovidesabriefoverviewoftheresearchthathighlightstheconcernslanguagebarriersraiseforachievingqualityofcare,discussesthelegalobligationsthatexistinthisarena,andreviewshowexistingCCHSAstandardsapplytolanguagebarriers.AppendixAtothispaperisareviewoftheCCHSAstandardsrelatingtolanguageandcommunication.BecausethemissionofthePEIFLHSNisnotonlytoraiseissues,buttoencouragethedevelopmentofsolutions,theresourcesandtoolsfoundintheprocessofpreparingthispaperarelistedinAppendixB.
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Communication Challenges & Quality of CareNote on terminologyCommunicationchallengesareassociatedwithunder-useofprimaryandpreventiveservices,limitedcomprehensionofmedicalinformation,lackofadherencetomedicaladvice,andlesscost-effectiveuseofmedicalservices,includingagreaterneedfortestsandlongermedicalvisits(Weissetal.2006).AsnotedintheseminalworkofSarahBowen,inCanada,mostresearchonhealthserviceutilizationandhealthstatushasfocusedontheeffectsofsocioeconomicfactors,andtoalesserextentonregionaldifferences.Researchexaminingtheimpactofcultureandethnicityhastendedtofocusondifferencesattributedtoculturalbeliefsandpractices,andnotontheeffectofsystemicbarrierstoaccess(Bowen,200�).Furthermore,inCanada,thediscussionconcerningaccesstohealthservicesinaperson’sfirstlanguage,particularlywherethatlanguageisanOfficialLanguageofthestate,tendstobeframedasa“rights”issue.However,whiletherearerightsaspectstothediscussion,fromahealthcareperspectivethefundamentalissueispatientsafetyandrisk:thereareinherentrisksassociatedwiththefailuretoaddresslanguagebarriersencounteredduringtheprovisionofhealthcareservices.
Internationally,thereisagrowingbodyofliteraturedocumentingtheimpactofcommunicationchallengesonaccess,useandqualityofmedicalservices.Thevocabularyforthesestudiesvaries,referringtolanguageaccess,languagebarriers.Theframeworkforthesestudiesalsovaries,oftenturningonlegalrightsofaccess,orasinthecaseofseveraloftheAmericanstudies,specifichealthcaredeliverymodelissuesrelatingtonon-insuredhealthcareorspecificsocialandethnicpolicyconcerns.Becausethispositionpaperfocusesonthemoreneutralconcernofqualityofcare,andappliestoalltypesofcommunicationchallengesincludinglinguisticminoritycommunityconcernsaswellashealthcareliteracy,thePEIFLHSNusestheterm“communicationchallenges”toembracethelargerscopeofqualityofcareandriskthatarisewhenhealthcareconsumerandhealthcareproviderhavedifficultiesexchanginginformation.Wherethispaperreferstoaspecificresearchpaperoradirectquote,deferenceisgiventotheauthor’schoiceofterminology.
Why Communication Is ImportantResearchindicatesthatcommunicationchallengeshaveanegativeimpacton:
•accesstotreatment•participationinpreventivemeasures•abilitytoobtainconsent•abilityforhealthprofessionalstomeettheirethicalobligations•qualityofcare,including -hospitaladmissions -diagnostictesting -medicalerrors•patientfollow-up•qualityofmentalhealthcare•patientsafety
Theeffectsofcommunicationchallengesonhealthcaredeliveryhavebeenconsideredinothercountries.AccordingtotheInstituteofMedicineoftheNationalAcademies(U.S.)�,communicationchallengescontributetoreducedquality,adversehealthoutcomes,andhealthdisparities(2004).Furthermore,thereisevidencethatcommunicationchallengesmayresultinincreaseduseofexpensivediagnostictests,increaseduseofemergencyservicesanddecreaseduseofprimarycareservices,andpoorornopatientfollow-upwhensuchfollow-upisindicated(Greising,2006).
� An American non-profit organization that provides evidence-based advice for the improvement of medicine http://www.iom.edu
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TheseareallissuesthattheCCHSAencouragesaccreditedfacilitiestoaddressintheon-goingjourneyofqualityimprovement.Abriefreviewofjustsomeoftheresearchthatlinkslanguageandqualityofcareissetoutbelow.
AccessThereiscompellingevidencethatcommunicationchallengeshaveanadverseeffectoninitialaccesstohealthservices.Thesechallengesarenotlimitedtoencounterswithphysiciansandhospitalcare.Patientsfacesignificantbarrierstohealthpromotionanddiseasepreventionprograms:thereisalsoevidencethattheyfacesignificantbarrierstofirstcontactwithavarietyofproviders(Bowen,200�).Theresearchindicatesthatthereisageneralpatternofloweruseofmanypreventiveandscreeningprogramsbythosefacinglanguagebarriers(Woloshinetal.,�997).Higherusehasbeenreportedforsomeemergencydepartmentservices,andforadditionaltestsorderedtocompensateforinadequatecommunication(Bowen,200�).
PreventionAnumberofstudiesfocusonutilizationofcancerscreeningprograms.FoxandStein(�99�)foundthatthemostimportantvariablethatpredictedwhetherwomenofallracialgroupshadamammogramwaswhethertheirdoctorshaddiscussedmammographywiththem.Hispanicwomen,comparedtoblackorwhitewomen,werelesslikelytohavephysicianswhodiscussedscreeningwiththem.Languagepreference(EnglishversusSpanish)wasstronglycorrelatedwithwhetherthephysiciandiscussedmammographywiththewomanornot.InaBritishstudyofparticipationincervicalscreeningprogramsbyNaishetal.(�994),languageandadministrationwereseentobebarrierstoparticipationbyclients,not,asreportedbyphysicians,lackofinterestinpreventionprograms.Solisetal.(�990)foundthatlanguageabilitypredictedtheuseofscreeningservices.Theysuggestedthattheeffectoflanguageonscreeningpracticeswasanaccessfactor(i.e.proficiencyinEnglishincreasedaccesstoservice).InastudyofhealthbehaviourofolderHispanicwomen,Marksetal.(�987)foundthattheuseofEnglishlanguagewasassociatedmostcloselywithincreaseduseofscreeningprograms.
InaCanadianstudy,Woloshinetal.(�997)analyzedself-reportedutilizationdataonbreastexamination,mammographyandPapscreeningfromthe�990Ontario Health Survey.HefoundthatFrenchspeakersweresignificantlylesslikelytoreceivebreastexaminationsormammography.Theseresultspersistedevenwhenadjustedforsocialandeconomicfactors,contactwiththehealthcaresystem,andmeasuresofculture.
ConsentConsenttotreatmentisafundamentalpillarofqualityofcare.Legislationprotectspatientsfromproceduresforwhichtheyhavenotprovidedinformedconsent.Furthermore,thecommonlawinCanadaprovidesthatwhereapatientdoesnotspeakanofficiallanguage,thephysicianmustensurethatthepatientunderstandstheinformationthatiscommunicatedbeforeadministeringtreatment.Forexample,inAnan vs. Davis,arefugeewassterilizedaftersheconsentedtowhatshethoughtwasaproceduretotreataninfectionthathadoccurredafterbirth.Therulinginthiscaseconcludedthatthedutytoensurethepatientunderstoodtheinformationincludedanobligationtobeattentivetothelanguageabilityoftheinterpreter,andtoensurethatthepatientwasreturningreasonableandresponsivereplies.InKorollos vs. Olympic Airways,aphysicianobtainedconsentfromafamilymemberoverthetelephoneforapatient’ssurgery.Thefamilymemberlaterstatedthathegaveconsentonlybecausehemisunderstoodtheurgencyofthesituation.Thecourtconcludedthatthedutyofthedoctorextendedbeyondcommunicationofthefacts,butalsorequiredapositivedutyonthedoctortoensurethatthepatientactuallyunderstoodtheinformation(Bowen,200�).
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Professional Codes of EthicsCodesofethicsregulatingthehealthprofessionsstresstheneedfortheprovidertoobtaininformedconsent,provideexplanations,ensureconfidentiality,andrefrainfrompracticingtheprofessionunderconditionsthatmayimpairservicequality.Fortheseethicalstandardstobeachieved,itisnecessarytoaddresscommunicationchallenges,whethertheyarisebecauseofalinguisticminoritycontextorbecauseofahealthcareliteracyissue(Bowen,200�).
Inrecognitionthat“communicatingcomplexinformationclearlyandeffectivelyisachallenge,butitiscriticalforethical,high-qualityhealthcare,”(EthicalForceProgram,2006,p.7)theAmericanMedicalAssociationEthicalForceProgramisdevelopingapatient-centeredcommunicationframework.TheDraftFrameworkreads:
Anorganizationshoulddeterminewhatlanguageassistanceisrequiredtocommunicateeffectivelywiththepopulationsitserves,makethisassistanceeasilyavailableandtrainitsworkforcetoaccessanduselanguageassistanceresources(EthicalForceProgram,2006,p.8,5b).
Quality of CareCasestudiesillustratehowcommunicationchallengesleadtodelayeddiagnosis,mis-diagnosis,andinappropriatereferral.Failuretoexplainthepatient’sconditionorrecommendedcare,orfailuretoensureconfidentialityorobtaininformedconsenthavebeendocumented.(Bowen&Kaufert,2000;Haffner,�992;Stevens,�993;Floresetal.,2000).Furthermore,communicationchallengesareassociatedwithincreasedriskofhospitaladmission,increasedriskofintubationforasthmatics,differencesinprescribedmedication,greaternumbersofreportedadversedrugreactions,andlowerratesofoptimalpainmedication.Thereisalsopreliminaryevidencethatsuchbarriersarerelatedtolessadequatemanagementofchronicdiseasessuchasasthmaanddiabetes.
Patient Safety Thefocusofpatientsafetyactionplansisshiftingfromretrospectiveanalysesofadverseeventsor“medicalerrors”,tomoreproactivestudiesofclinicalsystems,includingtheroleofinterpersonalcommunicationsinpatientsafety.Forexample,theUniversityofCalifornia,SanDiegoCenterforPatientSafetyiscurrentlyengagedinstudiesoftheroleoffailedinterpersonalcommunication(clinician-patient&clinician-clinician)inpatientsafety.2
Recently,theemphasisonsafetyhasalsobeenraisedinAustralianresearch.Megan-JaneJohnstoneandOlgaKanitsaki’spaperCulture, language, and patient safety: making the linksuggeststhatthefailuretorecognizethecriticallinkbetweencultureandlanguageandpatientsafety“unacceptablyexposespatientsfromminorityethno-culturalandlanguagebackgroundstopreventableadverseeventsinhospitalcontexts(2006,p.383)”.Theygoontosuggestthat
inordertoensurethattheminorityaswellasthemajoritypatientinterestsinreceivingsafeandqualitycareareproperlyprotected,theculture-language-patient-safetylinkneedstobeformallyrecognizedandthevulnerabilitiesofpatientsfromminorityculturalandlanguagebackgroundsexplicitlyidentifiedandactivelyaddressedinpatientsafetysystemsandprocesses(p.383).
2 SanDiego County Patient Safety, Goals of the SDCPs, http://meded.ucsd.edu/SDCPS/goals.html
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UndertheleadershipofthePatientSafetyAdvisoryCommittee,theCCHSAhasdevelopedPatientSafetyGoalsandRequiredOrganizationPractices.Nationalandinternationalliteraturewasreviewedtoidentifythemajorpatientsafetyriskareas,aswellaspatientsafetybestpractices.CCHSAcarriedoutadetailedreviewofitspatientsafety-relatedaccreditationsurveyrecommendations,conductedananalysisoftopcomplianceissues,andresearchedrelatedactivitieswithinotheraccreditingbodiesinternationally.
Thecommitteereviewedandprovidedrecommendationsonalistofpotentialpriorityareasforpatient/clientsafety.TheoutcomewasthecreationoffivePatientSafetyareas,sixPatient/ClientSafetyGoals,and2�RequiredOrganizationalPractices(ROPs).ThefivePatientSafetyAreaswereidentifiedasbeing:
•Culture
•Communication
•Medications
•Workforce/Worklife
•InfectionControl
AccordingtotheCCHSAwebsite,thegoalforthepatientsafetyareaofcommunicationisto:
Improvetheeffectivenessandcoordinationofcommunicationamongcare/serviceprovidersandwiththerecipientsofcare/serviceacrossthecontinuum.
The ROPs related to this goal are listed as being:
•Informandeducatepatients/clientsabouttheirroleinpatientsafety(writtenandverbalcommunication)
•Employeffectivemechanismfortransferofinformationatinterfacepoints
•Implementverificationprocessesandothercheckingsystemsforhigh-riskcare/serviceactivities
•Reconcilethepatient’s/client’smedicationsuponadmissiontotheorganizationandwiththeinvolvementofthepatient/client
•Reconcilemedicationswiththepatient/client’smedicationstothenextproviderofservice
BecausetheROPshavebecomepartoftheaccreditationprocesstoensurethatorganizationsaremeetingkeypatientsafetyissues,thePEIFLHSNrecommendsthattheapplicationoftheseROPsbeconsideredwithregardtohowtheorganizationaddressesthechallengesarisingfromcommunicationbarriers.Certainlytheinformingandeducatingofpatientsandclients,orthereconciliationofmedicationscannotbeeffectiveifcommunicationbarriersarenotaddressed.
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Medical ErrorsQuality, Patient Safety and Hospital Care for Latino Children: Addressing Parent and Provider Communication Challengesexaminedpatientsafetyissues,citingthatmistakesbyinterpreterswereasignificantcauseofmedicalerrorsinapediatricpopulation(Floresetal.,2003),andthat63%oferrorsduetoincorrecttranslationswereconsideredseriousenoughtohavemedicalconsequences–mistakesbyfamilymemberswereshowntobemoreseriousthanthosebyhospitalinterpreters.Italsocitedpoorcommunicationasthenumberonecauseofsentinelevents.3
“Theoneissuethatwouldhavethegreatestimpactonpatientsafetyisimprovedcommunication.”– Richard Croteau, MD, Executive Director of Strategic Initiatives, Joint Commission on Accreditation of Health care Organizations in a Sentinel Event Alert
TwoBritishColumbiacasesillustratetheliabilityriskforfailuretoaddresscommunicationchallenges.Inonecase,theB.C.SupremeCourtfoundadoctornegligentinhisexaminationanddiagnosisofamanwhoselegwasamputatedastheresultofthismis-diagnosis.Thecourtruledthatthepatient’slanguagedifficultyshouldhavemadethedoctorespeciallycarefulinconductinghisphysicalexamination.Thepatientwasawarded$�.3million(Needham&Wolff,�990).Inanothercase,languagebarrierswereidentifiedasacontributingfactorinthedeathofapregnantVietnamesewoman.ThecoronerinthecaserecommendedthattheCollegeofPhysiciansandSurgeonsassesstheneedforinterpretersforpatientswhospeaklittleornoEnglish(Walton,�996).Theissueoftheinterpreter’sroleinobtainingconsentwasalsoraisedintherecentinquiryintopediatriccardiacdeathsinManitoba(Sinclair,200�).
Closelylinkedwithpatientsafety,medicalerrorsarealsoakeytargetoftheCCHSAROPs.Asnotedabove,thePEIFLHSNrecommendsthattheapplicationoftheseROPsbeconsideredwithregardtohowtheorganizationaddressesthechallengesarisingfromcommunicationbarriers.
Hospital Admissions Leeetal.(�998)indicatedthatadultswhodidnotspeakthesamelanguageastheirhealthcareproviderhada70%greaterchanceofbeingadmittedtohospitalthanpatientswhodid.Theauthorsofthestudyproposedthataprovider,whentreatingpatientswherecommunicationchallengeswerepresent,wouldbemorelikelytoadmitthemtohospitalasaprecautionarymeasure.
Diagnostic Testing Hampersetal.(�999)foundthatincaseswherealanguagebarrierexisted,patientsweremorelikelytobegivenintravenousfluidsandadmittedtohospital.Theoverallaveragechargefortestswasalsosignificantlyhigher.
Patient Follow-up SarverandBaker(2000)foundthatbothpatientswhousedaninterpreter,andthosewhodidnotuseaninterpreterbutfeltonewasneeded,weresignificantlymorelikelytobedischargedwithoutafollow-upappointment.
3 The Joint Commission, an American hospital accreditation organization, defines a sentinel event as “an unexpected occur-rence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase, “or the risk thereof ” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.” http://www.aracnet.com/~oahhs/issues/jcaho/sentnl12.htm
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Mental Health Care Canadianresearchersidentifylanguageasthemostpervasivechallengetoaccessingappropriatementalhealthservices.Studiesindicatethatevenwhenpatientshavecontactwiththehealthcaresystem,theymaydelayseekingcareformentalhealthproblemsduetolanguagebarriers,andthereforeunderutilizementalhealthservices(CanadianTaskForceonMentalHelathIssuesAffectingImmigrantsandRefugees,�988;Nyman,�99�;Trauer,�995:Startetal.,�996:Roberts&Crockford,�997).Studiesalsoindicatethatpatientswithpsychiatricconditionsandlanguagebarriersaremorelikelytoreceiveadiagnosisofseverepsychopathology(Flores,2006).Counselingprogramproviders(includingthoseinareassuchasaddictionsandfamilyviolence)oftenmakenoaccommodationforlanguageaccess.Insteadtheymayreferclientstogeneric“helping”agencies(suchasorganizationsprovidinggeneralsettlementservicestoimmigrants)thatdonothavespecializedexpertise.Thisresultsinatwo-tierlevelofservice(CanadianTaskForceonMentalHelathIssuesAffectingImmigrantsandRefugees,�988;Stevens,�993;CanadaDrugStrategy,�996).
SafetyItistritetosaythatclinician-patientcommunicationisavitalelementinthedeliveryofhealthcare.Studieshaveshownthatmorethan70%oftheinformationonwhichphysiciansbasetheirdiagnosescomesfromthehistoryandphysicalexam:
Anythingthatcompromisesthequalityofthecommunicationbetweenpatientsandphysiciansrepresentsathreattothequalityofcareprovided.Clearcommunicationishardenough,evenwithEnglish-speakingpatients,whenthereareissuesoflowliteracyoragetoconsider.WhenthepatientdoesnotspeakEnglish,communicationbecomesthatmuchmoredifficult.Ina2003studyconductedbytheCaliforniaAcademyofFamilyPhysicians,almosthalfthephysicianssurveyedwerepersonallyfamiliarwithincidentsinwhichqualityofcarewascompromisedbylanguagebarriers(Roat,2005,p.3).
Theimpactofcommunicationchallengesinhealthcaredeliverywasillustratedina2002studytitledWhat a Difference an Interpreter Can Make: Health Care Experiences of Uninsured with Limited English Proficiency (Andrulis,Goodman&Prior).Inthatstudy,27%ofthosewhoneededbutdidnotgetaninterpretersaidthattheydidnotunderstandtheinstructionsfortakingtheirmedications,comparedtoonly2%ofthosewhoeithergotaninterpreterordidnotneedone.
OutcomesStudiesindicatethatcommunicationchallengescanalsohavenegativeeffectsontreatmentoutcomes.Forexample,aU.S.studyofoutpatientdrugcomplicationsbyGandhietal.(2000)demonstratedthataprimarylanguageotherthanEnglishorSpanishwassignificantlycorrelatedtoreporteddrugcomplications.LeSon&Gershwin(�996)foundthatpatientsunabletospeakEnglishwereover�7timesmorelikelytobeintubatedthanpatientswiththesamecharacteristicswhowerefluentinEnglish.Thiswasastrongercorrelationthanwitheducationlevels,orevenbeinganactivesmoker.Asimilarstudyofpediatricpatientsalsofoundthatalanguagebarrierwasasignificantpredictorforintubation(LeSon&Gershwin,�995).Moudgil&Honeybourne(�998)founddifferencesinpatientunderstandingofthediseaseandself-management.
Patient SatisfactionPatientsatisfactionisarecognizedandwidelyusedmeasureofeffectivenessofprovider-patientcommunication.Itisalsoanoutcomeofcare.Communicationchallengeshaveadditionallybeenfoundtobeassociatedwith:increasedtimespentintheemergencydepartment(Hampersetal.,�999),decreasedgeneralsatisfactionwithcare(David&Rhee,�998),andlowersatisfactionwithanumberofnon-clinicalaspectsofcare(Madhoketal.,�992).HuandCovell(�986)foundthatthepercentageofpatientsdescribingtheircareasmorethanadequatewasalmosttwiceashighforEnglishspeakingthannonEnglishspeakingpatients.
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Patient ComplianceAreviewoftheliteraturerevealsconsistentandsignificantdifferencesinunderstandingandcompliancewhenacommunicationchallengeexists.Thismaybeduetothefactthatpatientswhohadmoredifficultyunderstandingtheirphysicianarelesslikelytofollowtreatmentdirections,andalsobecausegoodcommunicationcanbeasourceofmotivation,reassuranceandsupport,aswellasanopportunitytoclarifyexpectations(Kaplanetal.,�989).GiventheagingoftheCanadiandemographicandtheaccompanyingincreaseinchronicdiseases,theimpactofpatientnoncompliancerelatingtodiseasemanagementwillgrowovertime.Improvingcompliancethroughimprovedcommunicationoptionswillbenefitallhealthcaredeliverystakeholders.
Research ContinuesRecentstudiescontinuetoidentifycommunicationasanimportantfactorinthedeliveryofhealthcareinthreekeyareas:qualityofcare,accesstocare,andcostofcare.CynthiaE.Roat(2005,p.32),inAddressing Language Access Issues in Your Practice: A Toolkit for Physicians and Their Staff Members,providedarecentscanoftheliteraturerelatingtotheAmericanexperience:
quality of care•A200�surveyshowedthatHispanicswhospokeSpanishathomeweremorelikelytounderstandonly
“someoralittle”ofwhatthephysiciansaid,morelikelytohavequestionstheydidn’task,andmorelikelytoidentifyproblemscommunicatingwiththeirphysician.
•Primarylanguageisanindependentpredictorofpatient-reporteddrugcomplications.•PatientswhoseprimarylanguagewasnotEnglishweresignificantlylesswillingtoreturntothesame
emergencydepartmentforfuturecare,andreportedmoreoverallproblemswithcare,communication,andtesting.
•NonEnglishspeakingpatientswhohadphysicianswhospoketheirlanguagehadbettermedicationcompliance,betterappointmentcompliance,andfeweremergencydepartmentvisitsthanlimitedEnglishproficientpatientswhosephysiciansdidnotspeaktheirlanguage.
access to care•Spanishspeakingpatientsarelesslikelytoseeaphysicianforpreventativehealthcaresuchasinfluenza
vaccinationsoramammogram.•SpanishspeakingpatientsdischargedfromemergencydepartmentsarelesslikelythanEnglishspeaking
patientstounderstandtheirdiagnosis,prescribedmedications,specialinstructions,andplansforfollow-upcare.
•InanationalU.S.survey,almost20%ofSpanishspeakingrespondentsreportednotseekingcarewhenneededduetolanguagebarriers.
cost of care •Whenpatientstakelongertobeseen,
-theirhealthissuesareusuallymoreadvanced,andhencemorecostlytoaddress,-theyaremorelikelytousetheemergencydepartmentratherthanprimarycare,whichisagreatercosttothehealthsystem,-theyaremorelikelytorequiremoretesting.
•Whenpoorcommunicationsaffectqualityofcare,-thereisagreaterlikelihoodofamalpracticesuit.
•Whentherearelanguagebarriers,-pediatricpatientstendtohavelongerhospitalstays,-emergencydepartmentvisitstendtobeshorter,withfewertests,butresultinmorerepeatvisits.
Delivery of Quality Health Care…
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Language & Standards
AsillustratedinthereviewoftheCCHSA’sexistingstandardsandcriteriathatrelatetocommunicationandlanguage(AppendixA),therehasbeenalong-standing,albeittacit,acknowledgmentoftheimportanceofcommunicationchallengestoqualitycare.Therefore,thispositionpaperisnotaskingfornewstandardsorcriteria.Theyarealreadyinplace.However,thePEIFLHSNbelievesitistimeforamoreexplicitrecognitionoftheimportanceoflanguageandcommunicationintheaccreditationprocessthroughtheaccreditationdialogue.
Canadaisnottheonlyjurisdictionfacingthischallenge.Forexample,theUnitedStateshasundertakenareviewofnationalstandardsforculturallyandlinguisticallyappropriatehealthcare.Thesestandardsexplicitlyaddresstheclients’righttobilingualstafforinterpretationservices,accesstoinformationintheirownlanguage,professionalstandardsforinterpreters,andinclusionoflanguageidentifiersindatacollection.ThesestandardsarebasedonU.S.legislationandenforcementcapabilities,anddescribealevelofservicewhichiscertainlynotyetavailableforminoritylanguagespeakersinCanada(OfficeofMinorityHealth,�999).Belgiumhasmadeacommitmenttoa“culturalmediator”modelforhealthinterpretation,andisactivelypromotinganddisseminatingresearch(Verrept&Louckx,�998).InAustralia,apublicinquiryexaminedrightstointerpreterservicesinthejusticesystemandinhealthcare(Lawrie,�999).
IntheUnitedStates,theJointCommission(theaccreditationbodyforAmericanhospitals)acknowledgesthat“…alackofsensitivityandresponsivenesstothelinguisticneedsandhealthbeliefsofdifferentculturesimpactsqualityofcare,patientsafety,andpatientsatisfaction”(TheJointCommission,n.d.a).Itswebsitestates:
TheJointCommissionviewsthedeliveryofservicesinaculturallyandlinguisticallyappropriatemannerasanimportanthealthcaresafetyandqualityissue.Healthcareorganizationsareencouragedtoprovideequitablecare,treatment,andservicesacrossdiversepopulations(TheJointCommission,n.d.b).
Toaddressthisconcern,theJointCommissioninitiateda30monthresearchprojectin2004toexaminehowhospitalsprovidehealthcaretodiversepopulations.TheworkwasconcludedinJune2006withareportentitled:Hospitals, Language, and Culture: A Snapshot of the Nation (Wilson-Stronks&Galvez).Thepurposeofthisprojectwasnottodevelopnewstandardsorsetnewrequirementsforaccreditation,butrathertobetterunderstandcurrentpracticeanddeveloprecommendationsthatwouldassisthealthcareprovidersingrapplingwiththechallengesofhealthcaredeliverytoadiversepopulation.Californiaispilotingaprogramtocreatesystem-widelanguageaccess(Jameson,2006).
SarahBowen,aleadCanadianresearcherintheeffectsoflanguagebarriersonthequalityofcareobservedthatthereisaneedfordevelopmentofnationalstandardsrelatedtolanguageaccesstohealthcare.Her200�reportonlanguageaccessinhealthcarepreparedforHealthCanadamadeseveralrecommendationsthatarerelevanttothePEIFLHSNpositionpaperfortheCCHSA:
•Examinethefeasibilityofincorporating,aspartofhealthsystemdatacollection,informationonpatientproficiencyinanofficiallanguage.
•Developinitiativestopromoteawarenessoftheimportanceofprovider-patientcommunicationandtheprofessionofinterpretationwithinthehealthprofessions.Promotetrainingontheeffectsoflanguagebarriersandworkingwithinterpretersasarequiredcomponentofpre-serviceprofessionalpreparation.
•Developstrategiestopromotedisseminationofresearchonlanguageaccesstopolicymakersandhealthserviceplanners.
… to Minority Language Clients and Communities
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TheCCHSAstandardsalreadyrequirethatcommunicationchallengesbeaddressedifthestandardsandcriteriaareappliedappropriately.AppendixAtothispaperreviewsrelevantCCHSAstandards,relatedcriteriaandhowcommunicationsbarrierscanbeaddressedthroughstrengthenedCCHSAguidelines.Furthermore,becauseofthedevelopmentoftheCCHSAPatientSafetyROPspertainingtocommunication,healthcareorganizationsmustaddresscommunicationbarriersaspartoftheirsafetyculture.ThePEIFLHSNbelievesthatthisobjectivewillbeenhancediftheCCHSAadoptstherecommendationsofthispaper.
ConclusionAchievingaccreditationbytheCanadianCouncilonHealthServicesAccreditation(CCHSA)iscriticalforhealthcareorganizationstoenablethemtodemonstratetothepublicthattheyprovidequalityhealthcareservices.Equallyasimportant,accreditedorganizationsattracthighqualityhealthprofessionals.Accreditationstandardsareusedtoassessthequalityofservicesprovidedbyanorganizationandareconstructedaroundthedimensionsofquality:
•Responsiveness;•Systemcompetency;•Client/communityfocus;and,•Worklife
Anorganizationcannotaddresstheclient/communityfocusdimensionwithouttakingintoaccountanybarrierstoeffectivecommunicationsbetweenthehealthcareproviderandconsumer.Thereisasignificantbodyofresearch,includinganimpressiveamountintheCanadiancontext,asidentifiedbySarahBowen’swork,thatidentifiescommunicationchallengesashavingsignificantqualityandriskmanagementimplicationsby:
•Limitingaccess;•Inhibitingparticipationinpreventivehealthcare;•Interferingwiththeabilitytoprovideinformedconsent;•Drivinguphospitaladmissionsandunnecessarydiagnostictesting;and,•Causingmedicalerrors,
andhenceunderminingpatientsafety.Moreover,theliteraturedemonstratesthatprovidingservicesinaclient’sfirstlanguage:
•Improvesaccesstohealthservices,particularlyhealthpromotionanddiseasepreventionactivities;•Improvestheaccuracyofhealthassessment;•Enablesinterpersonalinteractionthusenhancingthetherapeuticrelationshipwhichleadstomore
positiveclinicaloutcomes;•Leadstobetterunderstandingofandadherencetotheprescribedtreatmentplan;•Improvesclientsatisfaction;•Improvesqualityofcare;and•Reducesincidenceofriskmanagementissuesinservicedelivery.
Therearemanypotentialmeansofovercomingcommunicationchallengesinhealthcaredelivery.Ratherthanbeingprescriptive,thispaperisintendedtoheightentheawarenessoftheCCHSAtotheroleofcommunicationchallengesforminoritylanguagecommunitiesinqualityandpatientsafety.
Delivery of Quality Health Care…
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ThePEIFLHSNdoesnotnecessarilyendorseorpromoteanyonestrategyoveranother.Itskeyconcernisthatorganizationsneedsupportandencouragementtodevelopstrategiesthatenableappropriateaccesstoservicesinthehealthcareconsumer’sfirstlanguage.ThisiscriticaltoensuringthatthehealthcaresystemismeetingthequalityofcareexpectedwithinCCHSAaccreditedorganizations.Tothatend,thePEIFLHSNrespectfullyasksthattheCCHSAadoptthefollowingPEIFLHSNrecommendations:
Recommendation�: StrengthenCCHSAstandardsandguidelinesrelatedtolanguage-cultureaccessforminoritylanguagecommunitiesandclients.Examplesmaybedrawnfrom
AppendixA; Recommendation2: EncourageSelf-AssessmentTeamstoreviewtheircompositiontoreflectthe
communicationneedsofthecommunity,clientsandfamiliesinthedeliveryofhealthcare.Forexample,FrenchlanguageserviceproviderscouldbeincludedasmembersofSelf-AssessmentTeams;
Recommendation3: Developindicatorsorothermeansofevidencerelatedtolanguageaccess.Examplesmay
bedrawnfromAppendixC;
Recommendation4: Identifytheaccreditationstandardswhichrepresentthehighestpotentialrisktopatientsduetocommunicationchallenges.Anexamplemightincludeinformedconsent.
ThePEIFLHSNbelievesthattheaccreditationmodelforaddressingcommunicationchallengesforminoritylanguagecommunitieskeepsthefocusonthemostimportantaspectsofhealthcare:qualityandsafety.Theintentisnottoforceorganizationstoadoptanysingleformulaforachievingthesevalues.Instead,achievingqualityandpatientsafety(andaddressinglanguagebarriers)requirestheorganizationalintegrationofthesevaluesandtheinstillingofasustainableprocessofcreatingandnurturingaculturethatsupportsthesevalues.Thiswillresultinimprovedservicesandoutcomesforeveryone.
… to Minority Language Clients and Communities
�6
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LEADERSHIP AND PARTNERSHIP (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�.0 Addressingneeds
Theorganizationanticipatesandrespondstothecommunity’schangingneedsandhealthstatus.
TheFrench-speakingcommunityhasaneedforaccesstohealthcareinitsprimarylanguage.
�.� Communityprofile Shouldacknowledgelanguageaspectofdemographicsforcatchmentareaandidentifycommunicationneeds.
�.2 Maintainsinformation •Sharesinformationwithcommunity.
TrackingthestatisticsoftheFrenchlanguagepopulationshouldbeanongoingexerciseOrganizationslikePEIFLHSNshouldbeconsideredpartnersinthisinformationprocess.
2.0 Havingapositiverelationshipwiththecommunity.
Workingcollaboratively,theorganizationenhancestheefficiencyandeffectivenessofitshealthservicesinmeetingtheneedsofclients.
2.� Communicatewithhard-to-reachpopulations.
SpecificactionoutlinedinCCHSAshouldbenotedinaccreditationreport.
2.2. Theorganization’scommunicationactivitiesandstrategiesareeffective.
WorkwithorganizationslikethePEIFLHSNtodevelopmeasurementtools.
2.3 Organizationformslinkagesandpartnershipsacrosscontinuumofsectors.
WorkwithorganizationslikethePEIFLHSN,suchasinvolvingtheseorganizationsinPatientSafetyAdvisoryCouncils.
3.0 Promoteongoingcommunitydevelopment.
3.� Supportingactivitiesthatinformandeducatethecommunity.
InformationandeducationneedtobeinFrenchforFrench-speakingpopulation.
APPENDIX ACCHSA Standards Relating To Language Access
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
20
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
LEADERSHIP AND PARTNERSHIP (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
4.0 Meetingtheorganization’smandate
Theorganization’smissiongivesitdirection.
4.� MissionStatementhasinputfromcommunity.
ThisrequiresdialoguewithFrench-speakingcommunity.
4.2 Missiondescribeswhomtheorganizationserves.
NeedstoreflectpresenceofFrench-speakingcommunity.
5.0 Beingaccountabletoallstakeholders.
Organizationiseffectivelyandefficientlygoverned.
Whereaboardispresent,itsmembershipshouldreflectthediversityofthecommunityserved.
5.6 Sharesinformationwithcommunity. Informationneedstobecommunicatedinappropriatelanguagesandinaccessiblevocabulary.
6.0 Beingethical
Theorganizationdeliversservicesandmakesdecisionsinaccordancewithitsvalues,andwithitsowncodeofethicsorotherrecognizedcodesofethics.
Ethicalrequirementsforconsenttotreatment,equityofaccessrequireaddressinglanguageaccessissues.
7.0 Havingacleardirection
Theorganizationhasacleardirectionandachievesthedesiredresults.
Thestrategicplanshouldaddresshowcommunicationneedswillbeaddressed.
9.0 Appropriateallocationofresources. Thisshouldincludelanguageaccessresources.
9.� Consideringethics,values,socialcostsandbenefits.
9.2 Reviewingplanningpriorities.
�0.0Managingrisk
Thegoverningbodyandmanagerspreventandmanageanyriskstotheorganization.
2�
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
LEADERSHIP AND PARTNERSHIP (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�0.� Organizationidentifies,assessesandmanagesrisk.
•Considerethics,values,socialcostsand benefitswhenmakingdesicionsabout howtomanagerisk.
Researchshowsthatlanguagebarrierscreaterisks.
�0.2 Governingbodyandmanagersactivelysupportriskmanagementpractices.
�0.5 Organizationminimizesrisks. Howisthisdonewithrespecttolanguageaccessissues?
��.0 Organization’sfinancialresourcesareprotectedandcontrolled.
�2.0 Contractedservicesaredeliveredaccordingtothetermssetoutinthecontract.
�6.0Beingalearningorganizationandachievingpositiveoutcomes.
Theorganizationhasaclearlydefinedandcoordinatedqualityimprovementsystemtocontinuallymonitor,evaluate,andimprovequality.
Islanguageaccessaddressedintheirqualityimprovementplans?
�6.2 Provideenoughresourcesandtrainingtosupportqualityimprovementactivities.
�7.0 Theorganizationachievesthebestpossibleresultsoroutcomes.
Researchsuggeststhatlanguagebarriershavenegativeimpactsonoutcomes.Clientsatisfactionsurveysshouldincludeacommunicationandlanguageofaccesscomponent.
�7.2 Involvestaff,clients,otherorganizations,andthecommunity.
�7.3 Useresearchandbestpracticeinformationtoimprovemanagementpracticesandtheorganization’sperformance.
Isorganizationawareofworkbeingdoneonlanguageaccessissuesandqualityofcareandriskmanagement?
22
Appendix A
ENVIRONMENT (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�.0 Providingasuitableenvironment.
Theorganization’sphysicalenvironmentcontributestothewell-beingofclients,staff,andvisitors.
�.� Allsignsandsymbolsmustconsiderlanguageandliteracy.
ImprovedsignageinFrench.
3.0 Minimizingadverseevents. Theorganizationminimizespotentialhazardsandriskswherevertheclientsreceiveservices.
3.� Teachclientsandfamiliesaboutpotentialsafetyhazards,infectioncontrol,safeandproperuseofequipment,suppliesandmedicaldevices,howtocontacttheorganizationinanemergency.
Thisrequirescommunicationinappropriatelanguage.
5.0 Theorganizationpreventsandcontrolsinfections.
5.5 Theorganizationworkswithothersandthecommunitytopromptlydetectandrespondtothepresenceofnewandresistantvirusesandbacteria.
ThisrequirestheabilitytocommunicatewiththeFrench-speakingcommunity.
5.9 Theorganizationleads,participatesin,andsupportsactivitiesthatteachthecommunityhowtoreducetheriskofinfectionandpreventinfectionsfromspreadinginthecommunity.
ThisrequirestheabilitytocommunicatewiththeFrench-speakingcommunity.
8.0 Beingalearningorganizationandachievingpositiveoutcomes.
8.� Regularlyevaluatesandimprovesitsprocessesbyanalyzingclientandstaffsatisfaction.
Researchfindscorrelationbetweenlanguageofaccessandclientsatisfaction.
* Usually abbreviated or summarized to maintain focus on language access.
23
HUMAN RESOURCES (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�.0Addressingneeds
Theorganization’sdocumentedhumanresourcesplananticipatesandrespondstocurrentandfuturehumanresourcesneeds.
�.�Regularlyassessescurrentandfuturehumanresourcesneedsintheareasofstaffing,competenceandcomplyingwithlegislation.
Humanresourceplanshouldacknowledgeservicedeliverylanguageneeds.
�.2Theplanningprocessaddressesclients’needsandexpectations,methodsusedtodeliverservices,availableresources.
Researchfindscorrelationbetweenlanguageofaccessandclientsatisfaction.Humanresourceplanshouldacknowledgeservicedeliverylanguageneeds.
�.3Theorganizationinvolvesclientsinplanninganddevelopinghumanresourcesprocessesorservices.
Organizationshouldnotassumeitunderstandsclients’needs,butshouldengageinproductivedialoguewithclientcommunities.
�.4Theorganizationhaslinkagesandpartnershipswithotherorganizations.
2.0Beingalearningorganizationandachievingpositiveoutcomes.
Theorganizationregularlyevaluatesandimproveshumanresourceprocessestoachievethedesiredresults.
Staffshouldbekeptapprisedofresearchrelatingtoimpactofcommunicationschallengesonqualityofcareandpatientsafety.
3.0Havingtherightpeople
Theorganizationhasadequatenumbersofqualifiedstaff,independentpractitioners,andvolunteerstoprovidequalityservices.
PEIFLHSNtakesthepositionthatqualificationsshouldalsoincludelanguageabilitiestomeettheneedsofclients.
3.�Theorganizationselectsandrecruitsstaffbasedoncommunityneeds,statisticsandtrends.
6.0Enhancingperformance
Theorganization’sleaders,staff,andvolunteersdemonstratecompetence.
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
24
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
INFORMATION MANAGEMENT (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�.0 Addressingneeds
Theorganization’sinformationmanagementprocessesmeetcurrentandfutureinformationneedsandenhanceitsperformance.
�.� Theorganizationregularlyassessescurrentandfutureinformationneedssothatitcandeliverclientservices,andprovideappropriateeducationtousers,clients,andfamilies.
3.0 Supportingevidence-baseddecisionmaking
Theorganizationcollectsandreportsrelevantdataandinformationinawaythatirtimely,efficient,accurate,andcomplete.
Needsassessmentshouldincludepreferredlanguageofaccess,availabilityofalternatecommunicationresources(includingqualifiedinterpreter)forqualityimprovementanalysisandevaluationatthecommunitylevelandattheindividuallevel.
5.0 Staff,serviceprovides,clients,andfamilieshaveaccesstoinformationtosupportdecision-makingandimproveknowledge.
Thisrequiresinformationtobeavailableinappropriatelanguage.
5.3 Theorganizationmakeseducationmaterial,referencematerial,andresearchinformationavailabletostaff,clients,andfamilies.
HUMAN RESOURCES (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
6.2Theorganizationencourages,supports,andprovidesongoingeducation,training,anddevelopmenttocarryoutqualityimprovementactivities.
Doesorganizationsupportofficiallanguagetraining?
25
Appendix A
ACUTE CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�.0 Beingalearningorganizationandachievingpositiveoutcomes.
Theteamcontinuallyplansanddesignsitsservicestomeetthecurrentandfutureneedsofthepopulationsitserves,andtoachievethebestpossibleoutcomes.
ThisrequiresunderstandingofneedforFrenchlanguageresources,clientneedsforaccesstoappropriatelanguageforservicedelivery,andcorrelationbetweenlanguagebarriersandoutcomes.
2.0 Theteamusesresearch,evidence,andbestpracticeinformationtodevelopandimproveitsservices.
2.2 Informclientsaboutresearchactivitiesthatrelatetotheirserviceneeds,andhelpclientsaccesstheseactivitiesiftheywish.
Thisrequiresinformationtobeavailableinappropriatelanguage.
3.0 Theteammonitorsandimprovesthequalityofitsservicestoachievethebestpossibleoutcomes.
3.2 Whenevaluatingitsservices,theteaminvolvesclients,families,andotherorganizations.
Involvementrequiresstaffwhocancommunicatewithclients.
4.0 Achievingwellness
Theteam,workingwiththecommunity,promoteshealth,preventsordetectshealthproblemsearly,andmaximizesthewell-beingofthoseitserves.
Primaryhealthpromotionrequiresabilitytocommunicateinlanguageoftheaudience.
5.0 Beingresponsive
Theteam’sservicesareintegratedandcoordinatedtoensurecontinuityofserviceforthepopulationsitserves.
5.3 Theteamisawareofandusescomplementaryservicesofotherprovidersandorganizations;makingiteasierforclientstomovethroughtheservicesystem.
Istheorganizationusinglanguageresourcesavailablefromcomplementaryprovidersandorganizationstoaddresslanguagebarriers?
* Usually abbreviated or summarized to maintain focus on language access.
26
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
ACUTE CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
6.0 Theclients’firstcontactswiththeteamleadtothebestdecisionaboutservices.
Languagebarriersmustbeaddressed.Researchindicatesthatlanguagebarriersinhibitordelayfirstcontact.Researchalsosupportsneedforclearcommunicationinmakingappropriatecarechoices.
6.� Allpotentialclients,providers,andreferringorganizationscanaccesstheteam’sservices.
•Theteamidentifiesandremovesbarriers thatpreventclients,families,providers, andorganizationsfromaccessingservices.
Thisshouldincludeexplicitassessmentoflanguagebarriersandhowtoremovethem.
6.3 Theteamgivespotentialclients,families,providers,andorganizationssimple,writteninformationabouttherangeofservicesandtheircost,effectivenessandoutcomes,andalternatives
Tobeusefulthisinformationmustbeprovidedinappropriatelanguage.
6.4 Theteam’sprocessfordecidingwhethertoofferservicestopotentialclientsandfamiliesincludes
•Obtaining,withconsent,thepotential client’shistory. •Identifyingandaddressingclient’s immediateandurgentneeds.
•Consentismeaninglessiftheclientdoesnotunderstandwhatisbeingasked.
•Needsidentificationshouldincludelanguageofserviceneeds.
6.6 Whentheteamcannotmeettheneedsofpotentialclients,providers,andreferringorganizations,itexplainsthereasonswhy.
Suchexplanationsneedtobecommunicatedinappropriatelanguage.
7.0 Addressingneeds
Theteamaccuratelyandappropriatelyassessesitsclients.
7.� Theteamdeterminestheassessmentmethod,scopeandintensitybyconsideringanumberoffactorsincludinglanguage
•Theassessmentiscarriedoutwith adequateresources.
Languageisanessentialpartoftheassessmentprocess.Withadequatelanguageandcommunicationresources.
7.2 Assessmentofclients’strengths,abilities,needs,andforeseeablerisks,includesclients’abilitytocommunicateandcareforthemselves.
Onalargerscale,theabilitytocommunicateisanessentialpartoftheassessmentprocess.
27
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
ACUTE CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
7.3 Theteamsharestheassessmentresultswithclientsandfamiliesinaclearandeasy-to-understandway.
Thisrequiresthatlanguageaccessbeavailable.
7.4 Theteamhasprocessesforassessingandmanagingtheclient’spain.
Researchindicatesthatlanguagebarrierscanleadtoanundermanagementofpainissues.
9.0 Empoweringclients
Theteamworkswithclientsandfamiliestohelpthemactivelyparticipateinservicedeliveryandcarryouttheirresponsibilities.
Informationmustbeinappropriatelanguage.Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
9.� Theteamregularlygivesclientsandfamiliestimely,complete,andaccurateinformation.
Thissteprequirestheinformationbeunderstood.
9.2 Theteamprovidesappropriateeducationtoclientsandfamilies.
•Theeducationprocessconsidersthe clients’andfamilies’languageand ensuresthattheyunderstandthe information.
Thisrequiresanunderstanding&availabilityoftheappropriatelanguageforcommunicatingtheinformation.
9.3 Theteamprovidesappropriateemotionalsupportandcounselingtohelpclientsandfamilies.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
9.4 Theteamworkswithclientsandfamiliestocarryouttheirresponsibilitiesby
•Helpingclientsunderstandwhatthey areresponsiblefor. •Teachingpositivebehaviour.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.0 Theteamobtainsinformedconsentbeforestartinganyserviceorintervention.
Informedconsentrequiresthattheclientunderstandthechoicesandtheimplicationsofthedecisions.
�0.2 Theteamhasaprocessfordeterminingwhetherclientsarecapableofgivingtheirinformedconsent.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.3 Theteamobtainsclients’informedconsentbyverifyingthattheclientunderstandsalltheverbalandwritteninformation.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
28
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
ACUTE CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
��.0 Theteamprotectsandpromotestherightsofitsclientsandfamilies.
��.� Theteamisawareofandrespectstherightsofclientsandfamiliestotakepartinallaspectsoftheirserviceandmakepersonalchoices.
Howistheteamrespectingthisinlightoflanguageaccess?
��.3 Theteamcontinuallyeducatesitsclientsandfamiliesabouttheirrightsandhelpsthemexercisetheirrights
Howistheteamrespectingthisinlightoflanguageaccess?
��.5 Theteamhasaprocessforprocuringanddonatingorgansandtissuesthatincludesmakingthefamiliesorclientsawareoftheoptiontodonate.
Howistheteamrespectingthisinlightoflanguageaccess?
��.6 Theteamhasaprocessforhandlingclients’andfamilies’complaintsthatincludesexplainingtoclientshowtheycanfileacomplaint.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�2.0Settinggoalsandmonitoringachievements
Theteamhasanappropriateandintegratedserviceplanforeachclient.
�2.� Theteamworkswithclientsandfamiliestosettheclients’goalsandexpectedresults.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�2.4 Theteam’sclientsachievetheirsetgoalsandexpectedresults
•Theteamidentifiesandaddressesany barriersthatarepreventingclientsfrom reachingtheirsetgoalsandexpected results.
Languagebarriersshouldbepartofthisassessment.
�3.0 Deliveringservices
Theteamdeliverssafe,efficientandeffectiveservices.
Researchindicatesthatlanguagebarrierscanunderminethesafety,efficiencyandeffectivenessofservices.
�3.3 Theteamtakesallreasonablestepstokeepclientssafefrompreventableadverseevents,injuries,orinfectionsbyeducatingclientsandfamiliesonpreventingrisks.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
29
Appendix A
AMBULATORY CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�.0 Beingalearningorganizationandachievingpositiveoutcomes.
Theteamcontinuallyplansanddesignsitsservicestomeetthecurrentandfutureneedsofthepopulationsitserves,andtoachievethebestpossibleoutcomes.
ThisrequiresunderstandingofneedforFrenchlanguageresources,clientneedsforaccesstoappropriatelanguageforservicedelivery,andcorrelationbetweenlanguagebarriersandoutcomes.
2.0 Theteamusesresearch,evidence,andbestpracticeinformationtodevelopandimproveitsservices.
2.2 Informclientsaboutresearchactivitiesthatrelatetotheirserviceneeds,andhelpclientsaccesstheseactivitiesiftheywish.
Thisrequiresinformationtobeavailableinappropriatelanguage.
3.0 Theteammonitorsandimprovesthequalityofitsservicestoachievethebestpossibleoutcomes.
3.2 Whenevaluatingitsservices,theteaminvolvesclients,families,andotherorganizations.
Involvementrequiresstaffwhocancommunicatewithclients.
* Usually abbreviated or summarized to maintain focus on language access.
ACUTE CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�3.8 Theteammeetstheuniqueneedsofdyingclientsbyhelpingclientsmanagetheirpainandsymptoms.
Researchindicatesthatlanguagebarriersaffectpalliativecare.
�4.0 Theuseofmedicationsandothertherapeutictechnologiesissafe,efficient,effective,andpromotesthebestpossiblequalityoflife.
�4.2 Theteamgivesitsclientswrittenandverbalinformationaboutthemedicationsorothertherapeutictechnologiesthatareavailable.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
30
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
AMBULATORY CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
4.0 Achievingwellness
Theteam,workingwiththecommunity,promoteshealth,preventsordetectshealthproblemsearly,andmaximizesthewell-beingofthoseitserves.
Primaryhealthpromotionrequiresabilitytocommunicateinlanguageoftheaudience.
5.0 Beingresponsive
Theteam’sservicesareintegratedandcoordinatedtoensurecontinuityofserviceforthepopulationsitserves.
5.3 Theteamisawareofandusescomplementaryservicesofotherprovidersandorganizations;makingiteasierforclientstomovethroughtheservicesystem.
Istheorganizationusinglanguageresourcesavailablefromcomplementaryprovidersandorganizationstoaddresslanguagebarriers?
6.0 Theclients’firstcontactswiththeteamleadtothebestdecisionaboutservices
Languagebarriersmustbeaddressed.Researchindicatesthatlanguagebarriersinhibitordelayfirstcontact.Researchalsosupportsneedforclearcommunicationinmakingappropriatecarechoices.
6.� Allpotentialclients,providers,andreferringorganizationscanaccesstheteam’sservices.
•Theteamidentifiesandremovesbarriers thatpreventclients,families,providers, andorganizationsfromaccessingservices.
Thisshouldincludeexplicitassessmentoflanguagebarriersandhowtoremovethem.
6.3 Theteamgivespotentialclients,families,providers,andorganizationssimple,writteninformationabouttherangeofservicesandtheircost,effectivenessandoutcomes,andalternatives.
Tobeusefulthisinformationmustbeprovidedinappropriatelanguage.
6.4 Theteam’sprocessfordecidingwhethertoofferservicestopotentialclientsandfamiliesincludes
•obtaining,withconsent,thepotential client’shistory. •identifyingandaddressingclient’s immediateandurgentneeds.
•Consentismeaninglessiftheclientdoesnotunderstandwhatisbeingasked.
•Needsidentificationshouldincludelanguageofserviceneeds.
3�
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
AMBULATORY CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
6.6 Whentheteamcannotmeettheneedsofpotentialclients,providers,andreferringorganizations,itexplainsthereasonswhy.
Suchexplanationsneedtobecommunicatedinappropriatelanguage.
7.0 Addressingneeds
Theteamaccuratelyandappropriatelyassessesitsclients.
7.� Theteamdeterminestheassessmentmethod,scopeandintensitybyconsideringanumberoffactorsincludinglanguage.
•Theassessmentiscarriedoutwith adequateresources.
Languageisanessentialpartoftheassessmentprocess.Withadequatelanguageandcommunicationresources.
7.2 Assessmentofclients’strengths,abilities,needs,andforeseeablerisks,includesclients’abilitytocommunicateandcareforthemselves.
Onalargerscale,theabilitytocommunicateisanessentialpartoftheassessmentprocess.
7.3 Theteamsharestheassessmentresultswithclientsandfamiliesinaclearandeasy-to-understandway.
Thisrequiresthatlanguageaccessbeavailable.
7.4 Theteamhasprocessesforassessingandmanagingtheclient’spain.
Researchindicatesthatlanguagebarrierscanleadtoanundermanagementofpainissues.
9.0 Empoweringclients
Theteamworkswithclientsandfamiliestohelpthemactivelyparticipateinservicedeliveryandcarryouttheirresponsibilities.
Informationmustbeinappropriatelanguage.Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
9.� Theteamregularlygivesclientsandfamiliestimely,complete,andaccurateinformation.
Thissteprequirestheinformationbeunderstood.
9.2 Theteamprovidesappropriateeducationtoclientsandfamilies.
•Theeducationprocessconsidersthe clients’andfamilies’languageand ensuresthattheyunderstandtheinformation.
Thisrequiresanunderstanding&availabilityoftheappropriatelanguageforcommunicatingtheinformation.
9.3 Theteamprovidesappropriateemotionalsupportandcounselingtohelpclientsandfamilies.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
32
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
AMBULATORY CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
9.4 Theteamworkswithclientsandfamiliestocarryouttheirresponsibilitiesby:
•helpingclientsunderstandwhattheyare responsiblefor. •teachingpositivebehaviour.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.0 Theteamobtainsinformedconsentbeforestartinganyserviceorintervention.
Informedconsentrequiresthattheclientunderstandthechoicesandtheimplicationsofthedecisions.
�0.2 Theteamhasaprocessfordeterminingwhetherclientsarecapableofgivingtheirinformedconsent.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.3 Theteamobtainsclients’informedconsentbyverifyingthattheclientunderstandsalltheverbalandwritteninformation.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
��.0 Theteamprotectsandpromotestherightsofitsclientsandfamilies.
��.� Theteamisawareofandrespectstherightsofclientsandfamiliestotakepartinallaspectsoftheirserviceandmakepersonalchoices.
Howistheteamrespectingthisinlightoflanguageaccess?
��.3 Theteamcontinuallyeducatesitsclientsandfamiliesabouttheirrightsandhelpsthemexercisetheirrights.
Howistheteamrespectingthisinlightoflanguageaccess?
��.5 Theteamhasaprocessforprocuringanddonatingorgansandtissuesthatincludesmakingclientsawareoftheoptiontodonate.
Howistheteamrespectingthisinlightoflanguageaccess?
��.6 Theteamhasaprocessforhandlingclients’andfamilies’complaintsthatincludesexplainingtoclientshowtheycanfileacomplaint.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�2.0Settinggoalsandmonitoringachievements
Theteamhasanappropriateandintegratedserviceplanforeachclient.
33
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
COMMUNITY HEALTH SERVICES (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�.0 Beingalearningorganizationandachievingpositiveoutcomes.
Theteamcontinuallyplansanddesignsitsservicestomeetthecurrentandfutureneedsofthepopulationsitserves,andtoachievethebestpossibleoutcomes.
ThisrequiresunderstandingofneedforFrenchlanguageresources,clientneedsforaccesstoappropriatelanguageforservicedelivery,andcorrelationbetweenlanguagebarriersandoutcomes.
AMBULATORY CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�2.� Theteamworkswithclientsandfamiliestosettheclients’goalsandexpectedresults.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�2.4 Theteam’sclientsachievetheirsetgoalsandexpectedresults:
•Theteamidentifiesandaddressesany barriersthatarepreventingclientsfrom reachingtheirsetgoalsandexpected results.
Languagebarriersshouldbepartofthisassessment.
�3.0Deliveringservices
Theteamdeliverssafe,efficientandeffectiveservices.
Researchindicatesthatlanguagebarrierscanunderminethesafety,efficiencyandeffectivenessofservices.
�3.3 Theteamtakesallreasonablestepstokeepclientssafefrompreventableadverseevents,injuries,orinfectionsbyeducatingclientsandfamiliesonpreventingrisks.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
�4.0 Theuseofmedicationsandothertherapeutictechnologiesissafe,efficient,effective,andpromotesthebestpossiblequalityoflife.
�4.2 Theteamgivesitsclientswrittenandverbalinformationaboutthemedicationsorothertherapeutictechnologiesthatareavailable.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
34
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
COMMUNITY HEALTH SERVICES (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
2.0 Theteamusesresearch,evidence,andbestpracticeinformationtodevelopandimproveitsservices.
2.2 Informclientsaboutresearchactivitiesthatrelatetotheirserviceneeds,andhelpclientsaccesstheseactivitiesiftheywish.
Thisrequiresinformationtobeavailableinappropriatelanguage.
3.0 Theteammonitorsandimprovesthequalityofitsservicestoachievethebestpossibleoutcomes.
3.2 Whenevaluatingitsservices,theteaminvolvesclients,families,andotherorganizations.
Involvementrequiresstaffwhocancommunicatewithclients.
4.0 Beingresponsive
Theteam’sservicesareintegratedandcoordinatedtoensurecontinuityofserviceforthepopulationsitserves.
4.3 Theteamisawareofandusescomplementaryservicesofotherprovidersandorganizations;makingiteasierforclientstomovethroughtheservicesystem.
Istheorganizationusinglanguageresourcesavailablefromcomplementaryprovidersandorganizationstoaddresslanguagebarriers?
5.0 Theclients’firstcontactswiththeteamleadtothebestdecisionaboutservices.
Languagebarriersmustbeaddressed.Researchindicatesthatlanguagebarriersinhibitordelayfirstcontact.Researchalsosupportsneedforclearcommunicationinmakingappropriatecarechoices.
5.� Allpotentialclients,providers,andreferringorganizationscanaccesstheteam’sservices.
•Theteamidentifiesandremovesbarriers thatpreventclients,families,providers, andorganizationsfromaccessing services.
Thisshouldincludeexplicitassessmentoflanguagebarriersandhowtoremovethem.
5.3 Theteamgivespotentialclients,families,providers,andorganizationssimple,writteninformationabouttherangeofservicesandtheircost,effectivenessandoutcomes,andalternatives
Tobeusefulthisinformationmustbeprovidedinappropriatelanguage.
35
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
COMMUNITY HEALTH SERVICES (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
5.4 Theteam’sprocessfordecidingwhethertoofferservicestopotentialclientsandfamiliesincludes
•obtaining,withconsent,thepotential client’shistory. •identifyingandaddressingclient’s immediateandurgentneeds
•Consentismeaninglessiftheclientdoesnotunderstandwhatisbeingasked
•Needsidentificationshouldincludelanguageofserviceneeds.
5.6 Whentheteamcannotmeettheneedsofpotentialclients,providers,andreferringorganizations,itexplainsthereasonswhy.
Suchexplanationsneedtobecommunicatedinappropriatelanguage.
6.0 Addressingneeds
Theteamaccuratelyandappropriatelyassessesitsclients.
6.� Theteamdeterminestheassessmentmethod,scopeandintensitybyconsideringanumberoffactorsincludinglanguage.
•Theassessmentiscarriedoutwith adequateresources.
Languageisanessentialpartoftheassessmentprocess.Withadequatelanguageandcommunicationresources.
6.3 Theteamsharestheassessmentresultswithclientsandfamiliesinaclearandeasy-to-understandway.
Therequiresthatlanguageaccessbeavailable.
8.0 Empoweringclients
Theteamworkswiththecommunitytosupportthedevelopmentofthecommunity’scapacitiestoimproveitsownhealthandwell-being.
Thisrequiresthatlanguageaccessbeavailablethatisappropriateforcommunityserved.
8.� Theteamworksasapartnerwiththecommunitysharinginformation,knowledge,skillsandresources.
Whichrequiresworkinginappropriatelanguage.
8.2 Theteamsupportsthecommunity’sinvolvementinhealthandwellnessissues.
Whichrequiresworkinginappropriatelanguage.
8.3 Theteamsupportscommunityactionstoimprovehealthandwellness.
Whichrequiresworkinginappropriatelanguage.
36
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
COMMUNITY HEALTH SERVICES (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
9.0 Theteamworkswithclientsandfamiliestohelpthemactivelyparticipateinservicedeliveryandcarryouttheirresponsibilities.
Informationmustbeinappropriatelanguage.
9.� Theteamregularlygivesclientsandfamiliestimely,complete,andaccurateinformation.
Thissteprequirestheinformationbeunderstood.
9.2 Theteamprovidesappropriateeducationtoclientsandfamilies.
•Theeducationprocessconsidersthe clients’andfamilies’languageand ensuresthattheyunderstandthe information.
Thisrequiresanunderstanding&availabilityoftheappropriatelanguageforcommunicatingtheinformation.
9.3 Theteamprovidesappropriateemotionalsupportandcounselingtohelpclientsandfamilies.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
9.4 Theteamworkswithclientsandfamiliestocarryouttheirresponsibilitiesby:
•helpingclientsunderstandwhattheyare responsiblefor. •teachingpositivebehaviour.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.0 Theteamobtainsinformedconsentbeforestartinganyserviceorintervention.
Informedconsentrequiresthattheclientunderstandthechoicesandtheimplicationsofthedecisions.
�0.2 Theteamhasaprocessfordeterminingwhetherclientsarecapableofgivingtheirinformedconsent.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.3 Theteamobtainsclients’informedconsentbyverifyingthattheclientunderstandsalltheverbalandwritteninformation.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
��.0 Theteamprotectsandpromotestherightsofitsclientsandfamilies.
��.� Theteamisawareofandrespectstherightsofclientsandfamiliestotakepartinallaspectsoftheirserviceandmakepersonalchoices.
Howistheteamrespectingthisinlightoflanguageaccess?
37
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
COMMUNITY HEALTH SERVICES (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
��.3 Theteamcontinuallyeducatesitsclientsandfamiliesabouttheirrightsandhelpsthemexercisetheirrights.
Howistheteamrespectingthisinlightoflanguageaccess?
��.5 Theteamhasaprocessforhandlingclients’andfamilies’complaintsthatincludesexplainingtoclientshowtheycanfileacomplaint.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�2.0Settinggoalsandmonitoringachievements.
Theteamhasanappropriateandintegratedserviceplanforeachclient.
�2.� Theteamworkswithclientsandfamiliestosettheclients’goalsandexpectedresults.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�2.4 Theteam’sclientsachievetheirsetgoalsandexpectedresults.
•Theteamidentifiesandaddressesany barriersthatarepreventingclientsfrom reachingtheirsetgoalsandexpectedresults.
Languagebarriersshouldbepartofthisassessment.
�3.0Achievingwellness
Theteam,workingwiththecommunity,promoteshealth,preventsordetectshealthproblemsearly,andmaximizesthewell-beingofthoseitserves.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�3.2 Theteam,withitspartners,carriesoutactivitiestoreducetheriskandonsetofhealthproblems,andmaximizesthewell-beingofthepopulationitserves,providingongoinginformationandeducationtoclients,otherproviders,otherorganizations,andthepublicaboutcurrentandemerginghealthissues.
Partnershiprequireseffectivecommunication.
�4.0 Withitscommunitypartners,theteamprotectsthecommunityagainsthealthhazards.
Partnershiprequireseffectivecommunication.
38
Appendix A
CRITICAL CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�.0 Beingalearningorganizationandachievingpositiveoutcomes.
Theteamcontinuallyplansanddesignsitsservicestomeetthecurrentandfutureneedsofthepopulationsitserves,andtoachievethebestpossibleoutcomes.
ThisrequiresunderstandingofneedforFrenchlanguageresources,clientneedsforaccesstoappropriatelanguageforservicedelivery,andcorrelationbetweenlanguagebarriersandoutcomes.
2.0 Theteamusesresearch,evidence,andbestpracticeinformationtodevelopandimproveitsservices.
2.2 Informclientsaboutresearchactivitiesthatrelatetotheirserviceneeds,andhelpclientsaccesstheseactivitiesiftheywish.
Thisrequiresinformationtobeavailableinappropriatelanguage.
* Usually abbreviated or summarized to maintain focus on language access.
COMMUNITY HEALTH SERVICES (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�4.3 Theorganizationhasprocessesformanagingandsharinginformationaboutthehealthhazardsthatexistinthecommunity.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
�5.0Deliveringservices
Theteamdeliverssafe,efficientandeffectiveservices.
Researchindicatesthatlanguagebarrierscanunderminethesafety,efficiencyandeffectivenessofservices.
�5.3 Theteamtakesallreasonablestepstokeepclientssafefrompreventableadverseevents,injuriesorinfectionsbyeducatingclientsandfamiliesonpreventingrisks.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
�6.0 Theuseofmedicationsissafe,efficient,effective,andpromotesthebestpossiblequalityoflife.
�6.2 Theteamgivesitsclientswrittenandverbalinformationaboutthemedicationsthatareavailable.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
39
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
CRITICAL CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
3.0 Theteammonitorsandimprovesthequalityofitsservicestoachievethebestpossibleoutcomes.
3.2 Whenevaluatingitsservices,theteaminvolvesclients,families,andotherorganizations.
Involvementrequiresstaffwhocancommunicatewithclients.
4.0 Achievingwellness
Theteam,workingwiththecommunity,promoteshealth,preventsordetectshealthproblemsearly,andmaximizesthewell-beingofthoseitserves.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
4.2 Theteam,withitspartners,carriesoutactivitiestoreducetheriskandonsetofhealthproblems,andmaximizesthewell-beingofthepopulationitserves,providingongoinginformationandeducationtoclients,otherproviders,otherorganizations,andthepublicaboutcurrentandemerginghealthissues.
Partnershiprequireseffectivecommunication.
5.0 Beingresponsive
Theteam’sservicesareintegratedandcoordinatedtoensurecontinuityofserviceforthepopulationsitserves.
6.0 Theclients’firstcontactswiththeteamleadtothebestdecisionaboutservices.
Languagebarriersmustbeaddressed.Researchindicatesthatlanguagebarriersinhibitordelayfirstcontact.Researchalsosupportsneedforclearcommunicationinmakingappropriatecarechoices.
6.� Allpotentialclients,providers,andreferringorganizationscanaccesstheteam’sservices.
•Theteamidentifiesandremovesbarriers thatpreventclients,families,providers, andorganizationsfromaccessingservices.
Thisshouldincludeexplicitassessmentoflanguagebarriersandhowtoremovethem.
40
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
CRITICAL CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
6.3 Theteamgivespotentialclients,families,providers,andorganizationssimple,writteninformationabouttherangeofservicesandtheircost,effectivenessandoutcomes,andalternatives.
Tobeusefulthisinformationmustbeprovidedinappropriatelanguage.
6.4 Theteam’sprocessfordecidingwhethertoofferservicestopotentialclientsandfamiliesneedstobeadjustedforclientsandfamilieswithdiverseneedssuchaslanguageandculture.
6.6 Whentheteamcannotmeettheneedsofpotentialclients,providers,andreferringorganizations,itexplainsthereasonswhy.
Suchexplanationsneedtobecommunicatedinappropriatelanguage.
7.0 Addressingneeds
Theteamaccuratelyandappropriatelyassessesitsclients.
7.� Theteamdeterminestheassessmentmethod,scopeandintensitybyconsideringanumberoffactorsincludinglanguage.
•Theassessmentiscarriedoutwith adequateresources.
Languageisanessentialpartoftheassessmentprocess.Withadequatelanguageandcommunicationresources.
7.3 Theteamsharestheassessmentresultswithclientsandfamiliesinaclearandeasy-to-understandway.
Thisrequiresthatlanguageaccessbeavailable.
7.4 Theteamhasprocessesforassessingandmanagingtheclient’spain.
Researchindicatesthatlanguagebarriersaffectmanagementofpain.
9.0 Empoweringclients
Theteamworkswithclientsandfamiliestohelpthemactivelyparticipateinservicedeliveryandcarryouttheirresponsibilities.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
9.� Theteamregularlygivesclientsandfamiliestimely,complete,andaccurateinformation.
Thissteprequirestheinformationbeunderstood.
4�
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
CRITICAL CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
9.2 Theteamprovidesappropriateeducationtoclientsandfamilies.
•Theeducationprocessconsidersthe clients’andfamilies’languageand ensuresthattheyunderstandthe information.
Thisrequiresanunderstanding&availabilityoftheappropriatelanguageforcommunicatingtheinformation.
9.3 Theteamprovidesappropriateemotionalsupportandcounselingtohelpclientsandfamilies.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
9.4 Theteamworkswithclientsandfamiliestocarryouttheirresponsibilitiesby:
•helpingclientsunderstandwhattheyare responsiblefor. •teachingpositivebehaviour.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.0 Theteamobtainsinformedconsentbeforestartinganyserviceorintervention.
Informedconsentrequiresthattheclientunderstandthechoicesandtheimplicationsofthedecisions.
�0.2 Theteamhasaprocessfordeterminingwhetherclientsarecapableofgivingtheirinformedconsent.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.3 Theteamobtainsclients’informedconsentbyverifyingthattheclientunderstandsalltheverbalandwritteninformation.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
��.0 Theteamprotectsandpromotestherightsofitsclientsandfamilies.
��.� Theteamisawareofandrespectstheclients’andfamilies’righttotakepartinallaspectsoftheirserviceandmakepersonalchoices.
Howistheteamrespectingthisinlightoflanguageaccess?
��.3 Theteamcontinuallyeducatesitsclientsandfamiliesabouttheirrightsandhelpsthemexercisetheirrights.
Howistheteamrespectingthisinlightoflanguageaccess?
��.5 Theteamhasaprocessforprocuringanddonatingorgansandtissuesthatincludesmakingthefamiliesorclientsawareoftheoptiontodonate.
Howistheteamrespectingthisinlightoflanguageaccess?
42
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
CRITICAL CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
��.6 Theteamhasaprocessforhandlingclients’andfamilies’complaintsthatincludesexplainingtoclientshowtheycanfileacomplaint.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�2.0 Settinggoalsandmonitoringachievements
Theteamhasanappropriateandintegratedserviceplanforeachclient.
�2.� Theteamworkswithclientsandfamiliestosettheclients’goalsandexpectedresults.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�2.4 Theteam’sclientsachievetheirsetgoalsandexpectedresults.
•Theteamidentifiesandaddressesany barriersthatarepreventingclientsfrom reachingtheirsetgoalsandexpectedresults.
Languagebarriersshouldbepartofthisassessment.
�3.0Deliveringservices
Theteamdeliverssafe,efficientandeffectiveservices.
Researchindicatesthatlanguagebarrierscanunderminethesafety,efficiencyandeffectivenessofservices.
�3.3 Theteamtakesallreasonablestepstokeepclientssafefrominjuries,orinfectionsbyeducatingclientsandfamiliesonpreventingrisks.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
�4.0 Theuseofmedicationsandothertherapeutictechnologiesissafe,efficient,effective,andpromotesthebestpossiblequalityoflife.
�4.2 Theteamgivesitsclientswrittenandverbalinformationaboutthemedicationsorothertherapeutictechnologiesthatareavailable.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
43
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
HOME CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�.0 Beingalearningorganizationandachievingpositiveoutcome.
Theteamcontinuallyplansanddesignsitsservicestomeetthecurrentandfutureneedsofthepopulationsitserves,andtoachievethebestpossibleoutcomes.
ThisrequiresunderstandingofneedforFrenchlanguageresources,clientneedsforaccesstoappropriatelanguageforservicedelivery,andcorrelationbetweenlanguagebarriersandoutcomes.
2.0 Theteamusesresearch,evidence,andbestpracticeinformationtodevelopandimproveitsservices.
2.2 Theteaminformsclientsaboutresearchactivitiesthatrelatetotheirserviceneeds,andhelpsclientsaccesstheseactivitiesiftheywish.
Thisrequiresinformationtobeavailableinappropriatelanguage.
3.0 Theteammonitorsandimprovesthequalityofitsservicestoachievethebestpossibleoutcomes.
3.2 Whenevaluatingitsservices,theteaminvolvesclients,families,andotherorganizations.
Involvementrequiresstaffwhocancommunicatewithclients.
4.0 Achievingwellness
Theteam,workingwiththecommunity,promoteshealth,preventsordetectshealthproblemsearly,andmaximizesthewell-beingofthoseitserves.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
4.2 Theteam,withitspartners,carriesoutactivitiestoreducetheriskandonsetofhealthproblems,andmaximizesthewell-beingofthepopulationsitserves,providingongoinginformationandeducationtoclients,otherproviders,otherorganizations,andthepublicaboutcurrentandemerginghealthissues.
Partnershiprequireseffectivecommunication.
5.0 Beingresponsive
Theteam’sservicesareintegratedandcoordinatedtoensurecontinuityofserviceforthepopulationitserves.
44
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
HOME CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
5.3 Theteamisawareofandusescomplementaryservicesofotherprovidersandorganizations;makingiteasierforclientstomovethroughtheservicesystem.
Istheorganizationusinglanguageresourcesavailablefromcomplementaryprovidersandorganizationstoaddresslanguagebarriers?
6.0 Theclients’firstcontactswiththeteamleadtothebestdecisionaboutservices.
Languagebarriersmustbeaddressed.Researchindicatesthatlanguagebarriersinhibitordelayfirstcontact.Researchalsosupportsneedforclearcommunicationinmakingappropriatecarechoices.
6.� Allpotentialclients,providers,andreferringorganizationscanaccesstheteam’sservices.
•Theteamidentifiesandremovesbarriers thatpreventclients,families,providers, andorganizationsfromaccessing services.
Thisshouldincludeexplicitassessmentoflanguagebarriersandhowtoremovethem.
6.3 Theteamgivespotentialclients,families,providers,andorganizationssimple,writteninformationabouttherangeofservicesandtheircost,effectivenessandoutcomes,andalternatives.
Tobeusefulthisinformationmustbeprovidedinappropriatelanguage.
6.4 Theteam’sprocessfordecidingwhethertoofferservicestopotentialclientsandfamiliesincludes:
•obtaining,withconsent,thepotential client’shistory. •identifyingandaddressingclient’s immediateandurgentneeds.
•Consentismeaninglessiftheclientdoesnotunderstandwhatisbeingasked.
•Needsidentificationshouldincludelanguageofserviceneeds.
6.6 Whentheteamcannotmeettheneedsofpotentialclients,providers,andreferringorganizations,itexplainsthereasonswhy
Suchexplanationsneedtobecommunicatedinappropriatelanguage.
7.0 Addressingneeds
Theteamaccuratelyandappropriatelyassessesitsclients.
45
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
HOME CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
7.� Theteamdeterminestheassessmentmethod,scopeandintensitybyconsideringanumberoffactorsincludinglanguage.
•Theassessmentiscarriedoutwith adequateresources.
Languageisanessentialpartoftheassessmentprocess.Withadequatelanguageandcommunicationresources.
7.2 Assessmentofclients’strengths,abilities,needs,andforeseeablerisks,includesclients’abilitytocommunicateandcareforthemselves.
Onalargerscale,theabilitytocommunicateisanessentialpartoftheassessmentprocess.
7.3 Theteamsharestheassessmentresultswithclientsandfamiliesinaclearandeasy-to-understandway.
Thisrequiresthatlanguageaccessbeavailable.
7.4 Theteamhasprocessesforassessingandmanagingtheclient’spain.
Researchindicatesthatlanguagebarriersaffectmanagementofpain.
9.0 Empoweringclients
9.� Theteamregularlygivesclientsandfamiliestimely,complete,andaccurateinformation.
Thissteprequirestheinformationbeunderstood.
9.2 Theteamprovidesappropriateeducationtoclientsandfamilies.
•Theeducationprocessconsidersthe clients’andfamilies’languageand ensurestheclientsandfamilies understandtheinformation.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
9.3 Theteamprovidesappropriateemotionalsupportandcounselingtohelpclientsandfamilies.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
9.4 Theteamworkswithclientsandfamiliestocarryouttheirresponsibilitiesby:
•helpingclientsunderstandwhattheyare responsiblefor •teachingpositivebehaviour.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.0Theteamobtainsinformedconsentbeforestartinganyserviceorintervention.
Informedconsentrequiresthattheclientunderstandthechoicesandtheimplicationsofthedecisions.
46
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
HOME CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�0.2 Theteamhasaprocessfordeterminingwhetherclientsarecapableofgivingtheirinformedconsent.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.3 Theteamobtainsclients’consentbyverifyingthattheclientunderstandsalltheverbalandwritteninformation.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
��.0 Theteamprotectsandpromotestherightsofitsclientsandfamilies.
��.� Theteamrespectstheclients’andfamilies’righttotakepartinallaspectsoftheirserviceandmakepersonalchoices.
Howistheteamrespectingthisinlightoflanguageaccess?
��.3 Theteamcontinuallyeducatesitsclientsandfamiliesabouttheirrightsandhelpsthemexercisetheirrights.
Howistheteamrespectingthisinlightoflanguageaccess?
��.5 Theteamhasaprocessforhandlingclients’andfamilies’complaintsthatincludesexplainingtoclientshowtheycanfileacomplaint.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�2.0Settinggoalsandmonitoringachievements
Theteamhasanappropriateandintegratedserviceplanforeachclient.
�2.� Theteamworkswithclientsandfamiliestosettheclients’goalsandexpectedresults.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�2.4 Theteam’sclientsachievetheirsetgoalsandexpectedresults.
•Theteamidentifiesandaddressesany barriersthatarepreventingclientsfrom reachingtheirsetgoalsandexpected results.
Languagebarriersshouldbepartofthisassessment.
�3.0Deliveringservices
Theteamdeliverssafe,efficientandeffectiveservices.
Researchindicatesthatlanguagebarrierscanunderminethesafety,efficiencyandeffectivenessofservices.
47
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
LONG-TERM CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�.0 Beingalearningorganizationandachievingpositiveoutcomes.
Theteamcontinuallyplansanddesignsitsservicestomeetthecurrentandfutureneedsofthepopulationsitserves,andtoachievethebestpossibleoutcomes.
ThisrequiresunderstandingofneedforFrenchlanguageresources,clientneedsforaccesstoappropriatelanguageforservicedelivery,andcorrelationbetweenlanguagebarriersandoutcomes.
2.0 Theteamusesresearch,evidence,andbestpracticeinformationtodevelopandimproveitsservices.
2.2 Informclientsaboutresearchactivitiesthatrelatetotheirserviceneeds,andhelpclientsaccesstheseactivitiesiftheywish.
Thisrequiresinformationtobeavailableinappropriatelanguage.
3.0 Theteammonitorsandimprovesthequalityofitsservicestoachievethebestpossibleoutcomes.
3.2 Whenevaluatingitsservices,theteaminvolvesclients,families,andotherorganizations.
Involvementrequiresstaffwhocancommunicatewithclients.
HOME CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�3.3 Theteamtakesallreasonablestepstokeepclientssafefrompreventableadverseevents,injuriesorinfectionsbyeducatingclientsandfamiliesonpreventingrisks.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
�4.0 Theteamprevents,monitors,andpromptlyrespondstoanyadverseeffectsresultingfrommedicationusebyclients.
�4.� Theteamgivesitsclientswrittenandverbalinformationaboutthemedicationsorothertherapeutictechnologiesthatareavailable.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
48
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
LONG-TERM CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
4.0 Achievingwellness
Theteam,workingwiththecommunity,promoteshealth,preventsordetectshealthproblemsearly,andmaximizesthewell-beingofthoseitserves.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
4.2 Theteam,withitspartners,carriesoutactivitiestoreducetheriskandonsetofhealthproblems,andmaximizesthewell-beingofthepopulationitserves,providingongoinginformationandeducationtoclients,otherproviders,otherorganizations,andthepublicaboutcurrentandemerginghealthissues.
Partnershiprequireseffectivecommunication.
5.0 Beingresponsive
Theteam’sservicesareintegratedandcoordinatedtoensurecontinuityofserviceforthepopulationitserves.
5.3 Teamisawareofandusescomplementaryservicesofotherprovidersandorganizations;makingiteasierforclientstomovethroughtheservicesystem.
Istheorganizationusinglanguageresourcesavailablefromcomplementaryprovidersandorganizationstoaddresslanguagebarriers?
6.0 Theclients’firstcontactswiththeteamleadtothebestdecisionaboutservices.
Languagebarriersmustbeaddressed.Researchindicatesthatlanguagebarriersinhibitordelayfirstcontact.Researchalsosupportsneedforclearcommunicationinmakingappropriatecarechoices.
6.� Allpotentialclients,providers,andreferringorganizationscanaccesstheteam’sservices.
•Theteamidentifiesandremovesbarriers thatpreventclients,families,providers, andorganizationsfromaccessingservices.
Thisshouldincludeexplicitassessmentoflanguagebarriersandhowtoremovethem.
6.3 Theteamgivespotentialclients,families,providers,andorganizationssimple,writteninformationabouttherangeofservicesandtheircost,effectivenessandoutcomes,andalternatives.
Tobeusefulthisinformationmustbeprovidedinappropriatelanguage.
49
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
LONG-TERM CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
6.4 Team’sprocessfordecidingwhethertoofferservicestopotentialclientsandfamiliesincludes:
•Obtaining,withconsent,thepotential client’shistory. •Identifyingandaddressingclient’s immediateandurgentneeds.
•Consentismeaninglessiftheclientdoesnotunderstandwhatisbeingasked.
•Needsidentificationshouldincludelanguageofserviceneeds.
6.6 Whentheteamisunabletoprovideservicestoclients,ittellsclientsandfamilies,providers,andreferringorganizations,thereasonswhythesevicewasrefused.
Suchexplanationsneedtobecommunicatedinappropriatelanguage.
7.0 Addressingneeds
Theteamaccuratelyandappropriatelyassessesitsclients.
7.� Theteamdeterminestheassessmentmethod,scopeandintensitybyconsideringanumberoffactorsincludinglanguage.
•Theassessmentiscarriedoutwith adequateresources.
Languageisanessentialpartoftheassessmentprocess.•Withadequatelanguageandcommunication
resources.
7.2 Assessmentofclients’strengths,abilities,needs,andforeseeablerisks,includesclients’abilitytocommunicate.
Onalargerscale,theabilitytocommunicateisanessentialpartoftheassessmentprocess.
7.3 Theteamsharestheassessmentresultswithclientsandfamiliesinaclearandeasy-to-understandway.
Thisrequiresthatlanguageaccessbeavailable.
7.4 Thereisaprocessforassessingandmanagingtheclient’spain.
Researchindicatesthatlanguagebarriersaffectmanagementofpain.
9.0 Empoweringclients
9.� Theteamregularlygivesclientsandfamiliestimely,complete,andaccurateinformation.
Thissteprequirestheinformationbeunderstood.
50
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
LONG-TERM CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
9.2 Theteamprovidesappropriateeducationtoclientsandfamilies.
•Theeducationprocessconsidersthe clients’andfamilies’languageand ensurestheclientsandfamilies understandtheinformation.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
9.3 Theteamprovidesappropriateemotionalsupportandcounselingtohelpclientsandfamilies.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
9.4 Theteamworkswithclientsandfamiliestocarryouttheirresponsibilitiesby
•helpingclientsunderstandwhattheyare responsiblefor. •teachingpositivebehaviour.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.0 Theteamobtainsinformedconsentbeforestartinganyserviceorintervention.
Informedconsentrequiresthattheclientunderstandthechoicesandtheimplicationsofthedecisions.
�0.2 Theteamhasaprocessfordeterminingwhetherclientsarecapableofgivingtheirinformedconsent.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.3 Theteamobtainsclients’consentbyverifyingthattheclientunderstandsalltheverbalandwritteninformation.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
��.0 Theteamprotectsandpromotestherightsofitsclientsandfamilies.
��.� Theteamrespectstheclients’andfamilies’righttotakepartinallaspectsoftheirserviceandmakepersonalchoices.
Howistheteamrespectingthisinlightoflanguageaccess?
��.4 Theteamcontinuallyeducatesitsclientsandfamiliesabouttheirrightsandhelpsthemexercisetheirrights.
Howistheteamrespectingthisinlightoflanguageaccess?
��.6 Theteamhasaprocessforproviding,forgoing,andwithdrawinglife-sustainingtreatmentthatincludessharingtheguidelineswithclientsandfamilies.
Howistheteamrespectingthisinlightoflanguageaccess?
5�
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
LONG-TERM CARE (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
��.7 Theteamhasaprocessforhandlingclients’andfamilies’complaintsthatincludesexplainingtoclientshowtheycanfileacomplaint.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�2.0Settinggoalsandmonitoringachievements
Theteamhasanappropriateandintegratedserviceplanforeachclient.
�2.� Theteamworkswithclientsandfamiliestosettheclients’goalsandexpectedresults.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�2.4 Theteam’sclientsachievetheirsetgoalsandexpectedresults.
•Theteamidentifiesandaddressesany barriersthatarepreventingclientsfrom reachingtheirsetgoalsandexpected results.
Languagebarriersshouldbepartofthisassessment.
�3.0Deliveringservices
Theteamdeliverssafe,efficientandeffectiveservices.
Researchindicatesthatlanguagebarrierscanunderminethesafety,efficiencyandeffectivenessofservices.
�3.3 Theteamtakesallreasonablestepstokeepclientssafefrompreventableadverseevents,injuriesorinfectionsbyeducatingclientsandfamiliesonpreventingrisks.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
�4.0 Theuseofmedicationsissafe,efficient,effective,andpromotesthebestpossiblequalityoflife.
�4.2 Theteamgivesitsclientswrittenandverbalinformationaboutthemedicationsavailable
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation
52
Appendix A
MATERNAL/CHILD (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�.0 Beingalearningorganizationandachievingpositiveoutcomes.
Theteamcontinuallyplansanddesignsitsservicestomeetthecurrentandfutureneedsofthepopulationsitserves,andtoachievethebestpossibleoutcomes.
ThisrequiresunderstandingofneedforFrenchlanguageresources,clientneedsforaccesstoappropriatelanguageforservicedelivery,andcorrelationbetweenlanguagebarriersandoutcomes.
2.0 Theteamusesresearch,evidence,andbestpracticeinformationtodevelopandimproveitsservices.
2.2 Informclientsaboutresearchactivitiesthatrelatetotheirserviceneeds,andhelpclientsaccesstheseactivitiesiftheywish.
Thisrequiresinformationtobeavailableinappropriatelanguage.
3.0 Theteammonitorsandimprovesthequalityofitsservicestoachievethebestpossibleoutcomes.
3.2 Whenevaluatingitsservices,theteaminvolvesclients,families,andotherorganizations.
Involvementrequiresstaffwhocancommunicatewithclients.
4.0 Achievingwellness
Theteam,workingwiththecommunity,promoteshealth,preventsordetectshealthproblemsearly,andmaximizesthewell-beingofthoseitserves.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
4.2 Theteam,withitspartners,carriesoutactivitiestoreducetheriskandonsetofhealthproblems,andmaximizesthewell-beingofthepopulationitserves,providingongoinginformationandeducationtoclients,otherproviders,otherorganizations,andthepublicaboutcurrentandemerginghealthissues.
Partnershiprequireseffectivecommunication.
5.0 Beingresponsive
Theteam’sservicesareintegratedandcoordinatedtoensurecontinuityofserviceforthepopulationitserves.
* Usually abbreviated or summarized to maintain focus on language access.
53
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
MATERNAL/CHILD (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
5.3 Teamisawareofandusescomplementaryservicesofotherprovidersandorganizations;makingiteasierforclientstomovethroughtheservicesystem.
Istheorganizationusinglanguageresourcesavailablefromcomplementaryprovidersandorganizationstoaddresslanguagebarriers?
6.0 Theclients’firstcontactswiththeteamleadtothebestdecisionaboutservices.
Languagebarriersmustbeaddressed.Researchindicatesthatlanguagebarriersinhibitordelayfirstcontact.Researchalsosupportsneedforclearcommunicationinmakingappropriatecarechoices.
6.� Allpotentialclients,providers,andreferringorganizationscanaccesstheteam’sservices.
•Theteamidentifiesandremovesbarriers thatpreventclients,families,providers, andorganizationsfromaccessing services.
Thisshouldincludeexplicitassessmentoflanguagebarriersandhowtoremovethem.
6.3 Theteamgivespotentialclients,families,providers,andorganizationssimple,writteninformationabouttherangeofservicesandtheircost,effectivenessandoutcomes,andalternatives.
Tobeusefulthisinformationmustbeprovidedinappropriatelanguage.
6.4 Theteam’sprocessfordecidingwhethertoofferservicestopotentialclientsandfamiliesincludes
•obtaining,withconsent,thepotential client’shistory •identifyingandaddressingclient’s immediateandurgentneeds
•Consentismeaninglessiftheclientdoesnotunderstandwhatisbeingasked.
•Needsidentificationshouldincludelanguageofserviceneeds.
6.6 Whentheteamcannotmeettheneedsofpotentialclients,providers,andreferringorganizations,itexplainsthereasonswhy
Suchexplanationsneedtobecommunicatedinappropriatelanguage.
7.0 Addressingneeds
Thetheteamaccuratelyandappropriatelyassessesitsclients
7.� Theteamdeterminestheassessmentmethod,scopeandintensitybyconsideringanumberoffactorsincludinglanguage.
•Theassessmentiscarriedoutwith adequateresources.
Languageisanessentialpartoftheassessmentprocess.•Withadequatelanguageandcommunication
resources.
54
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
MATERNAL/CHILD (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
7.3 Theteamsharestheassessmentresultswithclientsandfamiliesinaclearandeasy-to-understandway.
Thisrequiresthatlanguageaccessbeavailable.
7.4 Thereisaprocessforassessingandmanagingtheclient’spain.
Researchindicatesthatlanguagebarriersaffectmanagementofpain.
9.0 Empoweringclients
9.� Theteamregularlygivesclientsandfamiliestimely,complete,andaccurateinformation.
•Theinformationthattheteamgivesto itsclientsandfamiliesisavailableinthe languageofthepopulationgroupsserved.
Thissteprequirestheinformationbeunderstood.ClearlythisrequiresFrenchlanguageservicesfortheFrench-speakingpopulation.
9.2 Theteamprovidesappropriateeducationtoclientsandfamilies.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
9.3 Theteamprovidesappropriateemotionalsupportandcounselingtohelpclientsandfamilies.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
9.4 Theteamworkswithclientsandfamiliestocarryouttheirresponsibilitiesby:
•helpingclientsunderstandwhattheyare responsiblefor. •teachingpositivebehaviour.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.0 Theteamobtainsinformedconsentbeforestartinganyserviceorintervention.
Informedconsentrequiresthattheclientunderstandthechoicesandtheimplicationsofthedecisions.
�0.2Theteamhasaprocessfordeterminingwhetherclientsarecapableofgivingtheirinformedconsent.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.3Theteamobtainsclients’consentbyverifyingthattheclientunderstandsalltheverbalandwritteninformation.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
��.0Theteamprotectsandpromotestherightsofitsclientsandfamilies.
55
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
MATERNAL/CHILD (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
��.�Theteamrespectstheclients’andfamilies’righttotakepartinallaspectsoftheirserviceandmakepersonalchoices.
Howistheteamrespectingthisinlightoflanguageaccess?
��.3Theteamcontinuallyeducatesitsclientsandfamiliesabouttheirrightsandhelpsthemexercisetheirrights.
Howistheteamrespectingthisinlightoflanguageaccess?
��.5Theteamhasaprocessforhandlingclients’andfamilies’complaintsthatincludesexplainingtoclientshowtheycanfileacomplaint.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�2.0Settinggoalsandmonitoringachievements
Theteamhasanappropriateandintegratedserviceplanforeachclient.
�2.� Theteamworkswithclientsandfamiliestosettheclients’goalsandexpectedresults.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�2.4Theteam’sclientsachievetheirsetgoalsandexpectedresults.
•Theteamidentifiesandaddressesany barriersthatarepreventingclientsfrom reachingtheirsetgoalsandexpected results.
Languagebarriersshouldbepartofthisassessment.
�3.0Deliveringservices
Theteamdeliverssafe,efficientandeffectiveservices.
Researchindicatesthatlanguagebarrierscanunderminethesafety,efficiencyandeffectivenessofservices.
�3.3Theteamtakesallreasonablestepstokeepclientssafefrompreventableadverseevents,injuriesorinfectionsbyeducatingclientsandfamiliesonpreventingrisks.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
�4.0Theteamprevents,monitors,andpromptlyrespondstoanyadverseeffectsresultingfrommedicationusebyclients.
�4.2Theteamgivesitsclientswrittenandverbalinformationaboutthemedicationsorothertherapeutictechnologiesthatareavailable.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
56
Appendix A
MENTAL HEALTH (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�.0 Beingalearningorganizationandachievingpositiveoutcomes.
Theteamcontinuallyplansanddesignsitsservicestomeetthecurrentandfutureneedsofthepopulationsitserves,andtoachievethebestpossibleoutcomes.
ThisrequiresunderstandingofneedforFrenchlanguageresources,clientneedsforaccesstoappropriatelanguageforservicedelivery,andcorrelationbetweenlanguagebarriersandoutcomes.
2.0 Theteamusesresearch,evidence,andbestpracticeinformationtodevelopandimproveitsservices.
2.2 Theteaminformsclientsaboutresearchactivitiesthatrelatetotheirserviceneeds,andhelpsclientsaccesstheseactivitiesiftheywish.
Thisrequiresinformationtobeavailableinappropriatelanguage.
3.0 Theteammonitorsandimprovesthequalityofitsservicestoachievethebestpossibleoutcomes.
3.2 Whenevaluatingitsservices,theteaminvolvesclients,families,andotherorganizations.
Involvementrequiresstaffwhocancommunicatewithclients.
4.0 Achievingwellness
Theteam,workingwiththecommunity,promoteshealth,preventsordetectshealthproblemsearly,andmaximizesthewell-beingofthoseitserves.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
4.3 Theteam,withitspartners,carriesoutactivitiestoreducetheriskandonsetofhealthproblems,andmaximizesthewell-beingofthepopulationitserves,providingongoinginformationandeducationtoclients,otherproviders,otherorganizations,andthepublicaboutcurrentandemerginghealthissues.
Partnershiprequireseffectivecommunication.
5.0 Beingresponsive
Theteam’sservicesareintegratedandcoordinatedtoensurecontinuityofserviceforthepopulationsitserves.
* Usually abbreviated or summarized to maintain focus on language access.
57
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
MENTAL HEALTH (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
5.3 Teamisawareofandusescomplementaryservicesofotherprovidersandorganizations;makingiteasierforclientstomovethroughtheservicesystem.
Istheorganizationusinglanguageresourcesavailablefromcomplementaryprovidersandorganizationstoaddresslanguagebarriers?
6.0 Theclients’firstcontactswiththeteamleadtothebestdecisionaboutservices.
Languagebarriersmustbeaddressed.Researchindicatesthatlanguagebarriersinhibitordelayfirstcontact.Researchalsosupportsneedforclearcommunicationinmakingappropriatecarechoices.
6.� Allpotentialclients,providers,andreferringorganizationscanaccesstheteam’sservices.
•Theteamidentifiesandremovesbarriers thatpreventclients,families,providers, andorganizationsfromaccessingservices.
Thisshouldincludeexplicitassessmentoflanguagebarriersandhowtoremovethem.
6.3 Theteamgivespotentialclients,families,providers,andorganizationssimple,writteninformationabouttherangeofservicesandtheircost,effectivenessandoutcomes,andalternatives.
Tobeusefulthisinformationmustbeprovidedinappropriatelanguage.
6.4 Team’sprocessfordecidingwhethertoofferservicestopotentialclientsandfamiliesincludes:
•obtaining,withconsent,thepotential client’shistory. •identifyingandaddressingclient’s immediateandurgentneeds.
•Consentismeaninglessiftheclientdoesnotunderstandwhatisbeingasked.
•Needsidentificationshouldincludelanguageofserviceneeds.
6.6 Whenteamcannotmeettheneedsofpotentialclients,providers,andreferringorganizations,itexplainsthereasonswhy.
Suchexplanationsneedtobecommunicatedinappropriatelanguage.
7.0 Addressingneeds
Theteamaccuratelyandappropriatelyassessesitsclients.
7.� Theteamdeterminestheassessmentmethod,scopeandintensitybyconsideringanumberoffactorsincludinglanguage.
•Theassessmentiscarriedoutwith adequateresources.
Languageisanessentialpartoftheassessmentprocess.•Withadequatelanguageandcommunication
resources.
58
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
MENTAL HEALTH (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
7.2 Assessmentofclients’strengths,abilities,needs,andforeseeablerisks,includesclients’abilitytocommunicateandcareforthemselves.
Onalargerscale,theabilitytocommunicateisanessentialpartoftheassessmentprocess.
7.3 Theteamsharestheassessmentresultswithclientsandfamiliesinaclearandeasy-to-understandway.
Thisrequiresthatlanguageaccessbeavailable.
9.0 Empoweringclients
9.� Theteamregularlygivesclientsandfamiliestimely,complete,andaccurateinformation.
•Theinformationthattheteamgivesto itsclientsandfamiliesisavailableinthe languageofthepopulationgroupsserved.
Thissteprequirestheinformationbeunderstood.
9.2 Theteamprovidesappropriateeducationtoclientsandfamilies.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
9.3 Theteamprovidesappropriateemotionalsupportandcounselingtohelpclientsandfamilies.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
9.4 Theteamworkswithclientsandfamiliestocarryouttheirresponsibilitiesby:
•helpingclientsunderstandwhattheyare responsiblefor. •teachingpositivebehaviour.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.0Theteamobtainsinformedconsentbeforestartinganyserviceorintervention.
Informedconsentrequiresthattheclientunderstandthechoicesandtheimplicationsofthedecisions.
�0.2Theteamhasaprocessfordeterminingwhetherclientsarecapableofgivingtheirinformedconsent.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.3Theteamobtainsclients’consentbyverifyingthattheclientunderstandsalltheverbalandwritteninformation.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
��.0Theteamprotectsandpromotestherightsofitsclientsandfamilies.
59
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
MENTAL HEALTH (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
��.�Theteamrespectstheclients’andfamilies’righttotakepartinallaspectsoftheirserviceandmakepersonalchoices.
Howistheteamrespectingthisinlightoflanguageaccess?
��.3Theteamcontinuallyeducatesitsclientsandfamiliesabouttheirrightsandhelpsthemexercisetheirrights.
Howistheteamrespectingthisinlightoflanguageaccess?
��.5Theteamhasaprocessforhandlingclients’andfamilies’complaintsthatincludesexplainingtoclientshowtheycanfileacomplaint.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�2.0Settinggoalsandmonitoringachievements
Theteamhasanappropriateandintegratedserviceplanforeachclient.
�2.�Theteamworkswithclientsandfamiliestosettheclients’goalsandexpectedresults.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�2.4Theteam’sclientsachievetheirsetgoalsandexpectedresults.
•Theteamidentifiesandaddressesany barriersthatarepreventingclientsfrom reachingtheirsetgoalsandexpected results.
Languagebarriersshouldbepartofthisassessment.
�3.0DeliveringServices
Theteamdeliverssafe,efficient,andeffectiveservices.
Researchindicatesthatlanguagebarrierscanunderminethesafety,efficiencyandeffectivenessofservices.
�3.3Theteamtakesallreasonablestepstokeepclientssafefrompreventableadverseevents,injuriesorinfectionsbyeducatingclientsandfamiliesonpreventingrisks.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�4.0Theuseofmedicationsandothertherapeutictechnologiesissafe,efficient,effective,andpromotesthebestpossiblequalityoflife.
60
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
REHABILITATION (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�.0 Beingalearningorganizationandachievingpositiveoutcomes.
Theteamcontinuallyplansanddesignsitsservicestomeetthecurrentandfutureneedsofthepopulationsitserves,andtoachievethebestpossibleoutcomes.
ThisrequiresunderstandingofneedforFrenchlanguageresources,clientneedsforaccesstoappropriatelanguageforservicedelivery,andcorrelationbetweenlanguagebarriersandoutcomes.
2.0 Theteamusesresearch,evidence,andbestpracticeinformationtodevelopandimproveitsservices.
2.2 Theteaminformsclientsaboutresearchactivitiesthatrelatetotheirserviceneeds,andhelpsclientsaccesstheseactivitiesiftheywish.
Thisrequiresinformationtobeavailableinappropriatelanguage.
3.0 Theteammonitorsandimprovesthequalityofitsservicestoachievethebestpossibleoutcomes.
3.2 Whenevaluatingitsservices,theteaminvolvesclients,families,andotherorganizations.
Involvementrequiresstaffwhocancommunicatewithclients.
4.0 Achievingwellness
Theteam,workingwiththecommunity,promoteshealth,preventsordetectshealthproblemsearly,andmaximizesthewell-beingofthoseitserves.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
MENTAL HEALTH (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�4.2Theteamgivesitsclientswrittenandverbalinformationaboutthemedicationsorothertherapeutictechnologiesthatareavailable.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
6�
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
REHABILITATION (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
4.2 Theteam,withitspartners,carriesoutactivitiestoreducetheriskandonsetofhealthproblems,andmaximizesthewell-beingofthepopulationitserves,providingongoinginformationandeducationtoclients,otherproviders,otherorganizations,andthepublicaboutcurrentandemerginghealthissues.
Partnershiprequireseffectivecommunication.
5.0 Beingresponsive
Theteam’sservicesareintegratedandcoordinatedtoensurecontinuityofserviceforthepopulationsitserves.
5.3 Teamisawareofandusescomplementaryservicesofotherprovidersandorganizations;makingiteasierforclientstomovethroughtheservicesystem.
Istheorganizationusinglanguageresourcesavailablefromcomplementaryprovidersandorganizationstoaddresslanguagebarriers?
6.0 Theclients’firstcontactswiththeteamleadtothebestdecisionaboutservices.
Languagebarriersmustbeaddressed.Researchindicatesthatlanguagebarriersinhibitordelayfirstcontact.Researchalsosupportsneedforclearcommunicationinmakingappropriatecarechoices.
6.� Allpotentialclients,providers,andreferringorganizationscanaccesstheteam’sservices.
•Theteamidentifiesandremovesbarriersthatpreventclients,families,providers,andorganizationsfromaccessingservices.
Thisshouldincludeexplicitassessmentoflanguagebarriersandhowtoremovethem.
6.3 Theteamgivespotentialclients,families,providers,andorganizationssimple,writteninformationabouttherangeofservicesandtheircost,effectivenessandoutcomes,andalternatives.
Tobeusefulthisinformationmustbeprovidedinappropriatelanguage.
6.4 Theteam’sprocessfordecidingwhethertoofferservicestopotentialclientsandfamiliesincludes:
•obtaining,withconsent,thepotential client’shistory. •identifyingandaddressingclient’s immediateandurgentneeds.
•Consentismeaninglessiftheclientdoesnotunderstandwhatisbeingasked.
•Needsidentificationshouldincludelanguageofserviceneeds.
62
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
REHABILITATION (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
6.6 Whentheteamcannotmeettheneedsofpotentialclients,providers,andreferringorganizations,itexplainsthereasonswhy
Suchexplanationsneedtobecommunicatedinappropriatelanguage.
7.0 Addressingneeds
Theteamaccuratelyandappropriatelyassessesitsclients.
7.� Theteamdeterminestheassessmentmethod,scopeandintensitybyconsideringanumberoffactorsincludinglanguage.
•Theassessmentiscarriedoutwith adequateresources.
Languageisanessentialpartoftheassessmentprocess.•Withadequatelanguageandcommunicationresources.
7.3 Theteamsharestheassessmentresultswithclientsandfamiliesinaclearandeasy-to-understandway.
Thisrequiresthatlanguageaccessbeavailable.
7.4 Thereisaprocessforassessingandmanagingtheclient’spain.
Researchindicatesthatlanguagebarriersaffectmanagementofpain.
9.0 Empoweringclients
9.� Theteamregularlygivesitsclientsandfamiliestimely,complete,andaccurateinformation.
•Theinformationthattheteamgivesto itsclientsandfamiliesisavailableinthe
languageofthepopulationgroupsserved.
Thissteprequirestheinformationbeunderstood.
9.2 Theteamprovidesappropriatehealtheducation,emotionalsupportandcounselingtohelpclients.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
9.3 Theteamworkswithclientsandfamiliestocarryouttheirresponsibilitiesby:
•helpingclientsunderstandwhattheyare responsiblefor. •teachingpositivebehaviour.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.0 Theteamobtainsinformedconsentbeforestartinganyserviceorintervention.
Informedconsentrequiresthattheclientunderstandthechoicesandtheimplicationsofthedecisions.
63
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
REHABILITATION (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�0.2 Theteamhasaprocessfordeterminingwhetherclientsarecapableofgivingtheirinformedconsent.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�0.3 Theteamobtainsclients’consentbyverifyingthattheclientunderstandsalltheverbalandwritteninformation.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
��.0 Theteamprotectsandpromotestherightsofitsclientsandfamilies.
��.� Theteamrespectstheclients’andfamilies’righttotakepartinallaspectsoftheirserviceandmakepersonalchoices.
Howistheteamrespectingthisinlightoflanguageaccess?
��.3 Theteamcontinuallyeducatesitsclientsandfamiliesabouththierrightsandhelpsthemexercisetheirrights.
Howistheteamrespectingthisinlightoflanguageaccess?
��.5 Theteamhasaprocessforhandlingclients’andfamilies’complaintsthatincludesexplainingtoclientshowtheycanfileacomplaint.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
�2.0Settinggoalsandmonitoringachievements
Theteamhasanappropriateandintegratedserviceplanforeachclient.
�2.� Theteamworkswithclientsandfamiliestosettheclients’goalsandexpectedresults.
Thisrequiresanunderstandingoftheappropriatelanguageforcommunicatingtheinformation.
�2.4 Theteam’sclientsachievetheirsetgoalsandexpectedresults.
•Theteamidentifiesandaddressesany barriersthatarepreventingclientsfrom reachingtheirsetgoalsandexpected results.
Languagebarriersshouldbepartofthisassessment.
�3.0Deliveringservices
Theteamdeliverssafe,efficient,andeffectiveservices.
Researchindicatesthatlanguagebarrierscanunderminethesafety,efficiencyandeffectivenessofservices.
64
Appendix A
* Usually abbreviated or summarized to maintain focus on language access.
REHABILITATION (6.0)
Standard&Criteria/Guidelines* PEIFLHSNComment
�3.4 Theteamtakesallreasonablestepstokeepclientssafefrompreventableadverseevents,injuriesorinfectionsbyeducatingclientsandfamiliesonpreventingrisks.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
�4.0 Theuseofmedicationsissafe,efficientandeffective,andpromotesthebestpossiblequalityoflife.
�4.2 Theteamgivesitsclientswrittenandverbalinformationabouthowtousemedicationsafelyandproperly.
Thisrequiresanunderstandingandavailabilityoftheappropriatelanguageforcommunicatingtheinformation.
65
APPENDIX B
Language Access Resources & Tools
Studies & Reports
Andrulis,D.,Goodman,N.,&Pryor,C.(2002,April).What a Difference an Interpreter can Make: Health Care Experiences of Uninsured with Limited English Proficiency.TheAccessProject.Boston,MA.
Bowen,S.(200�).Language Barriers in Access to Health Care,HealthCanada.
CRICO/RMF.(2006).What Works: Effective Practices for Office-based Care.SeeLanguageInterpretation(Section6)oftheirwebsite:http://www.rmf.harvard.edu/
EthicalForceProgram.(2006).An Ethical Force Program Consensus Report. Improving Communication – Improving Care. How health care organizations can ensure effective, patient-centered communication with people from diverse populations.AmericanMedicalAssociation.
TriadResearchInc.(2002).Final Evaluation Report, Evaluation of the Language and Culture Facilitation Pilot Project for Seniors Residing at the Jewish Senior Apartment Complex and Seniors in the Community Who Speak Russian and Yiddish,Calgary.
Weiss,L.,Bauer,T.,Hill,C.,Fuld,J.,&Bergman,J.(2006,May)Language as a Barrier to Health Care for New York City Children in Immigrant Families: Haitian, Russian and Latino Perspectives,DivisionofHealthPolicyandtheNewYorkForumforChildHealth,www.nyam.org/library/docs/LanguageBarrierReportMay2006.pdf
Wilson-Stronks,A.&Galvez,E.(2006).Hospitals, Language, and Culture: A snapshot of the nation. Exploring cultural and linguistic services in the nation’s hospitals.TheJoint-Commission.OakbrookTerrace,IL.
Resource Guides
Hardt,E.(200�).Research Issues on Medical Interpretation: Bibliography.TheNationalCouncilonInterpretinginHealthCare, www.ncihc.org
Jacobs,E.,Agger-Gupta,N.,Chen,A.Hm,Piotrowski,A.,&Hardt,E.J.(2003).Language Barriers in HealthCare Settings:AnannotatedBibliographyoftheResearchLiterature.TheCaliforniaEndowment,www.calendow.org
Sampson,A.(2006).Language Services Resource Guide for Health Care Providers,NationalHealthLawProgram.
Appendix B
66
Sample Policies, Standards & Toolkits
Improving Communication – Improving Care, Ethical Force Program Consenus Report,AmericanMedicalAssociation,ContentArea5b.Language
OfficeofMinorityHealth,National Standards on Culturally and Linguitically Appropriate Services (CLAS),www.omhrc.gov/templates/browse.aspx?lvl=2&1v1ID=15
Paras,M.(2005).Straight Talk: Model Hospital Policies and Procedures on Language Access,CaliforniaHealthCareSafetyNetInstitute.
Roat,C.E.(2005).Addressing Language Access Issues in Your Practice: A Toolkit for Physicians and Their Staff Members,CaliforniaAcademyofFamilyPhysicians.
WinnipegRegionalHealthAuthority,PoliciesonFrenchLanguageServiceshttp://www.wrha.mb.ca/about/policy.php
Patient Information Pamphlets
AmericanHospitalAssociationAwardWinningPoint-to-TalkBookletswww.massgeneral.org/interpreters/pointtalk.asp
Web Sites & Portals
http://cchsa.ca/Default.aspx–CanadianCouncilonHealthServicesAccreditationwebsiteoffersinformationonthestandards,andROPs
http://www.patientsafetyinstitute.ca/index.html–CanadianPatientSafetyInstitutewebsite
www.calendow.org/reference/publications/cultural_competence.stmOffersmanualsandworkbooks.Whiletheemphasisisonculturalcompetencies,languagebarriersarealsoincluded.
www.jointcommission.org/HLC/compiled_list.htmIncludesaddressesfortoolkits,guidelinesandstandards,andtrainingresources–whilethefocusisonaddressingneedsofSpanishpopulation,thereisgreatpotentialforcross-over
www.hablamosjuntos.org/mission.default.mission.aspHablamosJuntosoffersresourcesregardinglanguagepolicyandpracticeinhealthcare.WhilethefocusisontheneedsofSpanish-speakingpopulation,thereisgreatpotentialforcross-over
Appendix B
67
Appendix C
APPENDIX C
Evidence For MonitoringCommunication Challenges
• Publicsignageisbilingualinhealthcarefacilities.
• Patientbrochures,educationmaterialandpatient/clientconsentsareprovidedinappropriatelanguagesandreadinglevels.
• Assessmenttooltoidentifyneedforinterpreter/Accesstointerpretersasrequired.
• DirectoriesofFrenchspeakingstaff,whichincludelevelofcompetency,areavailable.
• Clientsatisfactiontoolsreflectlanguagerequirementsofpopulationandallowforinputonlanguageneeds.
• Patientsafetyeducationandcommunicationmaterials,includingmedicationinformation,areavailableinrelevantlanguagesandappropriatereadinglevels.
• Staffreceiveeducation/trainingonlanguageandcultureissues,inamannerwhichreflectscurrentresearchevidence,inrelationtoqualityofcareandpatientsafety.
• Theorganizationhasroutinedatacollectionprocessestoidentifyandmonitorlanguageneeds.Examplesincludecommunityneedsassessments,administrativedatacollectionatservicedeliveryentrypoints,andmonitoringindicators.
• Theorganizationstrategicplanaddressesaccessissuesrelatedtolanguageandorculture.ExamplescouldincludegoalsorobjectivesrelatedtoHRplanning,patientsafety,orqualityofcarewhichaddressortakeintoaccountanaccessissuerelatedtolanguageorculture.
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