Office for Civil Rights
Questions and Answers about the Effective Communication in Hospitals Initiative
Question 1: Why is OCR undertaking this Initiative at this time?
Answer 1: Consistent with OCR’s mission to ensure that all persons have access to health care without facing unlawful discrimination, this Initiative is designed to give hospitals the tools, information, and other technical assistance needed to meet the challenges of communicating effectively with persons who are limited English proficient (LEP) or who are deaf or hard of hearing.
Reports in the media, research studies, and our own case work reflect that communication with persons who are LEP or who are deaf or hard of hearing is an important and timely issue, because access to health care, patient safety, and quality of health care are directly dependent on effective communication.
Communication with increasingly diverse populations has also been an issue addressed on a number of recent occasions by the American Hospital Association (AHA).
In addition, the Joint Commission on Accreditation of Healthcare Organizations issued standards in January 2006 related to collection of data about language needs that also recognize the importance of effective communication in hospital settings.
Question 2: How did OCR select the first round of state hospital associations?
Answer 2: OCR developed certain criteria for the selection of the state hospital associations with which we initially desire to partner. These criteria include:
Demographics: changing or increasing populations of individuals with unique communication needs within the state;
Capacity: assessment of the state’s capacity to implement strategies and approaches that may improve communication with these populations;
Relationships: the desire to work more closely with a state with which OCR may have had less extensive contact in the past; and
Challenges: information suggesting that communication with the target populations may be raising some unique challenges in a state.
Question 3: If a state hospital association decides not to work with OCR at this time, will it be able to work with OCR on this issue at a later time?
Answer 3: Yes. We expect to reach out to other state hospital associations when we near the conclusion of this first round of collaborations. This outreach may take different forms:
In some circumstances, OCR may develop similar collaborative relationships with other state hospital associations and programs individually tailored to fit the needs of the association and its members;
In other circumstances, OCR may provide more general technical assistance and a range of resource materials to other state hospital associations and member hospitals;
Further, OCR, in collaboration with the AHA, will share the resources, best practice information, and educational materials that result from the initiative with all state hospital associations and hospitals.
Question 4: What resources or training does OCR expect to make available to the hospitals?
OCR has developed a web page that is geared specifically for hospitals addressing communication with patients and their companions who are LEP or who are deaf or hard of hearing. This webpage pulls together a wide range of informational materials, such as regulations, fact sheets, guidance, videos, and examples of voluntary compliance activities.
OCR expects to develop additional materials for the webpage through its collaborations with the state hospital associations, in particular, information about strategies and approaches that some hospitals have found effective for communication with the target populations.
OCR also is offering to conduct training and make presentations on various issues related to effective communication with the target populations.
Question 5: Will OCR be able to assist hospitals in finding ways to fund the costs of interpreter services?
Answer 5: Yes. OCR recognizes that meeting the costs of interpreter services and other auxiliary aids can be a challenge for hospitals. Consequently, identifying potential resources and creative approaches that hospitals or groups of hospitals can use to assist in meeting costs is an important aspect of the initiative. While OCR, of course, is not a Federal funding agency and therefore cannot fund the cost of interpreter services, we will explore with the state associations various options that may be available to address such costs.
Question 6: Will OCR distinguish, in its technical assistance, between what the law requires and what, though perhaps desirable from a consumer’s point of view, is not required by the law?
Answer 6: Yes. OCR will make available a wide range of technical assistance, including guidance on the legal requirements under Title VI of the Civil Rights of 1964, which prohibits discrimination on the basis of race, color, and national origin, and Section 504 of the Rehabilitation Act of 1973 and Title II of the Americans with Disabilities Act of 1990, which prohibit discrimination on the basis of disability. In addition, OCR will work with the state hospital associations and hospitals to identify best practices and tools that can be part of an effective communication program.
Question 7: What resources, time commitment, or other participation or support does OCR expect from the state hospital association?
Answer 7: Resource commitments by the state hospital association will vary, depending on the needs, interests, and resources of the association. OCR will develop a tailored program of technical assistance in collaboration with each state hospital association. The four core elements of the collaboration are:
Assessment of the issues and concerns of each participating state hospital association regarding effective communication with the target populations (where possible, the assessment will incorporate data reported in previous studies, such as the recent Health Research and Educational Trust (HRET) report on its Hospital Language Services Survey);
Development and implementation of educational and other activities to effectively and efficiently improve language access for the target populations;
Evaluation of both the process and the outcomes of the collaborative efforts; and
Sharing the results of these efforts in a manner that will assist other hospitals and state associations facing similar issues, using the communication vehicles of OCR and AHA and its affiliates, HRET, and the Institute for Diversity.
Question 8: If a state hospital association decides to collaborate with OCR in this initiative and one of its member hospitals gives OCR information that raises a compliance concern, will OCR open an investigation of the hospital?
Answer 8: No. OCR does not intend to turn this initiative into a compliance review of any participating hospital. OCR’s purpose is to provide technical assistance to hospitals so that they can develop and implement effective communication programs with the target populations. To that end, we will encourage hospitals to share information about their programs and the difficult challenges they face in meeting the diverse communication needs of patients and their families, and will respect the context in which the information is shared. If we identify procedures, policies or practices that raise a concern about compliance with the laws, we will share that feedback with the hospital and provide technical assistance on how to address the compliance concern. Of course, irrespective of this initiative, OCR has an independent obligation to address any discrimination complaint that it receives and over which it has jurisdiction.
Question 9: Will OCR share with any other organizations or make public any of the information it obtains from hospitals involved in the initiative?
Answer 9: OCR will share and make public only nonproprietary technical resources, best practice information, and educational materials. Except as may be required by the Freedom of Information Act, OCR will not share information about specific practices, policies and procedures at any individually identifiable hospital without that hospital’s consent.
Question 10: How does OCR propose to identify the issues and concerns in each state?
Answer 10: OCR will work with each state hospital association to identify issues and concerns. Demographic data will be helpful in this regard, including the recent HRET data derived from its language services survey, local hospital data regarding its patient and client population, and census data.