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Identifying and Preventing Medical Errors in Patients With Limited English Proficiency: Key Findings and Tools for the Field

Wasserman, Melanie; Renfrew, Megan R.; Green, Alexander R.; Lopez, Lenny; Tan-McGrory, Aswita; Brach, Cindy; Betancourt, Joseph R.

The Journal for Healthcare Quality (JHQ): May-June 2014 - Volume 36 - Issue 3 - p 5–16
doi: 10.1111/jhq.12065
CE Article
Continuing Education

Abstract: Since the 1999 Institute of Medicine (IOM) report To Err is Human, progress has been made in patient safety, but few efforts have focused on safety in patients with limited English proficiency (LEP). This article describes the development, content, and testing of two new evidence-based Agency for Healthcare Research and Quality (AHRQ) tools for LEP patient safety. In the content development phase, a comprehensive mixed-methods approach was used to identify common causes of errors for LEP patients, high-risk scenarios, and evidence-based strategies to address them. Based on our findings, Improving Patient Safety Systems for Limited English Proficient Patients: A Guide for Hospitals contains recommendations to improve detection and prevention of medical errors across diverse populations, and TeamSTEPPS Enhancing Safety for Patients with Limited English Proficiency Module trains staff to improve safety through team communication and incorporating interpreters in the care process. The Hospital Guide was validated with leaders in quality and safety at diverse hospitals, and the TeamSTEPPS LEP module was field-tested in varied settings within three hospitals. Both tools were found to be implementable, acceptable to their audiences, and conducive to learning. Further research on the impact of the combined use of the guide and module would shed light on their value as a multifaceted intervention.

For more information on this article, contact Melanie Wasserman

Melanie Wasserman, PhD, MPA, is a Senior Associate at Abt Associates who uses rigorous qualitative, quantitative, and technical assistance methods to further the practice of evidence-based care and prevention and to reduce health disparities. Over the past 12 years, Dr. Wasserman's work has focused on improving access to high-quality care for LEP, culturally diverse, and other vulnerable populations. She also has formal training and prior experience as translator and interpreter.

Megan R. Renfrew, MA is Senior Project Manager at the Massachusetts General Hospital Physicians Organization and former Senior Project Coordinator at the Disparities Solutions Center. She coordinates quality improvement initiatives focused on improving quality and decreasing costs and efforts to assess surgical appropriateness. Ms. Renfrew has over 14 years of experience in research and project management with a focus on racial and ethnic disparities in care, cross-cultural care, and quality improvement.

Alexander R. Green, MD, MPH, is the Associate Director of the Disparities Solutions Center and Senior Scientist at the Mongan Institute for Health Policy at Massachusetts General Hospital. He is also Chair of the Cross-Cultural Care Committee at Harvard Medical School. His work focuses on programs designed to eliminate racial and ethnic disparities in care, including the use of culturally competent quality improvement interventions, leadership development, and dissemination strategies.

Lenny Lopez, MD, MDiv, MPH, is Senior Faculty at the Disparities Solutions Center. Dr. Lopez is an internist trained at the Brigham and Women's Hospital (BWH), an Assistant Professor at Harvard Medical School, and is an Assistant at the Mongan Institute for Health Policy at Massachusetts General Hospital (MGH). His research interests extend across a range of issues relating to racial and ethnic disparities including language barriers and patient safety, quality measurement and improvement in hospital care, and the impact of health information technology on disparity reduction.

Aswita Tan-McGrory, MBA, MSPH, is the Deputy Director of the Disparities Solutions Center. She is a key member of the senior management team and supervises the broad portfolio of projects and administration of the Center. In addition, she works closely with the Director to chart the DSC's future growth and strategic response to an ever-increasing demand for the Center's services. Her interests are in providing equitable care to underserved populations and she has over 19 years of professional experience in the areas of disparities, maternal/child health, elder homelessness, and HIV testing and counseling.

Cindy Brach, MPP, is a senior health policy researcher at the Agency for Healthcare Research and Quality (AHRQ), where she conducts and oversees research on cultural competence, health literacy, primary care improvement, and Medicaid and CHIP. In addition to overseeing the development of TeamSTEPPS LEP tools, she has overseen the development of the AHRQ Health Literacy Universal Precautions Toolkit, the CAHPS Item Set for Addressing Health Literacy, and the Re-engineered Discharge (RED) Toolkit. She also serves on the Institute of Medicine (IOM) Health Literacy Roundtable and was a member of the National Project Advisory Committee for the enhancement of the National Standards for Culturally and Linguistically Appropriate Services.

Joseph R. Betancourt, MD, MPH, directs the Disparities Solutions Center at Massachusetts General Hospital, which works with healthcare organizations to improve quality of care, address racial and ethnic disparities, and achieve equity. He is Director of Multicultural Education for Massachusetts General Hospital (MGH), and an expert in cross-cultural care and communication. Dr. Betancourt served on several Institute of Medicine committees, including those that produced Unequal Treatment: Confronting Racial/Ethnic Disparities in Health Care and Guidance for a National Health Care Disparities Report.

© 2014 National Association for Healthcare Quality
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