THE IMPACT OF LANGUAGE BARRIERS ON PATIENT SAFETY AND QUALITY OF CARE
Final Report
Prepared by: Sarah Bowen, PhD
For: Société Santé en français
August, 2015.
KEY POINTS
1. Significant research has been conducted on the impact of language barriers on health and healthcare, particularly over the past two decades. This research, (and several sys-tematic and critical reviews) has provided compelling evidence of the negative impact of language barriers on healthcare access, patient satisfaction and experience, as well as disparities in receipt of care between English (dominant language) proficient patients and those facing language barriers.
2. Those facing language barriers also face increased risk of medication errors and com-plications, and adverse events. The rights of limited English proficient patients to in-formed consent and confidentiality are often not protected.
3. The research on language access does not align that well with the healthcare quality and safety literature; and not all applicable research is published in commonly-cited medical journals. This may contribute to low awareness of the risks of language barriers among providers and managers.
4. Due to data limitations, limited research on impacts of language barriers has been con-ducted in the Canadian setting. However, a review of the pathways through which lan-guage barriers impact quality of care and safety indicates that much of the international research is applicable in the Canadian context.
5. In contrast to the evidence of negative impacts of language barriers on quality of care (including risk of adverse events), there is not evidence of disparities in mortality be-tween English proficient patients and those facing language barriers. This finding is not unexpected, given what is known about the pathways by which language barriers affect care quality, and limitations of methods used to investigate the impact of language barri-ers on health outcomes.
6. There are several barriers to action in addressing the risks of language barriers to quali-ty of care and patient safety: lack of awareness of current research; gaps in Canadian research; lack of language coding in Canadian data; historical framing of linguistic ac-cess as an issue of cultural sensitivity (rather than patient safety); and failure to ade-quately “translate” available evidence into healthcare action.
7. Recent research has begun to outline the complexity of pathways by which language, culture, race/ethnicity and health literacy may affect patient care.
8. Current approaches to addressing the risks of language barriers rely on the dedication and insight of individual providers rather than implementation of effective, evidence-informed strategies at the system level. This is not acceptable in light of current knowledge of effective approaches to patient safety.
9. Implications of available evidence for future research, for the SSF, and for the patient safety movement are discussed.