About This Guide

Improving Patient Safety Systems for Patients With Limited English Proficiency: A Guide for Hospitals

Goal of the Hospital Guide

The goal of this guide is to help hospital leaders better understand how to address the issue of patient safety for limited-English-proficient (LEP) and culturally diverse patients.1 The guide can help hospital leaders:

  1. Foster a Supportive Culture for Safety of Diverse Patient Populations.
  2. Adapt Current Systems To Better Identify Medical Errors Among LEP Patients.
  3. Improve Reporting of Medical Errors for LEP Patients.
  4. Routinely Monitor Patient Safety for LEP Patients.
  5. Address Root Causes To Prevent Medical Errors Among LEP Patients.

Target Audience

This guide is intended for hospital leaders and executives in quality and safety, as well as other hospital leaders who work in related fields, such as directors of patient registration, nursing, and interpreter services. It can also be used by individuals within hospitals who are in a position to advise their leadership to take action on patient safety for LEP and culturally diverse patients or who are responsible for encouraging hospital leaders to address this issue. It is applicable to all types of hospitals (e.g., rural, urban, public, private, Veterans Affairs) and is constructed to be clear, concise, practical, and easy to read.

Organization of the Guide

The guide is organized to present:

  1. Evidence on the issue of patient safety for LEP and culturally diverse patients, including common causes and high-risk scenarios. We also present key reasons for addressing this issue, including the impact of an increasingly diverse nation on health care delivery, quality and cost drivers, and role of risk management and accreditation standards in patient safety efforts.
  2. Strategies and tools to improve patient safety systems. These include five key recommendations that aim to both improve detection of medical errors across diverse populations and prevent high-risk scenarios from becoming safety events.
  3. Team behaviors to improve LEP patient safety, presented in a new TeamSTEPPS® training module: Enhancing Safety for Patients With Limited English Proficiency (TeamSTEPPS LEP Module). The TeamSTEPPS LEP Module applies an evidence-based teamwork system to improve communication and reduce the number and severity of patient safety events affecting LEP and culturally diverse patients.
  4. Additional resources and case examples that can be used to implement these recommendations.

It is well understood that hospitals may have resource or other limitations that preclude a full rollout of this guides recommended strategies all at once. In such cases, we recommend that hospitals begin incrementally by choosing strategies that can be readily implemented. At minimum, hospitals should focus on addressing the root causes that lead to high-risk scenarios for medical errors among LEP patients, for example, by improving access to interpreters and training staff using the new TeamSTEPPS LEP Module.

This guide was created as part of a larger project called Improving Patient Safety Systems Implementation for Limited English Proficiency Populations, funded by AHRQ. This project used a robust mixed methods approach (Figure A) to:

  1. Identify the role language and cultural barriers have on patient safety events;
  2. Document how hospitals are addressing the safety of LEP and culturally diverse patients; and
  3. Provide guidance and tools to help hospitals address these issues.

The final products include this guide and a TeamSTEPPS LEP Module focused specifically on improving team communication to reduce medical errors for LEP patients. For more information on our methods, refer to Appendix D.

Figure A. Data Sources

Environmental scan. Searched the peer-reviewed and grey literature on the topic of patient safety and LEP and culturally diverse patients.

Interpreter pilot. Analyzed the results of a project where interpreters were asked to anonymously document information about incidents that had a negative impact on the safety of LEP patients.

Qualitative interviews. Interviewed frontline staff and clinical and administrative leaders to obtain input on conditions affecting safety of LEP and culturally diverse patients.

Town hall meeting. Conducted a town hall meeting with a diverse group of hospitals from across the Nation, as well as hospital associations and accrediting organizations, to get their thoughts on best practices for preventing, reporting, and documenting medical errors affecting LEP patients.


1 Note that we include sign language users among LEP patients. American Sign Language is a language in its own right and not a manual representation of English.

Current as of September 2012
Internet Citation: About This Guide: Improving Patient Safety Systems for Patients With Limited English Proficiency: A Guide for Hospitals. September 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/hospital/lepguide/lepguideabout.html