Improving Patient Safety Systems for Patients With Limited English Proficiency

Appendix E: Resources and Tools To Address Language and Cultural Barriers and Improve Patient Safety

Language Access, Patient Safety, and Cultural Barriers Resources

Agency for Healthcare Research and Quality (AHRQ),


  • TeamSTEPPS is an evidence-based teamwork system aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.

Hospital Language Services: Quality Improvement and Performance Measures

  • This paper describes the use of a multistage process to develop quality performance measures for Speaking Together participants. Early experiences with the measures highlight challenges with collecting information on patient care that has not previously been collected and the importance of engaging staff, including registration staff and senior management.

AHRQ Health Care: Innovations Exchange

  • The AHRQ Health Care Innovations Exchange offers busy health professionals and researchers a variety of opportunities to share, learn about, and ultimately adopt evidence-based innovations and tools suitable for a range of health care settings and populations.

American Medical Association,

Collecting and Using Race, Ethnicity, and Language Data in Ambulatory Settings

The California Endowment,

Assessing Language Access Issues in Your Practice: A Toolkit for Physicians and Their Staff Members

How To Choose and Use a Language Agency: A Guide for Health and Social Service Providers Who Wish To Contract With Language Agencies

  • How best to use a language agency? What can you expect from such a service? And how do you choose a good one? This publication is designed to assist health and human services administrators who are interested in contracting with a language agency and who are asking themselves these questions.

The Commonwealth Fund,

Promising Practices for Patient-Centered Communication With Vulnerable Populations: Examples From Eight Hospitals

Diversity Rx,

  • The purpose of DiversityRx is to improve the accessibility and quality of health care for minority, immigrant, and indigenous communities. We support those who develop and provide health services that are responsive to the cultural and linguistic differences presented by diverse populations.

Health Research and Educational Trust (HRET),

Disparities Toolkit

  • This Web-based toolkit provides hospitals, health systems, clinics, and health plans with information and resources for systematically collecting race, ethnicity, and primary language data from patients.

Improving Health Equity Through Data Collection and Use: A Guide for Hospital Leaders

Health Resources and Services Administration (HRSA),

United Health Communication Training: Addressing Health Literacy, Cultural Competency, and Limited English Proficiency

  • This free online training can improve providers' communication skills with patients and help overcome barriers that can keep patients from taking their medications, seeking primary care instead of going to the emergency room, or otherwise getting the full benefit of the quality care provided.

The Joint Commission,

Hospitals, Language, and Culture: A Snapshot of the Nation

  • This is the first report released by the Hospitals, Language, and Culture study. It presents the challenges hospitals face when providing care and services to culturally and linguistically diverse populations and discusses the way hospitals are addressing those challenges.

What Did the Doctor Say?: Improving Health Literacy To Protect Patient Safety

Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals

National Center for Cultural Competence (NCCC),

  • NCCC's mission is to increase the capacity of health care and mental health care programs to design, implement, and evaluate culturally and linguistically competent service delivery systems to address growing diversity and persistent disparities. NCCC also promotes health and mental health equity.

The National Quality Forum (NQF),

Endorsing a Framework and Preferred Practices for Measuring and Reporting Cultural Competency

  • This paper presents a framework and 45 practices to guide health care systems in providing care that is culturally appropriate and patient centered. The comprehensive framework for measuring and reporting cultural competency covers issues such as communication, community engagement, and workforce training. This report is intended to provide health care systems with the tools they need to help reduce persistent disparities in health care and create higher quality and more patient-centered care.

Safe Practices for Better Healthcare — 2009 Update

Robert Wood Johnson Foundation,

National Health Plan Collaborative

  • The National Health Plan Collaborative has created this toolkit of resources, lessons, best practices, and case studies to help other health plans join the effort to reduce disparities. AHRQ was a cosponsor of the Collaborative.

Speaking Together Toolkit

  • Ten hospitals with racially and ethnically diverse patient populations participated in RWJF's Speaking Together: National Language Services Network, a program aimed at improving the quality and availability of health care language services for patients with limited English proficiency (LEP).

Hablamos Juntos - Language Policy and Practice in Health Care

  • Hablamos Juntos (Spanish for "We Speak Together") is a unique project designed to forge connections between health care providers and the rapidly growing Latino health market. They offer translation and interpreter services resources.

Medical Interpreting Specific Resources

Certification Commission for Healthcare Interpreters (CCHI),

  • CCHI is the only certification body created by interpreters for interpreters and the public good. It will involve thousands of interpreters and users of interpreter services in defining their future and the credentials by which they will be known and respected.

California Healthcare Interpreting Association,

Standards of Practice (only standard that includes ethical decisionmaking)

International Medical Interpreters Association,

Medical Interpreting Standards of Practice (only standard that includes an assessment tool at the end)

  • The Medical Interpreting Standards of Practice document was the first set of standards to be developed in the field of spoken language interpreting in medical settings. It remains a vital evaluation and competency tool for professional interpreters all over the country, delineating core performance standards and competencies required of a competent interpreter.

A Medical Interpreter's Guide to Telephone Interpreting

  • Medical interpreters often have questions about telephone interpreting but often do not have access to general information about this area of interpreting. In July 2007, IMIA offered to respond to questions from its membership about this topic. This query, along with subsequent discussions with organizational members with extensive experience in providing telephone interpreting services, resulted in the compilation of questions and answers in this document.

IMIA Guide on Medical Translation

National Interpreter Advocacy Forum

  • The National Interpreter Advocacy Forum is a coalition of organizations and individuals that engage in effective advocacy for equitable treatment of language minority individuals.


National Board of Certification for Medical Interpreters,

  • The National Board aims to consolidate resources and avoid duplication in the field; coalesce existing efforts into a single national certification program; further the process and make certification available to the largest number of language in the largest number of locations; model a multiorganizational collaboration that recognizes certification efforts and other testing organizations' efforts without compromising their intellectual property; and have a comprehensive project to ensure national accreditation.

The National Council on Interpreting in Health Care (NCIHC),

National Standards of Practice for Interpreters in Health Care

National Code of Ethics

  • The National Code of Ethics standardizes expectations that the health care industry and patients should have of interpreters. The document places the code in the context of ethical behavior in general and then discusses each principle in the context of specific issues and dilemmas often faced by health care interpreters.

Registry of Interpreters for the Deaf,

RID Standard Practice Papers

Other Resources

Access Project

Community Access Monitoring Survey (CAMS) Project

  • The national report (available in English and Spanish) presents national CAMS findings. It compares the perceptions and experiences of adults who needed and had ready access to an interpreter with those of adults who needed and did not have an interpreter readily available and those who did not need an interpreter.

California Health Care Safety Net Institute

Straight Talk: Model Hospital Policies and Procedures on Language Access

  • The adoption of hospital policies and procedures is the essential mechanism to making a significant change in the operational actions of the U.S. hospital industry. It has been used throughout the history of this industry as a mechanism to change practice and establish expectations on a challenging issue. This document is designed to offer American hospitals a set of tools to use in updating their own internal policy and procedure manuals.

Institute for Diversity in Health Management's Institute Resource Center

Institute for Patient- and Family-Centered Care

Creating Advisory Councils

  • This guide discusses the purposes of an advisory council and explains all the necessary items that one may need to develop an advisory council (including council composition, structure, etc.).

Kaiser Family Foundation

Minority Health: Access to Care

  • This collection includes news updates, articles, and reports related to health and health care issues that affect underserved and racial and ethnic communities.

National Health Law Program

Language Access

Health Disparities

U.S. Department of Health and Human Services, Office for Civil Rights

U.S. Department of Health and Human Services, Office of Minority Health

A Patient-Centered Guide to Implementing Language Access Services in Healthcare Organizations

A Physician's Guide to Culturally Competent Care

  • This Web site offers continuing medical education and continuing education credit and equips health care professionals with awareness, knowledge, and skills to better treat the increasingly diverse U.S. population they serve.
Page last reviewed September 2012
Page originally created September 2012
Internet Citation: Appendix E: Resources and Tools To Address Language and Cultural Barriers and Improve Patient Safety. Content last reviewed September 2012. Agency for Healthcare Research and Quality, Rockville, MD.