Developing and Testing Performance Measures for Language Services

In January 2006, the Joint Commission on Accreditation of Healthcare Organizations released standards and elements of performance to support the provision of culturally and linguistically appropriate health care services to individuals. While hospitals around the country are developing innovative strategies to improve language services, there are no uniform or commonly accepted measures of quality and performance for hospital-based language services. As a component of a hospital quality improvement collaborative, researchers at George Washington University developed performance measures for language services, focusing on efforts to improve efficiency, productivity, timeliness, and effectiveness in the provision of language services to patients.

Language services performance measures were developed using a rigorous process, including multiple stages of review, pilot tests, and implementation by 10 hospitals selected through a competitive process to participate in a 16-month quality improvement learning network. The 10 hospitals are using these performance measures to test the effectiveness of interventions to improve quality of care for patients with limited English proficiency (LEP).

The performance measures are designed to be used in hospital settings, although they have applicability to other health care environments. The proposed measures were reviewed by researchers, interpreter services directors, and clinical managers at hospitals with linguistically diverse populations. Prior to implementation by the hospitals in the learning network, the performance measures and quality improvement tools were field tested at Boston Medical Center and the Children's Hospital of Philadelphia. The 10 hospitals using the performance measures in the learning network are located in eight states across the country. Spanish is the most common language spoken by LEP patients at nine of the hospitals. Interpreter services contacts with patients range from approximately 25,000 to over 125,000 per year.

Based on the stages of review and field tests, five performance measures were developed for testing within the learning network. These measures focus on the efficiency, effectiveness, timeliness, equity, and safety of hospital-based language services. For the first time, hospitals will be able to gauge the extent to which they are meeting the language needs of their patient populations, at the most critical points of care.

Performance measures are essential for improving quality and establishing benchmarks and standards for hospital-based language services. The measures developed for the learning network are the first step in establishing national standards and performance measures to help organizations assess and improve the quality of care provide to patients with LEP.