Rethinking language access to address disparities in quality of care: An organizational framework

In order to improve the quality of care available to patients that are limited English proficient (LEP), we offer a framework developed from a review of the literature on language services to help guide policymakers, hospital leaders, and health service providers  when considering delivery strategy and policy. 

Empirical literature describes exacerbated barriers to health care experienced by foreign-born populations that are also limited English proficient (LEP). Evidence indicates that disparities in the quality and systematic delivery of mandate language services (LS) persist. To  understand the context of this variation we review the evidence on how language services are conceptualized in the literature and in practice, as well as the role of place as a determinant of LS. 

We used a multi-dimensional approach to developing our framework. First we systematically reviewed the literature on  language services and offer a review of the dimensions currently used in the literature. Second, using geo-spatial theory, we evaluated the role of contextual place in the delivery of high quality LS.  The resulting framework is based on organizational-quality theory that can be used to study the delivery of language services.

The objectives of this review will place language services in a context relatable to the needs of hospital-organizations and policy makers to support research and scholarship that aims to improve quality of care for LEP patients. The need for coordinated care is critical in this era of health reform and a renewed emphasis on coordination of care for improved quality and efficiency is becoming the norm.