Dr. Glenn Flores Examines the Impact of Language Barriers on Healthcare for LEP Spanish Speaking Patients: Interpreters Greatly Improve Quality of Care and Patient Outcomes


Dr. Glenn Flores, Distinguished Chair of Health Policy Research at the Medica Research Institute, has conducted numerous studies demonstrating the potent impact of language barriers on health, specifically for limited English proficient (LEP) Spanish speaking populations.

Latinos are the largest racial and ethnic minority group in America, including more than 56.6 million people and comprising 18 percent of the U.S. population. This group faces language challenges that can impact multiple aspects of healthcare, including access to healthcare, health status, use of health services, patient-clinician communication, satisfaction with care, quality of care and patient safety.


In his research, Dr. Flores addresses how language barriers impact healthcare for this Latino subgroup. Title VI of the Civil Rights Act of 1964 states that denial or delay of medical care for LEP patients due to language barriers constitutes a form of discrimination and requires that all healthcare organizations provide adequate language assistance to LEP patients (US Department of Health & Human Services, 2016). However, decades of research reveal that language problems continue to impact LEP populations (Flores, 2005).

For example, “in psychiatric settings, LEP patients have a greater likelihood of a diagnosis of more severe psychopathology, are more likely to leave the hospital against medical advice, are less likely to establish a good rapport with the physician or other healthcare provider, are less likely to receive an adequate explanation of their therapeutic regimen and are less likely to give feedback to their physician or other healthcare providers (Flores, 2005).”

Language barriers can have a profoundly adverse impact on communication between healthcare providers and LEP patients. Specifically, ad hoc interpreters—including family members, friends, untrained medical staff and strangers from the waiting room or street—can lead to especially harmful consequences for LEP patients and families.

A study on a major pediatric residency program (Burbano O’Leary et al., 2003) found that “68 percent of the pediatric residents spoke little or no Spanish, and 53 percent of non-Spanish proficient residents used inadequate language skills in patient care often or daily. Many of the pediatric residents reported that LEP families under their care never or only “sometimes” understood their child’s diagnosis (noted by 53 percent of residents), medications (28 percent), discharge instructions (43 percent), and follow-up plan (40 percent). Eighty percent of residents avoided all communication with LEP families. Although all of the pediatric residents agreed that hospital interpreters were effective, 75 percent reported never/only sometimes using hospital interpreters.”

In patients with hypertension and diabetes, health status, physical functioning, psychological well-being, health perceptions and pain scores are higher (i.e. better) for patients whose physicians spoke their native language vs. those who did not (Pérez-Stable et al., 1997).

One study revealed a two-fold increased risk of medical events for Spanish-speaking patients who did not request an interpreter vs. those who did (Cohen et al., 2005). Serious medical events included medication errors, missed or delayed diagnoses, monitoring failure, procedures performed on the wrong patient, incorrect procedure performed and administration of breast milk given to the wrong patient.

An example of serious communication errors includes a published case describing a two-year-old child who fractured her clavicle after falling off her tricycle. The resident physician treating the child misinterpreted two Spanish words, diagnosed child abuse and contacted the Department of Social Services who, without an interpreter, had the mother sign over custody of both of her children (Flores et al., 2000).

The study concluded that compared with ad hoc interpreters and not using any interpreter, professional hospital interpreters result in significantly lower errors, including errors of potential clinical consequence. Ad hoc interpreters, and having no interpreter at all, can cause miscommunication, a lower quality of care can have the potential to cause medical errors (Flores et al., 2012).

InDemand video remote interpreting (VRI) technology is an efficient and effective way to provide access to medically qualified interpreters to support better care for LEP, Deaf and HOH patients.


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