We need to talk: Study highlights effort to overcome language barriers in surgical patient care

Communication between patients and health care professionals is a key aspect of ensuring the safe and effective delivery of care.

According to a U.S. Census Bureau report, more than 60 million people speak a language other than English at home, with 22 percent of those individuals stating they speak English poorly or not at all.*

These language barriers may complicate patient experiences, including the informed consent process. Miscommunication also may lead to adverse events, longer stays in the hospital, or decreased access to care and preventative services.

The June 2020 issue of The Joint Commission Journal on Quality and Patient Safety focused on an initiative to identify general surgery residents who are proficient in a non-English language and have them take the Clinician Cultural and Linguistic Assessment (CCLA) to become qualified bilingual staff speakers. In the study, “Surgical residents as certified bilingual speakers: A quality improvement initiative,” by Alex Solomon, MD, and colleagues—general surgery residents from the 2017–2018 academic year at Johns Hopkins Hospital, Baltimore, MD—were asked to self-identify as proficient in a language other than English in a survey that simply asked them to answer “yes” or “no.”

Of the residents who responded to the initial survey, 18 of 65 identified themselves as having proficiency in a language other than English. The languages that are offered for certification as part of the CCLA exam are as follows:

  • Amharic
  • Arabic
  • Armenian
  • Burmese
  • Cambodian
  • Cantonese
  • Dari
  • Farsi
  • French
  • German
  • Haitian Creole
  • Hindi
  • Hmong
  • Japanese
  • Korean
  • Mandarin
  • Pashto
  • Polish
  • Portuguese
  • Russian
  • Somali
  • Samoan
  • Spanish
  • Tagalog
  • Vietnamese

A total of 12 of those residents took the CCLA exam, and nine—75 percent—passed, with five certifying in the most commonly spoken non-English languages at the academic medical center. Fees for the exam were waived, and each resident was excused from clinical duties to complete the test.

As a result of the initiative, the number of certified residents increased from one to 10. The languages that the residents were certified in were as follows:

  • Spanish – 4
  • Farsi – 2
  • Arabic – 1
  • Cantonese – 1
  • Hindi – 1

An opportunity to connect

“Residents care deeply about the patients they care for yet are often very busy,” said Elliott R. Haut, MD, PhD, FACS, vice-chair, quality and safety for surgery, Johns Hopkins, and a co-author of the study. “Speaking to patients with limited English proficiency in their own languages helps residents build rapport with patients and saves time. This study demonstrates how this can be done in a safe and standardized fashion. Lowering the barriers to certification without lowering the standards for certification helps residents promote culturally sensitive, high-quality and equitable patient care. Resident quality improvement projects are key components of their education and can help lead to change for institutions.”

The study authors concluded that “language barriers result in health care disparities for patients with limited English proficiency.” But with the newly certified surgeons, it would allow for “increased language concordant care, which may be associated with improved outcomes.”

My personal feelings on this topic go beyond a CCLA-certified resident being able to translate to a patient. To me, a key aspect of this initiative is that many of these residents may have a much better understanding and appreciation of the culture and of the customs of these patients who may be immigrants or who have not had the opportunity to learn how to speak English. The residents may have lived in the same areas of the world as these patients, or they may have family who have shared with them traditions and culture associated with their ethnicity or point of origin.

Therefore, the resident’s ability to relate to the patient’s needs, values, and beliefs provides them with a unique opportunity for patient-centered care.

The study can be accessed here.


The thoughts and opinions expressed in this column are solely those of Dr. Pellegrini and do not necessarily reflect those of The Joint Commission or the American College of Surgeons.

*Ryan C. Language use in the United States: 2011. Report No. ACS-22. U.S. Census Bureau. Updated November 9, 2018. Available at: www.census.gov/library/publications/2013/acs/acs-22.html. Accessed November 24, 2020.

Solomon A, Calotta N, Kolarich A, et al. Surgical residents as certified bilingual speakers: A quality improvement initiative. Jt Comm J Qual Patient Saf. 2020;46(6):359-364. Available at: www.jointcommissionjournal.com/article/S1553-7250(20)30034-9/fulltext. Accessed November 24, 2020.

The Joint Commission. Quality improvement initiative certifies surgical residents as bilingual speakers to improve communication and delivery of care. June 2020. Available at: www.jointcommission.org/resources/news-and-multimedia/news/2020/06/quality-improvement-initiative-certifies-surgical-residents-as-bilingual-speakers/?ref=TJCAL20. Accessed November 24, 2020.


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