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Hurdling Language Barriers

Spanish-speaking patient with their physical therapist talking through the use of an online interpreter.

Division faculty members Ricardo Suarez and Janelle Gilmer take on language equity in healthcare, spurring improved patient care and systemwide action.




FOR RICARDO SUAREZ AND JANELLE GILMER, both assistant professors of clinical physical therapy at the USC Division of Biokinesiology and Physical Therapy, the process of treating non-English speaking patients proved challenging and inefficient.

Though hospital policy called for the use of a certified interpreter for non-English speaking patients, accessing such support was rarely easy. In many cases, Suarez recalls, he would not discover a language barrier until arriving at a new patient’s bedside. He would then scramble to find an interpreter or locate language-translation technology.

“We spent a lot of time trying to function in a system of just getting by,” Gilmer says.

The inefficiencies regularly frustrated physical therapists, frequently frazzled patients and too often impacted patient care. In Suarez and Gilmer’s department, which works extensively with liver transplant patients, Spanish-speaking patients had a 26.1 percent re-admission rate compared to 21.2 percent for English speakers. The rate for Spanish-speaking female patients sat even higher at 28.4 percent.

“As someone who identifies as Latinx, that disparity was troubling,” Suarez says.

Inspired by the nation’s social justice reckoning following the 2020 death of George Floyd, Suarez began contemplating solutions alongside Gilmer, a long-time colleague who shared his concern. If patients could more easily communicate in their preferred language, Suarez and Gilmer believed readmission rates would fall.

“We could certainly do more than get by,” Gilmer says.


Finding a Better Way


In late 2020, Suarez, Gilmer and team partnered with Keck Hospital’s Office of Performance and Transformation to further investigate the liver transplant population, 20 percent of whom list Spanish as their preferred language. Together, they reviewed data and existing processes. They analyzed operations and dissected barriers of communication. The efforts sparked a six-month pilot study launched in January 2021 to address language equity and care delivery among liver transplant patients.

“In our little corner of the world, we wanted to see if we could make a difference,” Gilmer says.

To confirm a patient’s preferred language, Suarez, Gilmer and members of the Performance and Transformation team developed a new script for physical therapists to use. (Though electronic medical records held preferred language information, it was cumbersome to find.)

If patients indicated a language other than English, the attending physical therapist then had clear protocols to determine the need for use of certified interpreters.

The interpretation services would then be provided either in-person by a hospital staff member or via videoconference calls or phone.

With language equity emerging a higher priority among physical therapists in Suarez and Gilmer’s department, work with certified interpreters soared.

In our little corner of the world, we wanted to see if we could make a difference.

Both Suarez and Gilmer found their non-English speaking patients becoming more active participants in their rehabilitation and recovery, truly meeting the goal of patient-centered care. Over the six-month pilot study, readmission rates decreased by 6 percent among Spanish-speaking liver transplant patients.

“Connecting with patients in their preferred language improved our impact and rapport with patients,” Gilmer says. “We were better able to understand their thoughts and needs and share responsibilities for care together.”

While Spanish-speaking patient Patricia Cano had worked with well-intentioned and compassionate English-speaking healthcare providers before, she calls the ability to communicate in her native tongue a game changer as she recovered from a liver transplant this past summer. Before, Cano grew frustrated at her inability to fully express herself to healthcare staff or understand the rationale behind a prescribed treatment.

With translation services readily available, however, she relished improved communication with her providers and felt more invested in her recovery, which included physical therapy work with both Suarez and Gilmer.

“It makes you feel more motivated,” Cano says.

Teresa Martinez, another Spanish-speaking patient, received extensive physical therapy at Keck Hospital following a liver transplant earlier this year. She, too, credits the accessibility of language services with propelling her recovery. It enabled her to clearly understand directions and better detail her condition to physical therapists.


Sparking Greater Movement


The positive impact on both physical therapy operations and patient care realized through the pilot study sparked further progress. It propelled the discovery of translation services within the department’s existing home exercise program and facilitated the creation of shared Spanish-language documents that other physical therapists in the USC system could access.

“This whole project made us curious and eager to explore what more we could do,” Gilmer says.

Over the last year, the effort has moved beyond Suarez and Gilmer’s “little corner of the world” and stimulated additional language equity initiatives at Keck Hospital, which features a patient population speaking more than 80 different languages. Suarez and Gilmer have presented their findings to more than 250 hospital employees, including administrators, and the project’s quantifiable impact combined with USC’s accelerating focus on addressing health disparities continues generating systemwide attention.

Recently, for instance, hospital leadership established an interdisciplinary language access working group to drive language equity. The group, which includes both Suarez and Gilmer, is leading efforts to develop guidelines enhancing language practices, streamline preferred language documentation, expand translation services and improve staff education modules related to language. It is also creating a health equity dashboard to assess performance.

These strong personal relationships cultivate trust, and that’s so key to the work of physical therapists and our role in improving patient care.

There has also been one subtle, yet important change enacted systemwide: whenever a provider opens a patient’s chart, the individual’s preferred language now resides on the banner bar for immediate recognition.

“Changing system habits and impacting patient care in a positive way is a special feeling,” Gilmer says.

And patients are feeling the effects.

Olga Fuentes, a Spanish speaker who worked with USC physical therapists prior to her kidney transplant last September, says the opportunity to communicate in Spanish provided confidence and comfort at a vulnerable time.

“I understood what the doctor said because it was explained to me in Spanish,” Fuentes says. “And if I didn’t understand it at that moment, then they could repeat it.”

Suarez says enabling patients to communicate in their preferred language cultivates deeper conversations and stronger connections between patient and provider. Today, he says there is more clarity, understanding and even excitement from non-English speaking patients to participate in their recovery.

“These stronger personal relationships cultivate trust, and that’s so key to the work of physical therapists and our role in improving patient care,” Suarez says.