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HHS offers cultural diversity guide

Washington—It was a miscommunication in health care gone awry.

A first responder misinterpreted a single Spanish word, "intoxicado," to mean "intoxicated" rather than its intended meaning of "feeling sick to the stomach," according to the account of a misunderstanding that led to a delay in diagnosis, which resulted in a potentially preventable case of quadriplegia and, ultimately, a $71 million malpractice settlement.

The Department of Health and Human Services cited this as an example of miscommunication in announcing enhanced national standards for culturally and linguistically appropriate services (CLAS) in health and health care April 24.

"Given the increasing cultural diversity over the last several decades and the rapidly changing landscape of health and health care in the United States, there is an increased need for health and health care professionals and organizations to provide effective, high-quality care that is responsive to the diverse cultural and linguistic needs of individuals served," said the 191-page document prepared by the HHS Office of Minority Health.

The enhanced national CLAS standards were presented not as regulations but rather as a 15-standard blueprint for individuals and organizations "to advance health equity, improve quality and help eliminate health care disparities." But within the CLAS framework developed in 2000 and enhanced in 2013, there are three types of standards of varying stringency: mandates, guidelines and recommendations.

According to the HHS Office of Minority Health, "[t]he CLAS standards are primarily directed at health care organizations; however, individual providers are also encouraged to use the standards to make their practices more culturally and linguistically accessible."   

Culturally and linguistically appropriate services are increasingly included in or referenced by local and national legislative, regulatory and accreditation mandates including Affordable Care Act provisions requiring that outreach and education efforts by insurance exchange "navigators" be culturally and linguistically appropriate and that insurance companies provide certain disclosures and notices in a culturally and linguistically appropriate manner, the document said.

Under Title VI of the 1964 Civil Rights Act, as implemented by Executive Order 13166, organizations receiving federal funds must take reasonable steps to provide meaningful access to their programs for individuals with limited English proficiency. Accrediting bodies such as The Joint Commission and the National Committee for Quality Assurance have established accreditation standards that target the improvement of communication, cultural competency, patient-centered care and the provision of language assistance services. And several states have recognized the importance of cultural and linguistic competency by legislating cultural and linguistic competency training in health care.

The enhanced standards are directed to a widespread audience including accreditation and credentialing agencies, community based organizations, educators, governance and leadership, health care and service providers, health and health care staff and administrators, patients and consumers, public health workforce and purchasers.

"Culturally and linguistically appropriate services can also help health and health care professionals and organizations gain a competitive edge in the market place," the standards document noted.