Massachusetts General Hospital

In late 2002, Mayor Thomas Menino convened the Boston teaching hospitals to explore their role in eliminating disparities in health and health care among racial and ethnic minorities in the city.  As part of this effort, Peter Slavin, MD, President of MGH, created the MGH Committee on Racial and Ethnic Disparities in Health Care in the spring of 2003, and charged it to:

     • Identify key areas where racial and ethnic disparities in health care may exist at MGH
     • Develop solutions to address disparities found at MGH

A total of 34 incidents were collected between April 2009 and March 2010 (28 of which met the specific criteria) and these cases were reviewed for key themes and safety implications. Several of the reported cases have major implications for quality and safety. For example, several cases included patients being seen without an interpreter, and one case of interpreter who arrived late and found major discrepancies in the information exchanged and understood between the patient and provider. Other examples include a family member mistranslating post-surgery instructions, and a consent form signed without any translation or explanation. Additionally, the two most reported themes (misuse of interpreter services and miscommunication) suggest the need for trainingand education in the utilization of interpreter services and improved communication skills. Further, these findings also suggest the need for diversity and cultural competency training for clinicians. The findings from this pilot will be used to inform patient safety efforts for LEP patients at MGH.

In 2010, the Committee focused its efforts in these areas:

Patient Safety Systems for Limited English Proficient (LEP) Patients – Improving Care for LEP Patients

The Disparities Solutions Center, in collaboration with Abt Associates, Inc. in Cambridge, MA, was awarded a four year contract by the Agency for Healthcare Research and Quality (AHRQ) to develop tools to reduce medical errors and improve care for LEP patients in hospitals. The project uses a robust mixed methods approach to 1) identify the role of language and cultural barriers on patient safety events; 2) document how hospitals are addressing the safety of LEP and culturally diverse patients; and 3) provide guidance and tools for how hospitals can address these issues. The final products, currently in development, include a Hospital Guide and a TeamSTEPPS Training Module focused on improving team communication to reduce medical errors for LEP patients.

The Hospital Guide will provide quality and safety leaders within hospitals with a variety of key guidelines and strategies for identifying, reporting, and addressing medical errors that occur as a result of language barriers in LEP and culturally diverse patients. The Guide will also provide hospital leaders on how to develop reporting systems that can successfully capture medical errors that predominantly affect LEP patients, as well as modalities that can be implemented to prevent errors for LEP and culturally diverse patients. The TeamSTEPPS training module is designed for the full interprofessional care team, including interpreters, and includes a case-based video vignette of an LEP patient in the emergency room.  The goal of the Module is to help the interprofessional care team acquire the knowledge, attitudes and behaviors needed to reduce the number and severity of patient safety events that affect LEP and culturally diverse patients. These tools will be available in 2012.

 Interpreter Pilot Project - Capturing Interpreters Perspectives on Patient Safety Issues

As part of the AHRQ LEP project mentioned above, we conducted an interpreter pilot project where we asked medical interpreters to document information about the types of situations or incidents that negatively impact the safety of LEP patients and who are racial/ethnic minorities. Any significant quality and safety events were reported to the MGH Quality and Safety Leadership immediately, otherwise incidents were reviewed by the MGH Interpreter Services Leadership and the Disparities Solutions Center’s project leadership quarterly.

Center for Community Health Improvement

Phone: 617-726-8197
Fax: 617-726-2224

Avon Breast Care Program
Contact Luz Betancourt at 617-887-3789