BUSI 311 Week 7 Discussion Board Forum 7 Example

Discussion Board Forum 7: Addressing Health Disparities Through Cultural Proficiency

BUSI 311 Introduction to Healthcare Administration, Discussion Board Forum 7

Thread by [Student Name]

The practice, its patients and the classmates are composites; the textbook, Scripture and the peer-reviewed articles cited are real.

Five years ago, about 5% of our practice's visits were with patients who prefer Spanish. Today it is about 20%. We never decided how to serve them; we improvised. Two bilingual medical assistants interpreted when they were free, family members interpreted when they were not and sometimes a patient's teenage child explained a new diagnosis to a parent. Buchbinder and Shanks (2017) describe cultural proficiency as more than individual sensitivity: it is an organization's capacity to serve diverse patients well, built into policy, staffing and resources. By that standard, we were not proficient. Our good intentions depended entirely on who happened to be working, which is the opposite of a reliable system.

The cost of improvising is documented. Mumau et al. (2025) reviewed 24 studies of patients with limited English proficiency in emergency and inpatient care and found recurring themes of communication errors and anxiety, failure to seek or receive the right services, in-hospital complications and organizational risk, along with uneven access to effective interpreters. They also discuss the biblical call to equitable care for foreigners.

Would paying for professional interpreters make a difference? Karliner et al. (2007) reviewed 28 studies and found that in all four areas examined, communication, use of services, clinical outcomes and satisfaction, professional interpreters improved care more than ad hoc interpreters and brought the care of patients with limited English almost up to the standard enjoyed by fluent English speakers.

I proposed three changes: a contract with a telephone and video interpreter service available in every exam room, a written policy that minors and untrained staff will not interpret clinical information and a field in our scheduling system to flag preferred language so an interpreter is ready before the patient arrives. We will track how often visits with Spanish-preferring patients use a professional interpreter and ask those patients, in Spanish, whether they understood their care plan. The service costs about as much as a part-time employee, which our physicians agreed was reasonable once they saw the risk we had been carrying. God told Israel that the stranger who sojourns with them shall be as the native among them, and that they shall love him as themselves (English Standard Version Bible, 2001/2016, Leviticus 19:34). A patient who cannot understand her own diagnosis has not truly been seen, no matter how long the visit lasted.

Reply to Gabriela

Gabriela, thank you for raising a practice many clinics share. You wrote that families at your pediatric clinic often bring an older child to interpret and that staff find it convenient. I understand why, since it saves time and families often offer, but the evidence argues strongly against it. Boylen et al. (2020) reviewed studies of hospitalized children from migrant and refugee families with limited English proficiency and found that families reported greater satisfaction with aspects of care when professional interpreters were used instead of ad hoc ones. Karliner et al. (2007) found that ad hoc interpreters, including family members, were associated with more communication errors and worse understanding than professionals. A child interpreting for a parent may also hear information about a parent's or sibling's health that no child should carry, and may soften bad news to protect a parent, leaving the parent without information they need to make decisions.

Paul told the Philippians to set aside rivalry and pride and to treat others as more important than themselves (English Standard Version Bible, 2001/2016, Philippians 2:3). Convenience for staff should never outweigh accuracy and dignity for the families we serve. A telephone interpreter takes only a minute or two to connect, and once staff use the service a few times, it usually becomes as easy as calling the child over. Could your clinic post signs in common languages telling families that free professional interpreters are available, so parents know they need not bring their children, and train front desk staff to offer the service at check-in?

Reply to Nathan

Nathan, your question is an important one. Your clinic relies on bilingual staff members to interpret, and you asked whether that is good enough. It depends on their training, their fluency in medical vocabulary and their other duties. Boylen et al. (2020) found no difference in the accuracy of a child's discharge diagnosis between families assigned professional interpreters and those cared for by bilingual physicians, which suggests that clinicians who are fluent in the patient's language can provide high-quality care directly, without a third person in the room. The picture is different for staff pulled from other work to interpret. A medical assistant who speaks Spanish at home may not know the medical terms for a procedure or a medication side effect, and when she leaves her own patients to interpret, both sets of patients wait. The problem is not her goodwill but the lack of training and time. Karliner et al. (2007) distinguished professional interpreters from ad hoc ones, including untrained staff, and found better outcomes with professionals.

A practical policy might be to test and certify bilingual staff in medical interpreting before they interpret, track how often they are pulled from their own work and use a professional service when they are unavailable. Jesus told the parable of the good Samaritan, who crossed a cultural divide to care for a wounded stranger (English Standard Version Bible, 2001/2016, Luke 10:33-34). Would your clinic consider paying a language differential to staff who earn certification, so that interpreting becomes a recognized part of their job rather than an unpaid favor?

References

Boylen, S., Cherian, S., Gill, F. J., Leslie, G. D., & Wilson, S. (2020). Impact of professional interpreters on outcomes for hospitalized children from migrant and refugee families with limited English proficiency: A systematic review. JBI Evidence Synthesis, 18(7), 1360-1388. https://doi.org/10.11124/jbisrir-d-19-00300

Buchbinder, S. B., & Shanks, N. H. (2017). Introduction to health care management (3rd ed.). Jones & Bartlett Learning.

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Karliner, L. S., Jacobs, E. A., Chen, A. H., & Mutha, S. (2007). Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Services Research, 42(2), 727-754. https://doi.org/10.1111/j.1475-6773.2006.00629.x

Mumau, A., Joseph, R., & Bridge, D. (2025). The impact of limited English proficiency on patient experiences and care in the United States. Journal of Christian Nursing, 42(2), E24-E35. https://doi.org/10.1097/CNJ.0000000000001276