Resource Center Poster Session II

Improving Patient Safety for Patients with Limited English Proficiency
Wednesday, March 13, 2013: 07:30 AM - 05:30 PM, OAK, East Hall
Background and Overview

Approximately 24 million people--8.5% of the U.S. population--are defined as having Limited English Proficiency (LEP).  Research suggests that among those who experience medical errors, LEP patients are more likely to be harmed, the harm is more likely to be serious, and the cause of harm is more frequently due to communication errors.  With support from The Agency for Healthcare Research and Quality, teams from the Disparities Solutions Center at Massachusetts General Hospital and Abt Associates  conducted research and developed a Hospital Guide and  TeamSTEPPS® LEP Training Module for interprofessional care teams so that hospitals can better identify and prevent medical errors in patients with limited-English proficiency. These are the first patient safety tools specifically designed to meet the safety needs of LEP patients. This panel presentation will provide an overview of the research findings that served as a foundation for the development of these tools, as well an overview of the key recommendations of the Hospital Guide and a preview of the TeamSTEPPS Module.

Study Design

To develop the Hospital Guide and TeamSTEPPS Module, we used a mixed methods approach that included: 1) qualitative interviews with frontline staff and leadership at three hospitals; 2) an interpreter patient safety pilot (interpreters were asked to document patient safety issues they witnessed); and 3) a Town Hall meeting with key leaders in patient safety to identify best practices for preventing, reporting, and documenting medical errors for LEP patients. 

Hospital Guide

Key components of the Hospital Guide include: 1) common causes of medical errors for LEP patients; 2) high risk scenarios for LEP patients; 3) role of behaviors and communication in medical errors for LEP patients; and 4) strategies to better identify and prevent medical errors in LEP patients. Validation of the Hospital Guide included key informant interviews with leaders in quality and safety at nine unique hospitals across the country. Leaders felt the Guide would have a positive and important impact on the broader field of quality and safety by “guiding tactics” and providing “a map telling us where to go.”

Team STEPPS LEP Training Module

TeamSTEPPS is a system to improve the quality, safety and efficiency of health care through improved team communication. The TeamSTEPPS Module includes videos, a slide presentation and structured communication tools and exercises.  Pilot-test results suggest that the TeamSTEPPS Module is simple and flexible enough to be implemented in a variety of settings. The intervention can also serve as a support or catalyst for change such as the addition or efficient re-allocation of interpreter resources. The TeamSTEPPS Module brings culturally and linguistically appropriate services into the mainstream patient safety effort by showing how team-based patient safety approaches can be adapted to meet the needs of linguistically and culturally diverse patients. 


The Hospital Guide and TeamSTEPPS® LEP training module will provide guidance and action-oriented tools for hospitals to address safety issues for LEP patients. Implementation of these tools can help hospitals reduce medical errors for LEP and culturally diverse patients.

  • Improving Patient Safety for LEP Patients Poster_FINAL.pdf (138.6 kB)
  • Presentation Information:

    Program: Poster Presentations (Main Conference)
    Primary Category: Organizational Cultural Competence
    Subtopics: Patient safety, Limited English Proficient, Implementing disparity reduction programs

    Region Addressed by Presentation: National
    Organization: Hospital

    Joseph R. Betancourt, MD, MPH , The Disparities Solutions Center, Massachusetts General Hospital, Boston, MA
      Massachusetts General Hospital
      The Disparities Solutions Center
      50 Staniford Street
      9th Floor, Suite 901
      Boston MA, USA 02145

      Phone: 617-724-7658
      Fax: 617-726-4120
      Email Address:

      Biographical Sketch:
      Dr. Betancourt directs the Disparities Solutions Center, which works with healthcare organizations to improve quality of care, address racial and ethnic disparities, and achieve equity. He is Director of Multicultural Education for Massachusetts General Hospital (MGH), and an expert in cross-cultural care and communication. Dr. Betancourt served on several Institute of Medicine committees, including those that produced Unequal Treatment: Confronting Racial/Ethnic Disparities in Health Care and Guidance for a National Health Care Disparities Report. He has also advised federal, state and local government, foundations, health plans, hospitals, health centers, professional societies, trade organizations, pharma, and private industry on strategies to improve quality of care and eliminate disparities. He is a practicing internist, co-chairs the MGH Committee on Racial and Ethnic Disparities, and sits on the Boston Board of Health as well as Health Equity Committee, and the Massachusetts Disparities Council.

    Melanie Wasserman, PhD , Abt Associates, Inc., Cambridge, MA
      Senior Associate/Scientist
      Abt Associates, Inc.
      55 Wheeler Street
      Cambridge MA, USA 02138

      Phone: 617.520.2714
      Email Address:

      Biographical Sketch:
      Melanie R. Wasserman, Ph.D, MPA, is a Senior Associate/Scientist at Abt Associates who also has formal training and prior experience as translator and interpreter. Over the past 12 years, Dr. Wassermanís work has focused on improving access to high-quality primary care for LEP, culturally diverse, and other vulnerable populations. Her recent projects have included the design and field test of new evidence-based tools to improve safety for patients with limited English proficiency; an evaluation of the implementation of health literacy tools for pharmacists; and leading a contract to help the U.S. Preventive Services Task Force better communicate with the public about its recommendations. Dr. Wasserman was a Peace Corps Volunteer in Niger (94-96) and speaks fluent French, Spanish and Hausa.