Language access services are critical to the Los Angeles County Department of Health Services (DHS) and can have a profound effect on the health and wellbeing of patients, with 54% of DHS patient visits among Limited English Proficient populations. To systematically know how many patients need language access services and establish a more standard program evaluation for continuity in the quality of services, FUSE Corps will partner with the Office of Language Access and Inclusion to host an Executive Fellow for one year to develop a comprehensive implementation plan with specific recommendations and measurable objectives across the Office’s focus areas.
This fellowship project begins on October 25, 2021, and ends on October 23, 2022. The fellowship begins with a multi-day virtual orientation the week of October 25, 2021. The selected Executive Fellow will begin their first day of providing services to the host agency on November 1, 2021.
The Los Angeles County Department of Health Services (DHS) is the second largest municipal healthcare system in the nation. It has an annual operating budget of over $6 billion and over 2.2 million patient visits a year, most of them low income, multilingual communities of color. DHS offers emergency, urgent and primary care through its twenty-six clinics across L.A. County with ambulatory care clinics at each site; three large critical care hospitals— two of them are level one trauma centers and one of them is a rehabilitation center. With 54% of DHS’ patient visits are with Limited English Proficient populations, language access services are critical to the county’s healthcare system and can have a profound effect on the health and wellbeing of patients. Currently, there’s significant variation of patient accessibility to language access services across the county. Some sites have robust in-person interpretation, equipment, policies, procedures, staff training; whereas other sites are at the beginning of adopting the culture and policy around language access services relying on unqualified interpretation services including untrained bilingual staff, patients’ friends and family members and Google translate to understand patients’ needs at times. The language access program at each site across the county is at a different level of capacity and maturity, which creates gaps for both patients and providers. With 54% of DHS patients requiring interpretation services, improving language access services across L.A. county’s healthcare system is critical and can have a profound effect on the health and wellbeing of millions of people.
In 2014, DHS began rolling out an Electronic Health Records system covering the entire network of hospitals and clinics which provided an opportunity to consistently document a patient’s language preference and needs in a way that was measurable and transparent. However, a lack of coordination and a system-wide approach to language services has continuously cost the county time and money. DHS has received citations from regulatory bodies and litigation that requires the agency to undergo optimization of its Electronic Health Records to identify and document provision of services, communicate resources to patients and workforce, to train workforce. DHS has made improvements to patient access to language services. Since 2018, DHS has hired an additional 45 healthcare interpreters, updated its technology platforms, and expanded access to video remote services across the entire enterprise to increase access to interpretation services and seeks to establish more standard program evaluation. Though DHS has made significant improvements in language access services, its ability to know systematically how many patients need language access services and the continuity of the quality of services remains an opportunity.
To support this work, L.A. County DHS will partner with FUSE Corps to host an executive-level Fellow for one year to assist the Director and staff of the Office of Language Access and Inclusion to develop a comprehensive implementation plan with specific recommendations and measurable objectives in each area of focus including electronic health record optimization, language needs and services screening and services provision work flows, workforce training plan that complement Electronic Health Records optimization implementation plan, stakeholder communication plans and language access services system evaluation protocol. The Fellow will assist in the process of standardizing and improving the patient experience to ensure that the agency best serves patients both in theory and in practice.
PROJECT SUMMARY & POTENTIAL DELIVERABLES
The following provides a general overview of the proposed fellowship project. This project summary and the potential deliverables that follow will be collaboratively revisited by the host agency, the Fellow, and FUSE staff during the first month of the project, after which a revised scope of work will be developed and agreed upon by the Fellow and the host agency.
Starting in November 2021, it is proposed that the Executive Fellow will lead an evaluation of DHS’s restructuring efforts to date; identify areas of weakness and develop the measuring system needed to ensure these changes have the desired impact: getting patients and workforce members to access qualified language services in a timely, accurate and private manner to meet DHS health system and patient needs. The FUSE Executive Fellow will begin a deep review and analysis of current enterprise operations by reviewing process maps, workflow analysis of key processes, programs, services, and documentation to understand the current state of the language access system. The Executive Fellow will review the current local, state and federal requirements and evaluate what data is collected to assess language and translation services and understand how language access services are evaluated. The Executive Fellow will also research frameworks for language access in other cities and counties, determine a set of best practices, and assess their applicability to L.A. DHS. To further understand the current state, the Fellow will launch a robust stakeholder engagement plan to include interviewing Office of Language and Inclusion staff, patients, community members and medical staff to understand what’s working, their needs and pain points in language access support. In addition, the FUSE Executive Fellow will conduct several site visits to at least 6 DHS sites to understand what language access and translation support looks like on the ground and to identify opportunities for improvement. By the end of the first phase, utilizing this initial listening tour with key stakeholders and the review of information gathered, the Executive Fellow will analyze gaps in communication, services, policy and administrative procedures, devise solutions to mitigate gaps and determine barriers to implementing any strategies. The Fellow will work with LAS staff to start to develop an implementation plan and opportunities to make immediate impact.
By April 2022, the Executive Fellow will fully develop their implementation plan that standardizes operations and communication for an optimal and highly effective language access service. The holistic implementation plan should include clearly defined roles and responsibilities for internal and external stakeholders; have a clear, unified vision for the future of the work, emphasizing actionable solutions that create a positive patient and provider experience ensuring limited English-speaking patients receive the best healthcare. In addition, the plan should include specific recommendation on how to leverage all available partnerships and resources for maximum support and include strategies to build internal capacity for the DHS workforce to support and sustain providing high quality language services. Throughout the process, the FUSE Fellow will incorporate community, staff, and provider feedback. By the end of third phase, the FUSE Executive Fellow will create a framework for DHS to use to guide the development of policies, procedures, and an approach to language access services for limited English proficient populations including patients who are deaf and hard of hearing. The framework will outline an optimal and highly effective language access services for DHS to include key performance indicators (KPIs) and establish a standard for language access operations, services, internal and external communications, policies and administrative procedures.
By October 2022, the Executive Fellow will deliver an implementation plan to include a list of detailed recommendations for future and ongoing improvements to the language access service program structure and with staff begin to launch recommended pilots as system and process changes as outlined in the plan. Working closely alongside a diverse group of stakeholders, the Executive Fellow will:
Desired Qualifications (not required)
FUSE Corps is an equal opportunity employer with a core value of incorporating diverse perspectives into our work at every level. We encourage candidates from all backgrounds to apply for this position.
Language access services are critical to the Los Angeles County Department of Health Services (DHS) and can have a profound effect on the health and wellbeing of patients, with 54% of DHS patient visits among Limited English Proficient…