Leadership Case Study: Trying to Speak the Same Language

A few years ago, a Spanish-speaking patient was admitted to Lehigh Valley Hospital in eastern Pennsylvania where Eric Gertner, MD, works. The patient came in through the emergency department where, without trained interpreters, staff determined that she had chest and abdominal pain.

Physicians ruled out the likely suspects, cardiac arrest and pulmonary embolism, and scheduled further tests, including a stress test and abdominal CT scan.

A Spanish-speaking psychologist happened to be visiting the hospital, so house staff asked him to help them communicate with the patient about her chest and abdominal complaints.

Instead, with just a few simple questions, the staff found out that woman really was suffering from a rash on her arm. She had developed stomach and abdominal pain because her family had told her the rash was contagious and she could not touch her children.

The woman was reassured by her physicians, given an antibiotic, and sent home—but not before the hospital had spent considerable resources on unnecessary care.

“Having more effective communication would have helped,” Dr. Gertner said.

What did they do?

Faced with a number of cases like this, Dr. Gertner and a few of his colleagues decided that something needed to be done.

They went to the hospital administration and asked for interpreters, as well as cultural competency education, to help staff interact with patients from different cultures.

What happened?

Their request was met with skepticism. There simply wasn’t enough data to demonstrate a need for such programs.

“Frankly, we hadn’t done our homework enough,” Dr. Gertner admitted.

The physicians regrouped and recruited others to their cause. They held a series of meetings to gather data and anecdotal stories to back up their case.

Then, they went back to the hospital administration with a more formal presentation and, this time, got the answer they needed to strt a new program.

“We were able to show that some patients were not able to communicate with their physicians, and that we could address this by developing an interpreter program and a more comprehensive program for cultural competence,” Dr. Gertner said.

The hospital now employs a number of full-time interpreters, as well as bi-lingual medical staff. They also developed a strategic cultural competency plan and are beginning to collect data on patients, measure the knowledge and attitudes of staff, and develop educational programs.

“We will be able to measure and hopefully reduce health disparities if and where they exist for traditionally underrepresented populations,” Dr. Gertner said.

What leadership skills were used?
  • Introspection—Rather than cast blame on the hospital administration for not going along with their initial request, the physicians took a careful look at how they had approached the problem.
  • Persistence—The team kept going after the initial “no.”
  • Goal-setting—The team had to ask themselves, “What are we trying to accomplish?”
  • Planning and organization—Nothing tests your planning and organizational skills like trying to guide a large group of busy physicians.
  • Communication—After their request was originally rejected, the team had to figure out how to better communicate their idea with the administration.

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Last Updated: 2/18/2009
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