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Med Care. 2010 Dec;48(12):1080-7. doi: 10.1097/MLR.0b013e3181f380bc.

Do hospitals measure up to the national culturally and linguistically appropriate services standards?

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Department of Health Policy Research, Palo Alto Medical Foundation Research Institute, Palo Alto, CA 94301, USA.



Federal regulations require that health care organizations provide language services to patients with limited English proficiency. The National Standards for Culturally and Linguistically Appropriate Services in Health Care (CLAS standards) provide guidance on how to fulfill these regulations. It is not known how US hospitals have incorporated them into practice.


To assess how US hospitals are meeting federal regulations requiring provision of language services using CLAS as a measure of compliance.


Cross-sectional survey.


Hospital interpreter services managers (or equivalent position).


Degree of meeting each of the 4 language-related CLAS standards.


Many hospitals are not meeting federal regulations. The majority reported providing language assistance in a timely manner in their first, but not their third, most commonly requested language. Although hospitals reported that they informed patients of their right to receive language services, many did so only in English. A majority of hospitals reported the use of family members or untrained staff as interpreters. Few reported providing vital documents in non-English languages. Overall, 13% of hospitals met all 4 of the language-related CLAS standards, whereas 19% met none.


Our study documents that many hospitals are not providing language services in a manner consistent with federal law. Enforcement of these regulations is inconsistent, and thus does not motivate hospitals to comply. Compliance will likely come with new guidelines, currently being written, by many of the regulatory organizations. Our study reinforces the importance of these efforts and helps target interventions to improve the delivery and safety of care to limited English proficient patients.

[Indexed for MEDLINE]

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