Organizational Responses to Address Access and Quality of Care Issues for Limited English Proficient (LEP) Patient Populations

Limited English proficiency is a risk factor affecting millions of persons living in the United States. It can compromise the person's access to care as well as the health provider's capacity to deliver high quality, safe, and cost-effective care. This study investigates the environmental influences (i.e., regulatory, socio-demographic factors) to which health care delivery organizations and public health departments must respond to meet the needs of limited English proficient (LEP) patients, and identifies organizational strategies employed in diverse settings. In-depth interviewing of key stakeholders from diverse organizations was utilized to gain perspectives on language access issues. Organizational theory, specifically open systems and resource dependence theories, guided this study, and helped to illuminate the exchanges between these organizations and tactics used to mitigate potential losses of power and autonomy. This study identified interagency collaborative efforts in language access policymaking and practice that varied in scope, formality, and resources. In general, collaboration was viewed favorably, and was an important vehicle to address health equity, limited resources, and increasing regulatory and financial pressures. However, administrators often found it difficult to secure leadership engagement and resource support, as well as maintain language access as a high priority issue within their respective organizations and across partner organizations due to competing and changing priorities. Further research is necessary to explore enabling factors in language access, in light of an ever increasing demand for linguistically appropriate services and limited resources within and across organizations