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The Benefits of Bilingual Pay Differentials in Healthcare: A Guide for Healthcare Workers

As of 2021, 8% of people in the United States ages five or older are limited English proficient (LEP). Historically, the difficulties that LEP populations experience in communicating with healthcare providers have contributed to disproportionately poor health outcomes. Additionally, because people of color are significantly more likely to be limited English proficient than white people, language barriers between patients and healthcare providers have also tended to exacerbate racial and ethnic disparities in health outcomes.

As healthcare providers seek ways to bridge the gap in healthcare, recognizing the importance of being able to communicate with patients from various cultural and linguistic backgrounds is crucial.

A bilingual pay differential is a compensation strategy that rewards healthcare workers who speak more than one language for their ability to effectively communicate with a diverse caseload. In recent years, bilingual employee pay differentials have become increasingly common as a mechanism for improving patient care and outcomes while recognizing the important skillset that bilingual employees bring to the table.

This article aims to explore the benefits of bilingual pay differentials in the healthcare industry and provide a step-by-step process for healthcare workers to obtain this valuable benefit.

Benefits of implementing a bilingual pay differential in healthcare settings:

I. Improved Patient Care and Satisfaction

Research has shown that children with limited English proficient parents are twice as likely to experience adverse medical events when hospitalized, potentially due to communication breakdowns when communicating with their doctor.

This makes sense, especially because medical symptoms are often described differently from one language to another. A one-to-one or highly literal translation may, therefore, be confusing or inaccurate. For example, in Spanish, one word is used to describe muscle cramps (calambres), while menstrual cramps are described using another (cólicos). In English, this distinction is not made, and additional context is used to determine the type of cramping being referred to.

Similarly, in English, pain can be described as ‘throbbing, stabbing, dull, or burning.’ In Spanish, however, a dull pain would be described as ‘sordo,’ which translates literally to ‘deaf.’ An English-speaking healthcare worker with only rudimentary Spanish or who is relying on a literal translation might misinterpret ‘deaf’ pain as numbness, which, in the worst case, could skew their assessment results and lead to misdiagnosis.

It’s clear that having staff that can communicate to patients in the language in which they feel most comfortable is essential for accurately understanding patients’ needs, concerns, and medical histories. Bilingual healthcare workers with high levels of proficiency can ensure more personalized care, including higher levels of accuracy in the diagnosis and treatment of disease, ultimately leading to improved patient satisfaction and better health outcomes.

II. Enhanced Cultural Competence

Language proficiency often goes hand in hand with cultural understanding. Bilingual healthcare workers can navigate cultural nuances, customs, and beliefs more effectively, fostering trust and rapport with patients from diverse backgrounds.

For example, in some cultures, it is believed that discussing a possible poor health outcome will cause it to occur. A healthcare provider who is unaware of this cultural belief may unknowingly break their rapport with a family or individual by informing them of medical risks or a potentially negative prognosis. Considering that poor communication and lack of trust between patients and healthcare workers have been shown to reduce patient compliance (e.g., attendance at follow-up medical appointments, taking medications as prescribed, etc.), a breach in rapport may have serious effects on health outcomes. 

Similarly, disease-related dietary advice that does not conform to the types of foods or cooking methods used by the patient is likely to have an impact on the patient’s ability to comply with the medical advice. Conversely, ensuring that healthcare providers possess the cultural competency skills to properly advise a client, taking into account their dietary practices, is likely to lead to increased compliance and better outcomes.

Cultural understanding contributes to a more inclusive and patient-centered healthcare environment. As bilingual healthcare workers tend to have knowledge of the cultures and customs of the languages they speak, creating a bilingual pay differential is one way to attract more bilingual employees and enhance cultural competency in the workplace.  

III. Increased Access to Healthcare

Language barriers can hinder patients’ access to healthcare services. Research has shown that LEP individuals perceive poorer patient-physician interaction than people who primarily speak English. This is likely a contributing factor in limited English proficient populations being less likely to have a regular health care provider, having fewer physician visits, and having lower rates of screening (e.g., blood pressure, cancer). Fewer preventative care visits may ultimately contribute to the worse outcomes these populations experience for many diseases, including certain cancers and mastitis.

By employing bilingual healthcare workers, healthcare organizations can reach a broader patient population, build trust in limited English-proficient communities, and ensure that language is not a barrier to receiving necessary medical care. Bilingual employee pay differentials incentivize healthcare workers to develop and maintain their language skills, thereby expanding access to healthcare services for linguistically diverse communities.

IV. Recruitment and Retention of Talent

Offering a bilingual pay differential is not only beneficial to patients receiving services and the healthcare workers accessing the benefit. It also provides significant benefits to employers who can attract and retain highly skilled healthcare professionals who possess in-demand language proficiency skills.

Bilingualism or multilingualism can give healthcare workers an edge not only because of their enhanced communication and cultural competency skills but also because it enables them to access and understand medical literature, research, and resources in multiple languages. This expands their knowledge base and enhances their ability to provide evidence-based care to a wider range of patients, making bilingual and multilingual employees an even more valuable asset for healthcare organizations.

Ultimately, by recognizing and rewarding language skills, healthcare organizations can create a competitive advantage in the job market and attract a more diverse and talented workforce. Additionally, employees who feel that they are recognized and valued for the skills that they bring to the table are likely to experience greater job satisfaction, leading to increased rates of retention and improving the reputation and recruitment potential of the organizations that employ them.

Process for Obtaining Bilingual Pay Differentials:

To be eligible to obtain a bilingual pay differential as a healthcare worker, there are typically certain steps and criteria that need to be followed. While the specific process may vary depending on the healthcare organization and its policies, here is a general outline of the steps involved:

1. Language Proficiency Assessment

Healthcare workers interested in obtaining bilingual pay differentials may be required to undergo a language proficiency assessment. This assessment can determine their proficiency level in speaking, listening, reading, and writing and whether they meet the eligibility criteria for the language pay differential.

To see an example of a language proficiency assessment, you can check out Alta’s Bilingual Medical Test.

2. Documentation and Verification

Healthcare workers may also need to provide documentation or evidence of their language proficiency, such as certifications, language test results, or previous experience working with linguistically diverse populations.

3. Application and Approval

Once the necessary documentation is gathered, healthcare workers can submit an application for the pay differential to their organization’s designated department. The application will be reviewed, and approval will be granted based on the organization’s criteria and available resources.

If you want to get more into the nitty-gritty of bilingual pay differential policies or are considering implementing a pay differential in your workplace but aren’t sure where to start, you can take a look at our article, How to Create a Bilingual Pay Differential Policy.

4. Ongoing Language Maintenance

To continue receiving the differential paid in recognition of their language skills, healthcare workers may be required to demonstrate ongoing language maintenance through periodic assessments or professional development activities.

Conclusion

Ultimately, bilingual pay differentials in healthcare offer numerous benefits, including improved patient care, enhanced cultural competence, increased access to healthcare, and recruitment and retention of talent. By recognizing and incentivizing language proficiency, healthcare organizations can create a more inclusive and effective healthcare system that meets the needs of diverse patient populations.

Janet Barrow holds a B.A. in Written Arts from Bard College and a Master of Speech-Language Pathology from the University of Sydney. She works as a pediatric speech pathologist and freelance writer and is currently finishing her first novel.

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