Core A—Systems of Care

Systems Design for Quality Improvement in the Care of Patients with LEP

2021–2024: CfC Awarded a Robert Wood Johnson Foundation Grant to Address Health Disparities

Strategic Design Leads Julie Woods and Sahib Singh co-designed and co-led a quality improvement pilot made possible in part with a grant from RWJF. This was a result of CfC’s participation in HEC. This systems design pilot focused on the possibility that issues of nonequivalent care for patients identified as having limited English proficiency (LEP) contributes to their poorer health outcomes.Situated at and subsequently co-designed with the Division of Hospital Medicine at UCSF Parnassus, the pilot attracted the participation of more than 40 UCSF healthcare practitioners as well as supporters and collaborators from a variety of departments including professional interpreters, quality improvement specialists, data scientists, clinical pharmacists, nurses, students and more. Eleven prototypes/interventions were designed and employed to better understand the experiences of patients with LEP in order to develop quality improvement measures that operated across the system of patient care—from the Emergency Department to discharge.

The pilot sought to achieve the following objectives:

  • Surface and understand systemic factors contributing to nonequivalent care and poor outcomes for patients with LEP compared to English-speaking patients.
  • Propose and test quality improvements that mitigate nonequivalent care for patients with LEP in service of improved health outcomes.
  • Foster a transdisciplinary model of collaboration for strategic improvement.
  • CfC expects to publish a full report early in 2025. Medical conference poster sessions, presentations and journal articles regarding the project are ongoing.

“Participating in this pilot program has led to many changes for LEP and non-LEP patients/families. We have increased our use of interpreters and translated AVS. We have previewed more discharge plans with families earlier in the admission. We have provided more notebooks/tools for families to take notes and improve the retention of the information presented during the admission. We have improved documentation of discharge plans in progress so bedside RNs and other interdisciplinary team members can be aware of the pending plans and weigh in earlier, if necessary.”

—Member of one of the prototype teams