Provider Survey

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HEALTHCARE PROVIDER SURVEY

We know that you are very busy, but please take a few minutes to answer the following questions – to help improve our services to you and your limited English proficient (LEP) patients in the future. Your answers will remain confidential, and your participation is completely voluntary. Thank you for your valuable time and assistance!

* Indicates required field

Facility or Organization *

Quality of Today’s Interpretation Service – Are the following statements true or false?

1. The interpreter was punctual and professional *

True False

2. The interpreter interpreted everything I said to the patient *

True False

3. The interpreter interpreted everything the patient said to me *

True False

4. I could ask the patient more detailed questions with interpreter here *

True False

5. The patient was more comfortable with the interpreter here *

True False

Information About Your Interactions with Limited-English Speaking Patients

6. Approximately what proportion of your patients are limited-English speaking? *

7. From which racial/ethnic group are they? (check all that apply) *

Arabic Armenian Cambodian Chinese Farsi Filipino Japanese Korean Russian Spanish Thai Tongan Vietnamese Other

Check all that apply

8. Have you ever encouraged any of your patients to bring an interpreter with them? *

Yes No

9. Does your health care organization provide interpretation for your limited-English speaking patients? *

Yes No

If yes, have you used any of the following sources for interpretation within the last 12 months?

Trained staff interpreters *

Yes No

Bilingual staff (non-trained) *

Yes No

Telephone language services *

Yes No

Patient’s friends or family members as interpreters *

Yes No

Community-based organizations *

Yes No

Volunteers *

Yes No

Contracted interpreters *

Yes No

Other: Who? *

10. Are you familiar with any state or federal laws regarding provision of interpretation services to limited-English speaking patients? *

Yes No

11. Which of the following would help you to improve the availability or accessibility of trained interpreters at your healthcare organization? (check all that apply) *

Administrative/management support of interpretation services Clear-cut procedures on how to obtain interpreters internally or externally (contracted interpreters) Additional budget specifically allocated for interpretation Cultural sensitivity training for staff Appropriate interpreter training for in-house bi-lingual staff In-service or videos depicting appropriate interpreter utilization A simple method to help determine the spoken language of any limited-English speaking client (language identification chart etc.) Other

12. Please provide any additional comments: *

SUBMIT

Thank you!

PALS for Health is a division of Special Service for Groups
515 S. Columbia Ave. Suite 320
Los Angeles, CA 90017
P: (213) 553-1818 | F: (213) 553-1876 | E: info@palsforhealth.org