Serving more than 2.85 million patients annually, primarily Medi-Cal and uninsured, California's 21 public health care systems are on the front lines of implementing health reform. In this newsletter, we hope to offer a window into that experience.




With millions of Californians eligible for new coverage as a result of the Affordable Care Act, public health care systems are working to compete as providers of choice for this newly eligible population by improving the experience of care within their delivery systems. For the 40 percent of Californians who speak a language other than English at home, being able to speak with health care providers in the language that they prefer can greatly enhance their care experience. Effective communication between providers and patients also helps ensure that patients receive the high quality care and support they need to get well and stay healthy.


Providers in public health care systems are pursuing a range of strategies to deliver truly patient-centered services that are respectful of and responsive to the linguistic needs of their patients. For example, Alameda Health System's (AHS) Interpreter Services program provides translation in 26 languages. As a multi-site public health care system in the Bay Area, videoconferencing allows AHS staff from different locations to provide language support regardless of which site patients frequent for care. Video medical interpretation (VMI) has resulted in a reduction in wait times for AHS patients, connecting patients to interpreters within five minutes of the request.


Puspa Rai, a native Nepali speaker, first learned of AHS's Interpreter Services in 2008 during a Refugee Health Screening Clinic at Eastmont Wellness, one of AHS's four neighborhood-based community Wellness Centers where she now receives her primary care. When Rai arrived at her appointment, she was met in-person by Ram Magar, a member of AHS's Interpreter Services Team and a Nepali speaker. Rai was easily able to communicate with the Eastmont Wellness staff, and has since used the VMI system during appointments at other AHS facilities.


"I like the way she [Magar] interprets for me," says Rai. "Interpreter Services has helped me a lot, especially when I have to go to Highland Hospital.   Having Ram there via video medical interpretation is very helpful."


In their efforts to best serve the culturally diverse communities that rely on their systems of care, California's public health care systems have become industry leaders in language services. In 2005, three such systems founded the Health Care Interpreter Network (HCIN), a cooperative of hospitals and clinics sharing trained health care interpreters through an automated video/voice call center to ensure patients receive care in the language they understand. The network has since grown to include 12 of California's public health care systems and other provider organizations across the nation, giving patients real-time access to trained interpreters in 170 languages. (For more information about HCIN, please visit their website.)


In tandem with technological tools like HCIN and VMI, California's public health care systems also pioneer unique solutions tailored to the particular communities that they serve. For example, caring for immigrant families in Salinas, Natividad Medical Center is seeing a growing number of patients who speak not just Spanish, but also exclusively indigenous languages from Mexico and Central America like Mixtec, Triqui, Mum, and Zapotec. Since trained interpreters who speak indigenous languages are not available through traditional interpreting services, Natividad partnered with their community to develop a new workforce. Victor Sosa, Language Access Coordinator, sought out indigenous language speakers whom he could train to become health care interpreters, and collaborated with Bridging the Gap, the oldest national healthcare interpreter training program in the United States, to adapt their basic 40-hour training for healthcare interpreters. To date, Natividad's interpreting program has trained 88 indigenous speakers.


This March, Natividad launched Indigenous Interpreting + , a service of the Natividad Medical Foundation to offer Natividad's network of interpreters and interpreter training to other hospitals and agencies across the nation. The program was co-founded by Angelica Isidro, a Mixteco Bajo/Medio-Spanish speaker who came to the U.S. from Oaxaca in 1991 to work as a farm laborer. Often accompanying people on their medical visits to help interpret, Angelica began helping indigenous members of the community better communicate with Natividad staff. Angelica has since completed medical interpreter training and an internship program at Natividad, and is now an important cultural liaison, helping to improve on-the-job practices to provide effective communication between the indigenous community and service providers around the country.


Angelica shares about her work as an interpreter, "I think it is very important for the community, that they understand when they come to the hospital what is wrong with them...that when they leave, they leave happy, that they were looked after. For me, being an interpreter is everything."


By combining in-person medical interpreters, bilingual staff, remote interpreting technologies, and community-driven initiatives like Indigenous Interpreting +, California's public health care systems stretch limited resources to provide a better overall experience of care for their patients. Reducing language barriers between patients and providers helps ensure that everyone receives the high quality health care they deserve and an equal opportunity to enjoy good health.




CAPH is a non-profit trade association that represents California's 21 public health care systems - comprised of county-owned and operated facilities, and University of California medical centers. In partnership with our quality improvement affiliate, the California Health Care Safety Net Institute (SNI), we work to strengthen the capacity of our members to advance community health, ensure access to high-quality, culturally sensitive health care services for all Californians, and educate the next generation of health care professionals. For more information, visit us at or