Language barriers put patients at higher risk in hospital

OTTAWA – A new report on unintended hospital harm shows a 30% higher rate of harmful events among patients who speak neither English nor French, compared with patients who speak either official language. The study was produced by the Canadian Institute for Health Information (CIHI).

In addition, the data suggests that a patient’s education level is associated with the likelihood of a harmful event occurring while in hospital. Specifically, patients with less than high school education had a 20% higher rate of experiencing a harmful event during their hospital stay.

The latest report from the Canadian Institute for Health Information (CIHI), Improving patient safety and quality of care: Applying an equity lens to hospital harm, sheds light on patient groups that may be more likely to experience unintended harms during hospital stays in Canada.

Using linked census data, the analysis reveals that some populations are at greater risk of experiencing unintended harm in Canadian hospitals.

This analysis suggests that strategies to improve communication between providers and patients with language and education barriers would improve the safety of hospital care.

“This data clearly shows that the system does not provide the same safe, reliable, high-quality care to all patients. Drilling down on this data will inform approaches to improve equity in safe, high-quality care, for example, by improving communications with older patients, those who have limited language skills in English and French, and patients with lower education levels,” said Dr. G. Ross Baker (pictured), professor emeritus, Dalla Lana School of Public Health, University of Toronto, and renowned patient safety expert.

Provincial/territorial and regional health systems and hospitals can use this national-level analysis as a model to identify variations in patient safety across their patient populations as they strive to provide safe and equitable healthcare.

Canadian patient safety by the numbers
Hospital harm is defined as the rate of acute care hospitalizations with at least one occurrence of unintended harm during a hospital stay.

Unintended hospital harm in Canada (2023–2024)

• 1 in every 17 hospital stays involves an incident of unintended hospital harm – this is approximately 150,000 out of 2.5 million hospital stays (6%).

Overall system cost and sustainability (2023–2024)

• The average cost of a hospitalization for patients experiencing an unintended harmful event is 4 times higher than the average cost of one without such an event ($42,558 versus $9,072).

Patient demographics (2014–2015 to 2022–2023 hospitalization records)

• Patients who are older, male, living in urban areas or living in lower-income neighbourhoods are at the highest risk of experiencing unintended harm during hospital stays in Canada.

Education (Statistics Canada 2016 Census linked to 2016–2017 to 2018–2019 hospitalization records)

• Patients who have less than high school education have a 20% higher rate of harmful events compared with patients who have high school education or more.

Language (Statistics Canada 2016 Census linked to 2016–2017 to 2018–2019 hospitalization records)

• Patients who do not speak English or French have a 30% higher rate of harmful events compared with patients who speak English or French.

How can health system partners improve patient safety?

Health leaders can improve equity in patient safety within their jurisdictions by promoting effective patient–provider communication during healthcare interactions to reduce unintended hospital harms for all populations.

“These findings highlight that when someone is unwell, effective communication with their care team is crucial for both safety and better health outcomes,” said Dr. Jennifer Zelmer, president and CEO, Healthcare Excellence Canada (HEC). “Healthcare providers can improve care by using strategies that address communication and language challenges, while also meeting the unique needs of patients who may be at higher risk of harm.”