How Healthcare Organizations are Implementing Disability Accommodations for Effective Communication: A Qualitative Study

Background Prior studies have documented that, despite federal mandates, clinicians infrequently provide accommodations which enable equitable healthcare engagement for patients with communication disabilities. To date, there has been a paucity of empirical research describing the organizational approach to implementing these accommodations. We asked US healthcare organizations how they were delivering these accommodations in the context of clinical care, what communication accommodations they provided, and what disability populations they addressed. Methods We performed 19 qualitative interviews with disability coordinators representing 15 US healthcare organizations actively implementing communication accommodations. We used a conventional qualitative content analysis approach to code the data and derive themes. Results We identified three major themes related to how US healthcare organizations are implementing the provision of this service: (1) operationalizing the delivery of communication accommodations in healthcare required executive leadership support and preparatory work at clinic and organization-levels; (2) the primary focus of communication accommodations was sign language interpreter services for Deaf patients and, secondarily, other hearing- and visual-related accommodations; and (3) providing communication accommodations for patients with speech, language, and cognitive disabilities was less frequent, but when done involved more than providing a single aid or service. Conclusions These findings suggest that, in addition to individual clinician efforts, there are organization-level factors that impact consistent provision of communication accommodations across the full range of communication disabilities. Future research should investigate these factors and test targeted implementation strategies to promote equitable access to healthcare for all patients with communication disabilities.