Bill Tan arrived in America when he was 15 years old. He knew just 500 words of English, but this was 500 more than his family members. The experience inspired him to found Transcendent Endeavors, a company whose core mission is to use technology to break down communication barriers.
26 million Americans have limited English proficiency (LEP) and this number is increasing fast. Transcendent Endeavors has seven projects designed to help people without strong English skills navigate in an English speaking world. Its Starling product is designed to improve communication in hospitals. It is currently in place at the NYU Medical Center and TE recently won a grant to deploy it in more health centers around the country.
Starling is a reinvention of the hospital bedside call button. Tan said that the call button was first invented by Florence Nightengale 150 years ago and the set up hasn’t really changed.
“It was a copper bell tied to a string, now it is a plastic button tied to a wire,” Tan said in an interview. “But call bells don’t articulate what the patients need. They are more of an obstacle to communication than a facilitator, and we realized that it is not the response that matters, so much as the request.”
Nurses are an overburdened workforce, and hospital interpreters are a limited and precious resource which should be reserved for more complicated tasks, like conveying a diagnosis or treatment regimen. Transcendent Endeavors collected data which found that on average, members of a care team answer 78 call light requests in a 12 hour shift, and that 53 percent of healthcare enter staff believe answering call bells hinders them from engaging in more critical care activities. Responding to these requests takes even longer when there is a language barrier involved.
Starling’s system is a bedside unit with icon buttons for a drink of water, request to get out of bed, needing to use the bathroom, wanting more pillows etc…Patients specify what their need is and nurses know right away what they want. Nurses can send a message back in the patents preferred language through Starling, and prioritize/delegate accordingly.
“Nurse managers now have a much better way to understand what is going on in the unit,” Tan said. “They can see what is happening in real time, how many patents are making requests, how efficiently the staff responds and all these data points can help them make decisions and optimize the work flow.”
Helping health staffs run more efficiently is valuable in-and-of itself. However this also has a significant impact for patients who are unable to verbalize what they want. Tan said that more than 90 million people in the US. have low functional health literacy. This means that when they are in a hospital or medical center, it is difficult to give and get information from doctors and nurses without an interpreter. Bridging these language gaps is frustrating and anxiety provoking on all sides, and in certain situations compromises the quality of care. Many immigrant families rely on their children who have developed strong English skills to guide them through the process, but this can mean taking kids out of school.
This was the case with Tan’s family.
“When I arrived here, I was usually the person taking my parents to hospitals and other services,” Tan said. “A lot of immigrant parents really value education and the last thing they want to do is yank their kids out of school to take them to the hospital. This is so backwards, and I thought there if there are tools out there to help other industries deal with multilingual populations, we needed to do that with health and education as well.”
Transcendent Endeavors was founded in 2001 and has received multiple NIH awards. Canopy, another one of its offerings, is an e-learning platform that promotes foreign-language proficiency among healthcare professionals so they engage more clearly with their patients and gain greater cultural sensitivity. Its SAGE product facilitates communication specifically surrounding complementary and alternative medicine (CAM), for interactions outside the hospital. MiniMiti Adventures is an animated series for children and their families that promotes healthy eating and physical activity. The Vocatta Messenger is a channel for healthcare professionals to deliver customized messages to recipients.
The company is also working on a “communication genome project” to “break communication down into its most elemental components” and “render the communication process into a machine-readable format.” Many of its products are based on this platform.
Tan said that tools and technology along these lines is “critical” now more than ever. Healthcare reform in the U.S. means millions of people who were previously un or under-insured — many of them immigrants– will soon be brought into the mainstream healthcare system. He said that the obstacles to reaching these populations are often economic and social, and products like these can have a huge impact on productivity as well as care quality. Its Florence Nightingale for a digital, polyglot world.