; the nature, length, and complexity of the communication involved; and the context in which the communication is taking place. A public accommodation should consult with individuals with disabilities whenever possible to determine what type of auxiliary aid is needed to ensure effective communication, but the ultimate decision as to what measures to take rests with the public accommodation, provided that the method chosen results in effective communication. In order to be effective, auxiliary aids and services must be provided in accessible formats, in a timely manner, and in such a way as to protect the privacy and independence of the individual with a disability. (7) Linguistic diversity in the health care and health-care-related services workforce is important for providing all patients the environment most conducive to positive health outcomes. (8) All members of the health care and health-care-related services community should continue to educate their staff and constituents about limited-English-proficient and disability communication issues and help them identify resources to improve access to quality care for individuals with limited-English proficiency and individuals with communication disabilities such as hearing, vision, or print impairments. (9) Access to English as a second language, and sign language instructions, readers, and other auxiliary aids and services, are essential to ensure effective communication and eliminate the language barriers that impede access to health care. (10) Competent language services in health care settings should be available as a matter of course. 202. Improving access to services for individuals with limited-English proficiency (a) Purpose Consistent with the goals provided in Executive Order 13166 ( 42 U.S.C. 2000d–1 note