This study used focus groups and a survey to identify systems-level approaches improving communication with patients with limited English proficiency (LEP). The majority of survey respondents reported less confidence communicating and forming relationships with LEP patients compared to English-proficient patients. While interpreter use has been shown to improve care for LEP patients, this study found that workflow constraints, supply-demand issues, variable interpretation quality, and gaps in communication interpretation services are barriers to interpreter use. A prior WebM&M Spotlight Case addresses the increased risk of error when communicating with LEP patients.