Language Services Quality Improvement at the Cambridge Health Alliance

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By Ranjani Paradise, PhD

Here at ICH, we work in close partnership with the Cambridge Health Alliance (CHA) on a number of research, quality improvement, and evaluation projects. CHA serves an extremely ethnically and linguistically diverse patient population. For example, last year, one in three of CHA’s outpatients, and one in four of inpatients, spoke a language other than English at home!

Because of this incredible linguistic diversity, CHA has long been working to ensure that limited English proficient (LEP) patients can communicate with their doctors in safe and effective ways. To support communication with LEP patients, the Multicultural Affairs and Patient Services (MAPS) Department offers professional interpreter services in three modalities: face-to-face, telephone, and videoconference. In addition, MAPS offers language testing for multilingual providers who wish to speak directly to their LEP patients.

For one of my ICH projects, I work with MAPS on language services quality improvement. Over the last several months, a major focus of our work has been to reduce the use of patients’ family members and friends as interpreters, as this practice can compromise the quality of communication in a number of ways.

When you think about potential risks related to using family/friends as interpreters, what comes to mind?

Perhaps the most obvious risk is that family members and friends are often not familiar with medical terminology, and may make errors or omissions during interpretation that could compromise patient safety. If an interpretation error or omission results in harm to the patient, this can have severe legal and financial consequences for the hospital. In one well known case, misinterpretation of a single word resulted in a $71 million lawsuit against a hospital after the patient ended up with quadriplegia (paralysis of both the arms and legs). This illustrates the fact that interpretation errors can present truly serious patient safety concerns as well as liability issues.

Another problem with using family members and friends to interpret is that they have a personal connection with the patient. Because of this:

  • Family members and friends may choose to withhold bad news or insert personal opinions into the conversation, which can compromise communication accuracy.
  • The patient, as well as the family member or friend, may be uncomfortable discussing sensitive information, such as sexual or mental health. This can create a situation where important information is not disclosed to the doctor. Imagine having to discuss the sexual history of a parent, and I’m sure you’ll understand why this can be a problem!

Communicating through a family member or friend may prevent a patient from being able to tell you about domestic violence or other abuse. In fact, a physician friend of mine (not at CHA) experienced this firsthand – a patient came to the hospital and she didn’t speak English, but her husband did. The hospital was not able to bring in a professional interpreter right away, so the patient’s husband interpreted. When the professional interpreter was later brought in, my friend had a chance to talk with the patient while the husband was out of the room. The patient stated that her husband had been abusing her and that she did not trust him to interpret for her. Patients should feel safe sharing this kind of information with their doctors, and using a family member or friend to interpret can compromise this.

As part of our quality improvement work, we monitor data each month to track how often family and friends are being used to interpret at CHA sites. We have also surveyed providers to understand reasons behind this practice. We got some terrific information from the survey: many providers were candid in sharing the challenges they face in caring for LEP patients, which really helped us understand their perspectives on this issue. We’re currently working on using the survey findings to identify resources that we can provide to help providers communicate with their LEP patients in the safest and most effective ways possible.

I’m glad to be a part of the team and look forward to supporting MAPS in their efforts to keep improving LEP patient care at CHA!

Ranjani Paradise, PhD is a Research Associate II at the Institute for Community Health.

The views expressed on the Institute for Community Health blog page are solely those of the blog post author(s), and do not necessarily reflect the views of ICH, the author’s employer or other organizations with which the author is associated.