All interactions benefit from high-quality communication, but when it comes to healthcare, lives may be hanging in the balance. Healthcare institutions have many choices when it comes to providing language assistance to the more than 25.9 million people in the US with low English proficiency (LEP). It is up to healthcare providers to determine which option is best in any given situation.
Why Provide Interpreters?
Using interpretation services adds an additional layer to the already complex practice of patient care. It’s not surprising that the question often arises as to whether professional interpretation services are worth it. The answer is a resounding YES. First of all, it is required under Section 1557 of the Affordable Care Act that hospitals, health plans, clinics, nursing homes, physicians, and other providers must offer qualified interpreters to LEP patients.
Not only is it required, but studies have shown that lack of interpretation services leads to reduced-quality care. Communication barriers often keep LEP individuals from seeking and getting primary and preventative care.
When these individuals do get care, those same barriers often lead to poor knowledge and understanding of their diagnosis, inadequate adherence to their treatment plan, and an increased rate of medical errors and poor health outcomes. Sub-par communication has also been shown to lead to patient aggression, lack of informed consent, and increased testing.
Studies also show that high-quality interpretation services address these problems. Use of an interpreter in medical settings has been shown to increase patient satisfaction, decrease adverse outcomes, and improve adherence to treatment.
What Are Your Choices?
There are three modalities of providing interpretation services—face-to-face interpreting, over-the-phone interpreting, and video-remote interpretation. All three modalities present their own advantages and disadvantages.
Research has shown that over-the-phone interpretation does not provide as many benefits or as much patient satisfaction as other modalities. Face-to-face interpretation offers the best, most reliable method of communication with the LEP community, but video-remote interpretation is a great alternative when an in-person option is not feasible.
The first question any provider requiring an interpreter needs to ask is whether a qualified interpreter of the desired language is available. Of nearly equal importance to whether the right interpreter is available is when that interpreter is available. In some cases, providers can plan ahead, but in certain medical situations time is of the essence. If a face-to-face interpreter is not immediately available in a time-sensitive situation, the provider might want to opt for another modality.
It’s also important that the interpreter being used has the right qualifications. If technical procedures are being explained, for example, the interpreter provided should be familiar with and knowledgeable about the jargon being used. This is often an issue when a patient wants to use their own interpreter. It is up to the health provider to determine whether this is truly in the patient’s and the facility’s best interest.
When Face-to-Face Is Most Important
While face-to-face interpretation is the “gold standard,” it is not feasible in every situation. There are, however, certain situations in which the quality of communication provided by face-to-face interpretation is critical. These situations include when an interpretation session:
- Will be quite long.
- Will be providing complex information that must be discussed and explained in detail, such as a complex medical procedure for which the risks and benefits must be fully understood by the patient.
- Is being provided for sensitive situations, such as end-of-life decisions.
- Will be provided in a group setting, such as a family conference, where several members of the group may be participating.
- Involves a mental-health patient.
- Would be enhanced through the use of visual cues such as body language.
While it would be nice to not have to consider cost, it’s a necessary part of determining the best and most appropriate medical care. Many clinical encounters are short in duration and more easily lend themselves to working with either an over-the-phone or video interpreter. As noted above, however, there are instances in which a face-to-face interpreter should be provided even if it is a more-costly solution. In a perfect system, a healthcare institution would have all three modalities available and employ services in the most cost-efficient and effective manner that delivers optimum patient care.
While providing interpretation is always an added cost, it also increases preventative care and adherence to post-treatment rules. It is, therefore, likely that interpretation services actually cut care costs in the long term.
An ongoing concern, no matter what modality of interpretation is used, is the protection of information transmitted during an interpretation session. While the issue is typically easily addressed for over-the-phone and video interpretation, the issue can present a problem when face-to-face interpretation is used for a rare language with a small population of speakers.
In these cases, the patient and interpreter might know each other. In such a situation, a facility may opt for using a different modality in order to maintain patient confidentiality.
A Lot to Consider
Working with face-to-face interpreters offers multiple benefits for both patients and practitioners. Those benefits, however, must always be weighed against many other factors when developing a robust interpreter-services program that provides effective and cost-efficient service.
To ensure ongoing and evolving interpretation services, healthcare providers should continually monitor service patterns, population trends, and patient outcomes. Better communication equals better patient care, and better patient care is the ultimate goal.