Lost in Translation
What happens when a person who speaks a language other than English enters a hospital? One who is fortunate enough to enter one of the one-quarter of American hospitals that offer professional interpreters or other language access services can expect to understand what is going on and to communicate comfortably with the care providers. For the approximately 75% of U.S. hospitals remaining, language access has become a common concern as increasing immigration levels expand ethnic groups.
Nearly 52 million people—one in 12—in the United States speak a language other than English at home. In fact, more than 300 languages are spoken in the United States. Basing their calculations on the 2000 census, demographers estimate that the number of people with limited English proficiency (LEP) ranges from 11 million (those who speak English “not well” or “not at all”) to more than 22 million (those who speak English less than “very well”). And those numbers are expected to continue to grow.
- On-staff professional interpreters;
- Outside contractors to recruit, train, and provide interpretation services;
- Outside agencies (at least two);
- Teleconferencing and videoconferencing companies; and
- Bilingual clinical staff.
“This should be a sophisticated mix with clear instructions on how to use each resource,” explains Roat. “There should also be training to teach the staff how to work with interpreters, because working within a language access program is definitely a learned clinical skill.”
This type of program is flexible and functional. It is not tied to one method because that would compel staff to adapt each situation to fit that one resource.—AK
The Effects on Healthcare
The growing diversity of the United States population has a direct effect on healthcare providers. In order to provide appropriate and safe care, a provider must rely on accurate information from the patient. Simultaneously, the patient must be able to understand health instructions and treatment options in order to participate in his or her care. Language is the vital bridge in this process.
So what happens, for example, when an English-speaking emergency department physician faces a Spanish-speaking patient seeking medical care? Often, the hospital staff will turn to the patient’s family to act as interpreters. If that is not possible or advisable, the clinician may ask a bilingual staff member to help. This is commonly called dual-role or ad-hoc interpreting because the employee’s primary job in the healthcare organization (whether clinical or non-clinical) involves something other than interpreting.
While ad-hoc interpreters fulfill immediate needs by thoughtfully stepping in and helping out, many are asked to interpret outside their areas of expertise as they interrupt their own work. And an interpreter who has received no specialized training cannot be expected to achieve the same results as a professional interpreter. Simply being bilingual is not enough; professional medical interpreting is a learned skill.
Yet many healthcare organizations across the United States are not prepared to provide professional linguistic access for their patients. This is not to say that care providers would not like a professional interpreter program in the healthcare organization. Providers from a wide range of services have reported that language barriers and inadequate funding of language access services present major problems in ensuring both access to and quality of healthcare for LEP individuals. Funding, in particular, is one of the major reasons healthcare organizations hesitate to implement dedicated interpreter departments.
