Language barrier has been recognized as a major cause of racial and ethnic disparity of health provision (Woloshin, 1995). The ability of the patients to communicate effectively with the staff in a healthcare agency is of uttermost importance for several and obvious reasons. From the very beginning of the encounter between the patient and the clinician, the latter has to be able to extract accurate and detailed clinical history; otherwise, it would be very difficult to make the correct diagnosis. Consequently, there is an overrepresentation of people with poor English proficiency in the misdiagnosed cases in the United States healthcare system.
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Secondly, at some point in the course of treatment, the doctor is usually required to give the patient detailed information regarding the regime or self-care; in some medical cases, failure to understand sections of this information may lead to serious and even potentially fatal consequences. While a patient may be confused by the complexity of medical information even when they have excellent English proficiency, it is unfortunate how a language barrier can compound this problem. Additionally, crucial decisions on the part of the patient may be hard to make; including issues such as giving consent for surgical procedures if the correct information is not relayed.
It has been shown that among the patients that stand experience of a potentially fatal event during hospitalization, those with poor English proficiency are overrepresented in this group (Dobson, 2007). It has been therefore recognized that the absence of trained medical interpreters in American hospitals is putting such needy patients at an elevated risk compared to their proficient contemporaries. Some of the healthcare provision agencies have tried to remedy this anomaly; however, this has not been an industry initiative; only 25% of such facilities have programs to train medical interpreters. To make matters worse, extremely few medical professionals have the right training to work with a medical interpreter (Sobralske et al, 2008).
The current conformation of the American population is telling in the manner which the health provision sector needs to provide interpretation services to their clients. About 18% of all Americans have a second language other than English; therefore, there are over 100 languages spoken in the United States (Sobralske et al, 2008). Additionally, approximately 20 million people are categorized as having limited proficiency in English; and in 2000 they accounted for about 8% of the total American population. This may seem like a big chunk of the population; however, the most alarming fact is that just a decade before this, the proportion was 6%; this is no doubt a segment that is growing at a very fast rate (Dobson, 2007); the alarm comes from the lack of preparation by the healthcare industry to handle the changing population.
The matter of the fact is that language is not the only issue that causes racial and ethnic disparity in the quality of healthcare services provided; it form a part of a larger issue of culture which also incorporates social structures, customs, values, practices and religion (Robins et al, 1998; Donini-Lenhoff and Hedrick, 2000). The factors also include sexual orientation, race, ethnicity, gender and socioeconomic status. A failure to adopt policies that favor groups that are distinctly different in the aspect of culture will lead to an alienation of this segment with serious negative implications on their general health status (Denboba et al, 1998).
The introduction of medical interpreters in healthcare setups is the only feasible solution to counter the expected growth of the segment of population that requires this service; and to reduce and prevent the disparity in the quality of services between people with a poor proficiency of English. Such interpreters would increase to safety of the patients since accurate diagnoses will be made without the barrier of language; and the patient would be able to follow the medical regimes to the latter. Additionally, the healthcare system would be made more efficient as medical professionals would spend less time on such a patient as they would in the presence of a language barrier. Therefore, the main goals of introducing interpreters in hospitals are to increase patient safety, to reduce disparity of quality of services caused by the language barriers and to improve the efficiency of the operations of hospitals.
Previously, industry regulators have tried to influence the industry to adopt policies aimed at reducing the impact of language on the quality of medical services offered. For example, in 2006, the Joint Commission of Accreditation of Healthcare Organizations sanctioned new standards that instructed all hospitals to capture the information of all patients in regards to their ethnic language so as to recognize the need to bring in an interpreter during examination and treatment (Sobralske et al, 2008). This is an improvement from the assumption that a language problem does not exist.
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The policy will be implemented in a two pronged attack; one being the hiring of trained (general) interpreters and the other increasing the number of medical interpreters trained and hired. Before, such steps are taking; surveys will be taken in the community served by the hospitals to find out the languages which are offering the most challenge to the hospitals since it’s not sustainable to hire interpreters for all languages. In real sense, people from the same ethnic origin tend to live in close communities thus there will always be the dominant language in the area. Additionally, a program to coordinate the language service between the various hospitals in a region will be created whereby they can share interpreters when the need arises.
This will be hired on a need basis; that is different hospitals will receive different numbers and diversity of interpreters depending on their need. Some, of the hired staff will remain part of a general pool that can be shared between hospitals and can be deployed quickly when need arise; this is especially for the less common languages where hiring permanent staff for each hospital is not sustainable. Before deployment, the staff will undergo a one month crash program to familiarize them with medical terms so that they can communicate better with the medical professionals.
The aim of this move is to cover the deficit that is already there in provision of language services in hospitals.
Teaching hospitals will be compelled to introduce medical interpretation training into their programs for those who do not have them; and to increase their intake of scholars for those who already have programs. These programs have to be approved by the Joint Commission of Accreditation of Healthcare Organizations so that they can be a standard quality. This move is aimed at preparing for the expected demand for language services in the future in lieu of changing demographics.
During the implementation of the program various challenges barred maximum success. From the beginning, there was no proper coordination between the general interpreters and the doctors; although they had received albeit short training in medical language, they still did not know how to frame some of the questions and instructions from the doctor. This problem however is temporary since the well trained medical interpreters will have a strong foundation in medical practice. However, most medical professionals are not trained to work with interpreters; the only solution for this is to take them through professional improvement courses.
A second challenge was the unwillingness of some healthcare financing agencies to pay for interpretation services leaving the patient to foot this bill; some segments of the healthcare industry still do not consider language services as being essential for effective service provision. Consequently, some of the patients declined to utilize this service as they were not covered by the health insurance.
Finally, in some instances, crucial time was wasted waiting for the arrival of an interpreter from the general pool for some of the less common languages. There were no serious implications for the patients in questions; but the cases revealed serious shortcomings in the interpreter sharing program; this can be overcome by better planning and coordination.
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Evaluation of the program
Despite the many challenges encountered, the program was a success. There was a net reduction in the number of patients experiencing potentially fatal events in hospitals among people who were categorized as poor proficient in English; this was attributed to better diagnosis and treatment of cases; and better adherence to the prescribed regime.
Additionally, the hospitals located in communities with a high concentration of bilingual people showed significant improvement in the efficiency of serving customers as the doctors were able to communicate better with their patients. The most significant benefit however was the appreciation by the medical staff of the importance of having interpreters as they were able to see their benefits themselves; this in my view was the greatest victory since future endeavors will be driven by the professionals themselves.
Denboba D. L et al. (1998): Reducing Health Disparities through Cultural Competence: Journal of Health Education 29: S47–S53.
Dobson Roger (2007): US hospital patients with poor English have more serious adverse events than proficient speakers: British Medical Journal 2007; 334:335. Web.
Donini-Lenhoff F. G and H. L. Hedrick (2000): Increasing Awareness and Implementation of Cultural Competence Principles in Health Professions Education: Journal of Allied Health 29: 241–45.
Robins L S et al. (1998): Improving Cultural Awareness and Sensitivity Training in Medical School: Academic Medicine 73 (Supplement 10, 1998): S31–S34.
Sobralske Mary, PhD, RN. Ellen Raney, MD Brian Carino, MD (2008): Ethnic Diversity, Language Barriers, and Interpretation in a Children’s Orthopedic Clinic: Washington State University; Intercollegiate College of Nursing.
Woloshin S. (1995): Language Barriers in Medicine in the United States: Journal of the American Medical Association 273: 724–28.