Examining Interpreter Services to Better Characterize Areas for Quality Improvement.

Abstract

Introduction: Medical providers utilize professional medical interpreters (PMIs) daily. Despite this, the challenges PMIs may experience when translating surgical care has not been well explored. Limited English-language proficiency (LEP) patients depend on PMIs for accurate understanding of their care and the lack of quality control can further disenfranchise an already vulnerable population. To address this, we interviewed interpreters to investigate their perspective on language access and current policies. Our study aims to better understand the challenges interpreters face and explore possible interventions.

Methods: Snowball sampling was used to recruit medical interpreters across various hospitals throughout the US through an electronically distributed survey. Twenty individuals participated in 30-60 min Zoom interviews which were transcribed. All identifiable information was redacted. Coding and analysis were done using MAXQDA software. Our codebook was adjusted according to the iterative process intrinsic to qualitative research.

Results: Three major themes regarding challenges to interpretation were identified. The table summarizes themes with representative quotes. First, improved access to patient information prior to appointments resulted in better quality interpretation. Presessions with clinicians were noted to serve as a way for the interpreter to establish their role and limitations. Second, clinician knowledge on how to work with an interpreter was variable. Interpreters associated poor communication with clinicians with negative patient care outcomes due to poor interpretation. Finally, verifying patient understanding was also noted to be difficult. Better organized and funded departments were better able to identify and mitigate challenges, providing more consistent quality interpretation.

Conclusions: Suboptimal use of medical interpreters negatively impacts the health of LEP patients. Our study suggests that there are gaps in clinician knowledge regarding how to work with interpreters. Currently, no guidelines exist illustrating how to work with PMIs. Similarly, no formal curriculum exists to prepare future providers for working with LEP patients. A better workflow and quality control of language services is needed to ensure patients are receiving equitable care.