Bridging the Language Gap
Some hospitals make non-English-speaking patients feel right at home
Good intentions. But many hospitals are struggling. There are no national numbers on how many of them offer language services, but a recent survey by Flores of all hospitals in New Jersey found that 97 percent didn't have any full-time interpreters. Some 80 percent provided no formal training for staff on working with medical interpreters.
Untrained--though well-meaning--bilingual people acting as interpreters can create many problems. In a 2001 study, when researchers videotaped 21 Spanish-speaking patients at a Southern California clinic that used nurses as interpreters, they found that just over half of the interactions had bad enough miscommunications that doctors didn't completely understand the patients' symptoms. In a 2003 study, Flores found that hospital staffers used as interpreters--who had no formal training--were particularly prone to "false fluency" errors: misinterpreting words or concepts based on a limited understanding of the language. For instance, one interpreter used a Puerto Rican colloquialism for mumps when talking to a Central American mother, who didn't understand it. Other interpreters didn't know the right Spanish words for "medicine" and "results," while others didn't ask about drug allergies.
AnMed Health Medical Center is trying to do better than that. The community hospital in Anderson, S.C., population 25,000, has been part of a project funded by a Robert Wood Johnson Foundation program to improve hospital language services in the region. "Five percent of our patients now speak a language other than English," says Juana Slade, the hospital's director of diversity and language services. "Most of those are Spanish speakers, but there's also Russian, Chinese, and deaf people who use American Sign Language."
Before Slade's department was created in 2001, "things were really decentralized and a little confused," she says. Each nursing unit had its own list of bilingual interpreters on the staff and would call on them when needed. Often, Slade says, that meant patients and doctors would have to wait until a staffer was finished with his or her regular job. Or--since doctors are in a hurry--it meant doctors or nurses would charge ahead into a sea of misunderstandings.
Slade set out to avoid these problems by instituting a system that starts the moment a patient arrives. Admitting clerks ask about preferred language. "If it's not English, or they have trouble answering questions in English, that's a full stop," Slade says. "The computer screen won't let the clerk continue until a language is identified." (For emergency admissions, a triage nurse does much the same thing after a patient is stabilized.) That language preference follows the patient to every medical appointment, every clinical encounter. "If they go to radiology, we're there waiting for them," says Slade. "If a doctor comes in for rounds, we're there too." If a nurse has an unscheduled chat with a patient about pain or medicine, she is under strict instructions to page language services first; someone is there in five minutes.
And that someone is properly trained. Every one of the 20 interpreters has gone through a 40-hour course on medical interpreting. "People joke and call me a language cop, but this is really important," says Janine Ferra, the hospital's language services manager. One of the major lessons: An interpreter is there to translate word for word what the patient says to the doctor and vice versa. "You are not there to be an advocate or to add information you think is important," says Ferra.
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