How professional interpreters can improve hospital ratings

Consumer choice plays a big part in healthcare in many countries and hospital ratings are a key factor in helping people decide where they will get treated. The United States, where healthcare has long been seen as a marketplace with providers competing against each other, publishes regular hospital ratings and several European countries, including the UK and Germany, have now adopted a ratings format.

Good ratings depend on ability to provide quality healthcare to all sections of diverse populations. This includes growing numbers of non-English speaking residents where language barriers can create additional challenges and affect outcomes. According to current statistics, there are 61.8 million foreign speakers in the US, including around 25 million (over 8 percent of the population) with limited English proficiency (LEP). In the UK, there are 4.2 million foreign speakers including around 1 million LEP (nearly 2 percent of the population).

This article will look at the role played by fully qualified interpreters in helping hospitals to meet these challenges and, in doing so, improve their ratings.

Links between LEP patients and poor health outcomes

It is well established that LEP populations within many countries suffer worse health outcomes than the English-speaking population. This relates to both general level of health and experiences within healthcare systems. A 2005 study in the US between English-speaking and LEP hospital patients found that LEP patients experience:

• Longer hospital stays
• Increased risk of surgical infections
• Increased risk of delays due to problems understanding instructions
• Higher readmission rates due to problems understanding how to manage and treat their condition

These kinds of problems can affect the long-term health of patients as well as increasing the costs of healthcare. They also negatively impact on the patient experience of healthcare, which can make them less likely to seek future help.

Benefits of using interpreters in a healthcare setting

Interpreters offer an effective solution to the problems experienced in providing healthcare to LEP patients. They improve the channels of communication between carer and patient, leading to better health outcomes. In some instances, professional interpreters have succeeded in raising the quality of care for LEP patients to levels similar to those for English-speakers.

The use of an interpreter helps in the following ways:

Reducing miscommunication

One of the most serious risks of providing healthcare and medical treatment to LEPs without the aid of an interpreter is that of miscommunication, which can lead to errors in diagnosis and treatment. In the worst cases, this can seriously compromise a patient’s safety. In the US, around 21 percent of healthcare-related events resulting in serious injury or death are caused by miscommunication, and 30 percent of Medical Malpractice lawsuits cite miscommunication as a factor. Having a qualified medical interpreter present ensures that the patient understands what is happening and greatly reduces the risk of things going wrong.

Improving patient knowledge

As well as preventing communication errors, interpreters can also build a patient’s knowledge and understanding of their health condition through explaining key concepts and elaborating on advice given. This can be especially important when it comes to post-surgery care, e.g. adhering to treatment and taking medication, attending follow-up appointments and taking preventative measures. There is evidence to suggest that patients aided by professional interpreters are more likely to undergo preventative screenings and successfully manage a range of conditions.

Improving relationships with health professionals  

Having an interpreter present improves the dialogue between doctor/surgeon and patient, meaning that the patient is more likely to develop feelings of trust, open up and offer more information about symptoms, how they are feeling, etc. This helps doctors better understand the situation and give an accurate diagnosis. Improved dialogue and trust also makes it more likely that medical advice will be followed and it helps to ensure that consent to any medical treatment is properly informed.

Ensuring that services are culturally appropriate

Interpreters can use ‘soft skills’ such as interpersonal skills and sensitivity to make sure that healthcare is given in a culturally appropriate way. As the interpreter understands both cultures, they are able to smooth the flow of communication so that both messages and treatment are delivered in a way that avoids any unnecessary alienation or embarrassment.

Professional interpreters vs ad hoc interpreters

Of course, any interpreter is better than no interpreter at all. But the importance of using professional medical interpreters rather than ad hoc or community interpreters (relatives, friends, bilingual member of staff, etc.) where possible cannot be overstated.

Professional medical interpreters should be used over ad hoc interpreters because:

• They are professionally trained in medical interpreting and are familiar with medical terminology and culture.
• Ad hoc interpreters, while usually being able to communicate general meaning, won’t necessarily know the exact medical terms or translations. While an ad hoc interpreter is cheaper, mistakes made can be costly in the long run. The most famous case is that of a Spanish-speaking man in the US who was awarded $71 million after an ad hoc interpreter mistake left him quadriplegic.
• Professional medical interpreters are familiar with medical technology and procedures and are best placed to deal with a patient’s worries or fears.
• Medical interpreters are trained in ethics and will know what kind of advice they are able to give, what to do in difficult situations, etc.

Research has shown that fully trained medical interpreters make fewer errors, with one study finding that professional interpreters with more than 100 hours of training made only 2 percent of errors, compared to 12 percent for professional interpreters with fewer than 100 hours of training, and 22 percent for ad hoc interpreters.

Impact of using professional interpreters on hospital ratings

So how does the presence of medical interpreters affect hospital ratings? Different countries use slightly different ratings systems but each is based around quality and safety of care, with patient experience playing a vital part.

For example, hospitals in the US are given a star rating by the Centers for Medicare and Medicaid Services (CMS) which scores on mortality, safety, readmission rates, patient experience and effectiveness of care. In the UK, assessments are carried out by the Care Quality Commission (CQC) based on safety, effectiveness, care quality, responsiveness to people’s needs and leadership. Patient satisfaction surveys make up a core part of the rating.

Through reducing miscommunication, improving patient knowledge, improving the carer-patient relationship and ensuring services are culturally appropriate, professional interpreters can help drive up ratings scores primarily by improving patient satisfaction with the service. Improving communication flows and patient understanding also impacts upon safety levels, through reducing errors in diagnosis and treatment, and reduces readmission rates through improving after-care.

Patient satisfaction

Today, hospital assessments are heavily centered around patient experience. Gone are the days when they simply had to tick off a checklist designed by some upper level health authority. Modern techniques involve surveying patients on a whole range of indicators to ensure that services are delivered to a satisfactory level.

As part of the CMS guidelines in the US, hospitals administer the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) which asks questions related to communication, responsiveness, environment, discharge information and pain management. In the UK, CQC patient surveys assess access, cleanliness, relationships with staff, quality and safety of care, and quality of information.

Many of these areas are affected by the quality of interpreting services available. If a patient can’t communicate properly with a doctor or doesn’t clearly understand information given to them, the whole patient-doctor relationship is compromised and care quality is affected. This results in lower scores given.

There is plenty of evidence suggesting good quality interpreters improves patient satisfaction. One study in the US found that language services improves satisfaction by 72 percent and increases customer loyalty by 58 percent. Another controlled trial study in emergency departments found that the presence of medical interpreters raised levels of patients very satisfied with services from 22 percent to 91 percent. Elsewhere, a European-wide study highlighted strong links between hospital interpreting and high patient satisfaction.

Other benefits

In addition to improving patient satisfaction scores, the presence of interpreters can also improve hospital ratings through:

• Improved safety – with professional medical interpreters making fewer errors than ad hoc interpreters or no interpreter being present, this greatly reduces the risk of misdiagnosis or errors in treatment which can seriously harm a  patient.
• Reduced readmission rates – as interpreters can help patients understand their diagnosis, follow treatment guidelines and schedule follow-up appointment, the risk of readmission is reduced. Evidence shows that patients who receive help from professional interpreters are more likely to adhere to treatment guidelines.

There are many other indirect ways that medical interpretation services can help improve the hospital environment, for example by making the lives of healthcare staff easier which enables them to do a better job. This no doubt also has an impact on hospital scores. With the number of LEP residents in the US and Europe likely to further increase over the next 20-30 years, interpreters are likely to play an important role in hospital ratings for some time to come.