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Staff and patients currently face challenges when accessing interpreter services, leading to a low uptake of services in a hospital setting.
Culturally and linguistically diverse people face greater challenges when accessing and navigating the Australian health care system. These range from individual factors such as poor health literacy and low English proficiency, to organisational challenges around language barriers and poor cultural competency of health care providers. People with low English proficiency also report poorer patient experiences and are likely to have worse health outcomes than people who speak the language. All these factors highlight the importance of interpreter services in facilitating communication between culturally and linguistically diverse patients and providers, and their contribution to alleviating the gap in health inequities for this cohort.
Despite almost 30% of people in Australia being born overseas and 3.4% self-identifying as not speaking English well, the rates of professional interpreter use remains low within the public health system. There are a number of identified barriers which contribute to this, including limited resources, lack of knowledge around how to access an interpreter, and the use of family members in place of professional interpreters.
The challenges facing interpreter use
We conducted a study at a hospital in New South Wales looking at how rates of interpreter use could be improved for patients with low English proficiency. The hospital was located in an area of Sydney where two-thirds of residents do not speak English at home, which is three times higher than the state average. Our research involved matching patient records to the interpreter service booking system data to see which patients flagged as requiring an interpreter on admission were provided with interpreter services during their stay. The other component of the study involved conducting focus groups with junior medical officers and nursing staff at the hospital to identify the challenges they faced when accessing interpreter services and how they thought these barriers could be overcome.
Looking at the data, we found that most of the patients who were flagged as requiring an interpreter in their patient records were not provided with an interpreter during their stay at hospital. Interestingly, interpreter services were also provided to patients who were marked as not requiring an interpreter on admission, highlighting poor documentation practices or incorrect identification of patients with low English proficiency by staff. Given that staff do not usually document the reason for using an interpreter in the patient record, it was difficult to determine which types of conversations these interpreters were used for and whether it was in line with NSW policy on when interpreters are required.
The focus groups provided further insight into why interpreter usage was low from the perspective of hospital staff. Staff noted that they were aware of the policies around using an interpreter for non-English speaking patients but reported that accessing an interpreter was often difficult and a time-consuming process. Bookings for an interpreter must be made via phone or email and should also be made three days in advance to when the interpreter is required. Clinicians highlighted that it is often difficult to determine the exact time that they would be seeing an inpatient and that the booking system did not allow for flexibility around potential changes in schedule. As a result, it was often more convenient to use family members, bilingual staff members or basic English to communicate with patients instead of arranging for a professional interpreter.
Efficiency and flexibility needed
In order to address these challenges, a system is needed which efficiently allocates interpreter services to patients who need an interpreter, while still accommodating for the way staff members deliver care to patients on the wards. Resourcing will always be a challenge for the public health care system and ensuring that there is a booking system that is flexible and easy-to-use may increase staff willingness to book for an interpreter. An electronic booking system may be a potential solution that streamlines current processes, reducing the time it takes to currently book for an interpreter via phone or email.
The impact of the coronavirus disease 2019 (COVID-19) pandemic should also be recognised in reducing the use of face-to-face interpreter services in hospital settings. During the pandemic, staff were advised to use telephone and video interpreting in line with COVID-19 precautionary measures, with in-person interpreters only allowed on-site in exceptional circumstances. Staff noted the challenges associated with the increased use of telephone interpreters, particularly when communicating with patients who are hard of hearing or have cognitive impairments. Having in-house interpreters who are available to provide face-to-face interpreter services at the facility would be ideal, but the limited resources available make this unlikely.
Limited resources continue to be the greatest challenge when meeting requests for interpreters in a timely manner. To improve the current uptake of interpreter services at a facility level, it seems that more streamlined processes and flexible systems need to be introduced to improve the booking and allocation of interpreters so that the experience is more convenient for staff and patients.
Until this happens, staff will continue to use family members or other bilingual speakers instead of booking a professional interpreter simply because it is the quicker and more convenient option.
Davina Tang is a Policy and Strategy Manager for Diversity Hub at Sydney Local Health District
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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