Tags: patient safety , redesigning care , research and discovery

The disparities that patients with limited proficiency in English experience during care are disconcerting, to say the least. For instance, patients with Limited English Proficiency (LEP), are more likely to experience adverse events such as medical errors due to communication problems, and are more likely to suffer physical harm when errors occur.

In fact, research has shown this issue extends beyond the patient’s ability to communicate with their doctors. In a recent survey of 15,800 physicians about the topic of bias, 32% of physicians (both male and female) admitted they held specific bias towards patients for whom there was a language difference. 

Exacerbating this issue, said Aswita Tan-McGrory, the Deputy Director of the MGH Disparities Solutions Center, “is the fact that many patients may have cultural norms that prevent or dissuade them from telling a physician when they do not understand what is being told to them." At other times, she said, a patient’s family member may “fill in” as an unofficial interpreter, which can lead to further complications and disparities in care, as they are not equipped to accurately relay a doctor’s advice or findings.

Many patients may have cultural norms that prevent or dissuade them from telling a physician when they do not understand what is being told to them

Discoveries like these led the Disparities Solutions Center, in collaboration with the MGH Institute of Health Professions (IHP), to develop an e-module training program for providers that would help them work more effectively with professional interpreters to ensure quality and safety for patients with LEP. The e-learning modules were pilot-tested with physicians and midwives in the MGH OB Department in 2014 as part of the MGPO Quality Incentive program. In an innovative touch, physicians’ efforts are bolstered by mobile interpreter phones on a pole (IPOPs), and “VPOP” video communication devices, which consist of a live video audio connection to an interpreter. Each hospital floor typically has these, Tan-McGrory said, which helps facilitate patient and clinician access to an interpreter if an in-person interpreter is not available. 

“Once we had an effective e-learning module that trained clinicians and medical and nursing students on how to work with interpreters, making this a mandatory training was a big win for us. It speaks to the MGH commitment to patients with LEP,” Tan-McGrory said.

To date, implementation of a feasible, interactive, e-learning program for working effectively with professional interpreters has been well received by clinical staff. MGH’s next Annual Report on Equity in Healthcare Quality (AREHQ) will include a new analysis of readmissions data by language and will examine whether patients with LEP are receiving the necessary interpreter services to help prevent avoidable readmissions. Results from this analysis will guide future interventions to reduce readmissions in this population.

Tan-McGrory and her team hope the successes keep mounting, and that the quality of care keeps improving as a result of these integrated language service programs.

“I think a lot of the providers now recognize the importance of patients getting language services the moment care begins,” she said. “One provider we’ve spoken to says the program has already proven itself invaluable as it reminded him of the importance of using an interpreter from the very start of a new patient relationship.”

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