Speaking together: Findings from a hospital disparities collaborative

Hospitals recognize the need to improve services for patients and families with limited English proficiency (LEP) to assure safe, high quality care. However, assuring prompt access to interpreted services can be a significant challenge in a large medical center, serving many language groups. Providers struggle to identify the need for interpretation, and are wary of waiting for professional interpretation to communicate with families. Participants will learn about process improvement strategies for interpreted care, drawing on experiences from an ongoing 10-hospital collaborative to develop models of excellence in providing care to LEP families.

Interpreter Services at Seattle Children’s has used a PDSA quality improvement approach in improving access and provision of interpreter services. We conducted two multidisciplinary week-long Rapid Process Improvement Workshops to improve identification of interpreter need and the efficient dispatch of interpreters.  These workshops laid the foundation for Seattle Children’s Robert Wood Johnson Foundation funded “Speaking Together” project to identify best practices for interpreter services.

Successes and innovative approaches:

• Gathering data to measure timeliness and duration of interpreter encounters
• On-line computer order entry of interpreters
• Hiring more staff interpreters and dedicating interpreters to the Emergency Department and Day Surgery teams
• Creating on-line orientation for contractors to meet Joint Commission standards
• Creating dedicated “SPEAK” telephone line for 24 hour staff instant access to phone interpreter
• Piloting and installing quick-dial phones on inpatient units for easy access to telephonic interpretation
• Creating a Toll-Free Family Phone Interpreting line, allowing families to call Children’s from the community with the assistance of an interpreter
• Decreasing the number of replacement interpreters from 41 per month in fall, 2006 to 10 per month in December, 2007.
• Launching a staff education/communication campaign to encourage the use of phone interpretation while waiting for a live interpreter or for brief communications.

Challenges:

• Seeking effective ways of communicating changes and resources across the organization. 
• Rather than using the telephone, some staff prefer to “wing it” using inadequate  communication or may delay communication while waiting for an in-person interpreter.  We continue to strategize ways to make phone interpreting user-friendly.
• Trialing speed dial phones in just a few rooms required staff to remember where they were in order to place LEP families in those beds.

Take home messages and opportunities for replication:

• “Don’t wait, communicate!” -- help staff pick up the phone while waiting for an in-person interpreter.
• Families embraced the Family Phone Interpreter line.  It empowers them to initiate communication and take charge of their child’s healthcare experience.
• Integrating all telephonic language access into one easy-to-use phone: Dial SPEAK or quick dial phones to improve staff willingness to use the equipment.
• A “road show” is most effective in implementing new procedures and technology.
• Installation of phones in patient rooms improved when we installing them in occupied rooms, as it facilitated on-the-job teaching of staff on use the phones.