Summary of the Quality Issue
Diverse populations, which form a significant part of the American population, experience significant issues related to the language barrier. This is more evident in the healthcare system, whereby the need for medical interpreters has heightened. According to statistics, Americans with limited English proficiency (LEP) are estimated to be over 25 million (Juckett & Unger, 2014).
Communication problems between LEP patients and health care providers have resulted in many health care facets encompassing patient safety, health status, access to care, as well as employment of health services (Juckett & Unger, 2014). With regard to this, LEP patients fail to seek care when required, have reduced visits to physicians, fail to follow medical advice, ignore follow-up appointments, fail to adhere to drugs prescriptions, have reduced understanding of treatment and diagnosis after visit to the emergency department, experience amplified medical complications, and end up having low satisfaction with the care being provided, as well as with the hospital experience. These are health disparities, which are caused by the language barrier. The result is low quality of care and poor health outcomes among the LEP patients. On the other hand, language concordance amplifies health status of patient, satisfaction, as well as devotion to the follow-up visits and drugs.
Effective communication between patient and healthcare practitioner is vital in the provision of quality care. Considering the seriousness of medical consultations, hospitals have come up with a strategy of employing medical interpreter services in order to bridge communication barriers. Communication between patient and care provider helps in collection of the important diagnostic information, besides permitting the negotiation of disease management. Lack of effective communication can compromise this information.
In order to enhance quality of health care, Federal Policy necessitates hospitals to offer sufficient communication support to the LEP patients through the use of medical interpreters. They bridge the gap between the health care providers and patients by ensuring effective communication. The main responsibility of professional medical interpreters is to offer language services, but it has been evidenced that ad hoc interpreters are usually employed instead. These include friends, family members, hospital staff, as well as the strangers, who are not trained in medical interpretation (Karliner et al., 2007). Title VI of the Civil Rights Act of 1964 requires the hospitals, which obtain federal financial help, to adhere to the services of professional medical interpreters (Karliner et al., 2007). They are well familiar with medical terminologies required to interpret the history of a patient and diagnosis. This understanding is vital in preventing the probability of medical errors and malpractice risk. Professional interpreters possess knowledge regarding the languages, cultures, and beliefs of the patients. This allows communication of health information to flow in a manner that puts into consideration belief systems, cultural traditions, and medicine, as perceived in western and non-western cultures.
The impact of medical interpreter services on the quality of healthcare has been investigated by many scholars. According to Karliner et al. (2007), interpreters supplement the employment of bilingual staff and clinicians with the intention of enhancing the quality of medical care provided to the LEP patients and to reduce the disparities related to health. As illustrated in the review of literature by the various researchers, the impact of different kinds of interpreters has been provided. These encompass untrained, ad hoc, as well as trained interpreters (Juckett & Unger, 2014). The kind of interpreter used determines the level of care provided to the patient. Compared to the rest, trained medical interpreters provide the health outcomes, and they are recommended by the federal policies. In general, positive impact on clinical care of the LEP patients has been evidenced by using professional interpreters.
According to the studies, the provision of medical interpreters to the LEP patients decreases costs of care (Karliner et al., 2007).
Besides, the time spent by the LEP patients in the emergency departments is also shortened, enabling a healthcare provider to attend to more patients. Medical interpretation also improves the relationship between a patient and a practitioner. In spite of many positive impacts linked with the employment of medical interpreters, it appears that healthcare providers fail to understand them or are perhaps ignorant. Juckett & Unger (2014) evidence this by arguing that most healthcare settings do not completely utilize interpreters. A number of factors are linked to this including the apparent costs of employing professional interpreters, privacy issues, if the ethnic background of patients and interpreters is the same, time restraints, as well as problems in acquiring interpreters for up-and-coming languages (Juckett & Unger, 2014). Some medical practitioners also depend on their communication skills, and this is not appropriate.
The competency, as well as qualifications of medical interpreters, should be addressed by establishing education, evaluation, and certification standards. The importance of this is the improvement of quality of healthcare. In the US, national standards for medical interpreters have been developed by the National Council on Interpreting in Health Care (Karliner et al., 2007). However, states have not collectively adopted these standards, meaning that there are no federally acknowledged guidelines. As a result, individual states have endeavored to address the interpreters’ competency by creating interpretation standards. Through this, they are able to abide by the federal law; besides maintaining the quality of care provided to the diverse populations. For instance, Washington formed the Language Interpreter Services and Translations (LIST) with the aim of administering language certification and testing for interpreters (Juckett & Unger, 2014). The Hennepin Ethical Standards have been established in Minnesota to offer a set of standards used for interpretation during the service delivery. Competency standards have also been established to assure the competency and knowledge of medical interpreters. The creation of standards helps in establishing a favorable atmosphere, where the LEP patients receive quality health care. In general, they seek to reduce health disparities for the LEP patients.
In a nutshell, the use of medical interpreters has been linked with high the quality of health care. However, professional interpreters have been shown to possess the knowledge and competency required in the interpretation process. Professional interpreters have a good knowledge of medical terminology and the corresponding skills, which lessens the likelihood of malpractice risk. They improve patient-provider communication, amplify patient satisfaction, enhance health outcomes, lessen misdiagnosis, enable better access by the LEP patients to the service use, and reduce costs. Professional interpreters have the capacity to facilitate an open discussion regarding personal sensitive matters including domestic abuse and sexuality. In spite of these many benefits, the use of professional medical interpreter services has not been fully employed in most healthcare settings, where the encounter of the LEP patients is high.
An explanation of one aspect of quality management within the framework of public policy and/or regulatory procedures
The emergence of language barriers in the sector of health care has been a subject of concern in many nations across the globe. Though scholars continue to argue on the ways the health insurance coverage can be expanded in order to increase health care access to the low income earners in America, language barrier continues being a hindrance to achieving access to health care and improving the quality of it. Several studies reveal that there is a link between language barrier and making of the inaccurate diagnoses (Juckett & Unger, 2014). A study carried out in the local health departments in 1992 indicated the effects language barrier has on the capability of the non-English speaking patients to book appointments, explain how they feel, understand the medical terms used, and follow the instructions given for medication (McLeod, 1996). Researchers have discussed that language barrier weakens the quality of health care for the providers and patients, an issue accelerated by the technical and esoteric language health providers use in their line of duty. The impact of language barriers in the health care sector is substantial because of the variance in ethnicity. The Limited English Proficiency populace continues to grow, and this makes the problem of language barrier be more serious, as it is compounded by the additional factors, such as cultural diversity.
Title VI of the Civil Rights Act outlaws the conduct that disproportionately impacts the individuals with limited English proficiency, as this conduct institutes national origin discrimination. This conclusion was reached by the Supreme Court in 1974. Six years later, the Department of Health and Human Services (DHHS) of the United States issued a notice with further clarification on the link between the Civil Rights Act and language by stating that individuals should not be subjected to discrimination based on their nationality in health and human services programs, for the reason that their primary language is not English (Juckett & Unger, 2014).
In 2000, the then United States’ president, Clinton, gave an executive order 13166: “Improving Access to Services for Persons with Limited English Proficiency” (Juckett & Unger, 2014). The order required every federal agency to provide financial assistance to the entities that are non-federal to publish guidance on the way those, who receive funds from the federal government, can provide access to the people with limited English proficiency, so as to comply with the regulations of Title VI.
The Department of Health and Human Services issued a policy guideline in 2003 in order to help those receiving federal funding in accomplishing their responsibilities to offer access to the limited English proficient persons under the current law (Karliner et al., 2007). The policy elucidates present legal requirements for those with limited English Proficiency by providing a depiction of the factors that those receiving federal funds must contemplate before fulfilling their responsibilities to the people with limited English Proficiency.
Titles II and III of the Americans with Disabilities Act (ADA) require health care providers to guarantee an operative communication to the persons suffering from hearing loss. The communication should be as effective as communication with people without the hearing disability. Equally, health care providers should communicate effectively with other individuals suffering from hearing loss, as well as customers and clients seeking or receiving services. Notably, these people must not be patients of the health care provider, and subject to the prevailing circumstances, they could be guardians, parents, and spouses of the patient (Millman, 1993).
Health care providers are allowed to use a variety of auxiliary services and aids to guarantee effective communication. The aids include assistive listening devices, qualified interpreters, television decoders, note takers, communication materials, and written materials for the deaf. The requirement for auxiliary aid is flexible, meaning the health care provider is free to choose from the different alternatives, as long as they achieve operative communication for the persons with hearing disability. Before using any auxiliary aid or service, the department of Justice stipulates that health care providers should consult with the individual and consider their self-assessed communication needs.
Irrespective of the type of ancillary services and aids offered, it is important to maintain quality and accuracy of the services, so as to circumvent serious consequences to an individual. The ancillary aids used are needed to offer effective and safe medical treatment. Therefore, a provider using an interpreter ought to ensure that the interpreter is competent and in a position to work effectively, impartially, accurately, both expressively and receptively, using the necessary medical vocabulary and terminology (Karliner et al., 2007).
There are various kinds of interpreters (Millman, 1993). Therefore, it is important for the providers to ascertain the needs of the person with the hearing loss before contacting an interpreter. Some of the individuals with the hearing disability may need interpreters with fluency in the American Sign Language, a language with a different grammar and syntax as other English languages. On the other hand, some individuals may need the interpreters who use the following:
- Signed English – a type of signing that use similar words as English;
- Oral interpreters – with special interest of communicating words to the persons with hearing disabilities;
- Cued speech interpreters – who use visual cues to aid in lip-reading.
Irrespective of their importance, the Americans with Disabilities Act does not allow the use of auxiliary services that exert undue burden or alteration of the services and goods a health provider offers (McLeod, 1996). Undue burden has been defined as a substantial difficulty. The Department of Justice identifies several factors to be considered in determining if an action exerts an undue burden. They include financial resources of the health care provider, cost of the auxiliary aid or service, necessary legal safety requirements, effect on the operation and resources of the provider, and the trouble of locating and providing the ancillary aid or services. Some auxiliary aids still exert the undue burden. Nonetheless, it is the duty of the health care provider to deliver alternative auxiliary aid that does not result in the undue burden or cause alteration. In some instances, the cost of providing the auxiliary service may exceed the patient’s charge (McLeod, 1996). As such, it is expected that the health care provider will treat the cost of furnishing the auxiliary aid and service as an overhead cost of running a business. Consequently, as long as providing an ancillary aid or service does not exert pressure on the business of the provider, and it does not alter their services, the provider has a duty to pay for the ancillary aid or service. ADA strictly prohibits health care providers from charging a patient for the provision of auxiliary aid.
Concluding Remarks
Language barrier is a major concern in the healthcare setting that is characteristic of the diverse patient populations. In particular, the LEP patients are placed at a disadvantage, as they experience communication problems during the delivery of care. However, this can be solved by using the services of professional medical interpreters, who are well acquainted with medical terminologies, and act as a link between the patient and the care provider. The lack of medical interpreters means that the increasing diverse populations would continue experiencing health disparities and diversities as well as low quality care. As portrayed in the discussion, medical interpreters assist in interpreting vital health information to both parties, leading to effective health communication. The employment of medical interpreters is linked with the enhanced quality of care for the LEP patients. They increase patient’s satisfaction, access to care, devotion for follow-ups and drugs, and enhanced health results. The relationship between the patient and the physician relies on the improved communication. This means that quality and access to care can only be enhanced if effective communication exists between the two parties. It is the initial step in enhancing the delivery of care.
Within the framework of regulatory procedures, various aspects of quality management have been provided. For instance, Title VI of the Civil Rights Act of 1964 requires the hospitals, which obtain federal financial help, to hire the services of professional medical interpreters in order to enable access to care for the LEP patients. In addition, Title III of the Americans with Disabilities Act (ADA) requires health care providers to offer or acquire medical interpreter services for these persons. Various auxiliary aids may be used in this case, but the ending result should be the effective communication, which allows health information to be exchanged between the patient and the care provider.
