Healthcare Interpretation Network Trained Interpreters – an Important Member of the Care Team:

1. Healthcare Interpretation Network Trained Interpreters – an Important Member of the Care Team: The careprovider’s perspective Grace Eagan, MA UHN Interpretation and Translation Services

2. Agenda • From Patient-Centred to Patient as Partner • Interpreter as Member of Care Team • Two common scenarios: Patient Trying to Dismiss and Family Member Trying to Dismiss • Strategies to encourage the patient/family to work with an interpreter

3. Patient-centred to Patient as Partner Common principles: • Trusting relationship based on mutual respect • Patients are now expected to take an active role in their care • Shared informed decision-making • Patient’s health information is understood within the context of their values and circumstances

4. The “Eldridge Decision” (1997) "…where sign language interpreters are necessary for effective communication in the delivery of medical services, the failure to provide them constitutes a denial of s. 15(1) of the Charter [of Rights and Freedoms]….” Eldridge v. British Columbia (Attorney General), Supreme Court of Canada

6. “Without language, we lose the most… …effective tool for establishing a meaningful relationship with patients and the opportunity to address individual worries and fears. Ultimately, professional medical interpreters have the unique ability to assist clinicians in establishing the healing connections that form the foundation of ethical and culturally sensitive care.” Schapira L et al. “Lost in Translation: Integrating Medical Interpreters into the Multidisciplinary Team” (2008) Oncologist 13(5): 586-592.

7. Interpreters: Members of the Care Team “As a speech-language pathologist, my most challenging cases frequently involve patients who have language impairments and do not speak English. Medical Interpreters help me connect with these patients immediately so I can provide valuable education and strategies. They also afford me the opportunity to really involve patients as partners in the rehab process which greatly contributes to positive outcomes.”

8. Interpreters: Members of the Care Team “Medication education is a crucial part of patient care in any unit.  A patient’s successful discharge is achieved when they understand the dose, directions, indication, and side effects of their relevant medications.”

9. Interpreters: Members of the Care Team “Not only is it beneficial, it is crucial.  In pre-admission, we do pre-op teaching that is necessary to help improve post-op progress, and we also do a risk assessment and medical history on the pt.  Family members are not familiar with the medical terminology and sometimes guess at the answers. Without a professional interpreter, patient outcomes and safety are compromised.”

10. Interpreters: Members of the Care Team “Trained interpreters are the most trusted tool in a clinician’s toolkit when communicating with LEP patients.”

11. Communication Goals & Benefits • Connect with pt • Risk assessment • Patient history • Teaching • Pt understanding • Immediately • Positive outcomes • Patient safety • Successful discharge

12. Two common scenarios • The patient insists on using his/her limited English to speak to the clinician • A family member insists on interpreting for the patient

13. Patient Wants to use Limited English Self-empowerment Sharing a language with the clinician Concern about confidentiality and privacy • Demonstrate an appreciation of the patient’s preference • Try to explore the patient’s reasons and address them • Communicate why you need the interpreter for yourself • Offer options: Interpreter on stand-by to clarify as needed Interpreter interprets what you say

14. Family Wants to Interpreter Control content Be valuable and needed Concern about confidentiality and privacy • Demonstrate an appreciation of the family’s preference • Try to explore the family’s reasons and address them • Communicate why you need the interpreter for yourself and the patient, and alternate roles for the family • Offer options: Interpreter on stand-by to clarify as needed Interpreter offers whispered simultaneous

15. Bigger Picture Strategies • Have a policy that backs up and empowers staff by requiring professional interpretation services for specific care situations (e.g. obtaining informed consent) • Educate staff of risks of using ad-hoc (or no) interpretation • Involve additional mediation resources in policy-making and training initiatives (Bioethics, Patient Relations)

16. Bigger Picture Strategies, cont’d • Remove “Relationship to patient” from Interpreter signature line on consent forms • Develop a Language Access Plan • Identify a champion within upper management • Involve community members in language services initiatives • Promote directly to patients

17. Bigger Picture Strategies, cont’d

18. Thank you. Contact: grace.eagan@uhn.ca