The rooms at the Moffitt-Long Hospital in San Francisco are state-of-the-art — screens, wires, and array of high-tech gadgetry surrounding sleek beds. Look on the bedside, though, and you’ll find a relatively low-tech solution to one of the hospital’s more stubborn problems.
Serving one of America’s more diverse cities, Moffitt-Long’s clientele includes people who speak Chinese, Spanish, French, Portuguese, and a slew of other languages. But when these people become patients, they must interact with a predominantly English-speaking staff.
In 2008, the facility tried to close the language gap by installing bedside interpreter telephones. The devices have two handsets, one for the patient and the other for the doctor or nurse. The device connects them both to a third-party interpreter in one of more than 200 languages. It’s one of the few hospitals in the country with such universal coverage. Boston Medical Center, which has been using phones since the 1970s, is another.
Doctor-patient relationships are often predicated on both parties speaking the same language. And, even then, the interaction can be stressful. A language barrier only magnifies those challenges, and could mean the difference between successful care, continuing illness, or worse.
The number of people facing language hurdles is already significant — at BMC, for instance, 32 percent of patients have “low English proficiency.” And, with that figure set to rise nationwide in coming years, translation services will undoubtedly become an ever more crucial aspect of medical care.
Before the bedside phone, Moffitt-Long Hospital relied primarily on in-person interpretation. But the interpreters had limited availability and required advance scheduling, says Leah Karliner, an associate professor at the University of California, San Francisco, which runs Moffitt-Long.
Having phones at every bed makes the frequent yet short conversations that often occur in hospitals much more convenient. She’s been chronicling the surprising impact of the phones, most recently in an article in the February issue of the Journal of General Internal Medicine.
Use of professional interpretation has increased fourfold since the phones were installed (other forms of interpretation stayed about the same). Better communication has led to a significant drop in readmission rates for patients with low English proficiency and improved their ability to provide informed consent.
The study also found that the expansion actually saves the hospital money. While the interpretation bill runs into the thousands of dollars each month, Karliner says the company provides the phones for free, and the price per minute keeps dropping. It’s now below $1 per minute for common languages. Any expense outweighs the cost of unnecessary readmissions, lawsuits, or the other ramifications of miscommunication. The total estimated savings: $161,404 per month.
Despite the advantages, language access in American hospitals has progressed slowly, often only prodded along by politicians. While the Supreme Court acknowledged a right to language services in the 1970s, it wasn’t until President Bill Clinton directed federal agencies to tie the provision to public funding that change began to occur. The pace accelerated under the Obama administration.
Bruce Adelson, a former Department of Justice lawyer and language access law consultant, said the Affordable Care Act has been one of the big drivers of change. The ACA included penalties for 30-day readmission and gave more weight to patient satisfaction surveys, both of which are affected by a patient’s language-interpretation experience.
Today, hospitals have the legal responsibility to provide interpretation services free of charge.
Of course, there also are times when phones might not be the best option. For sensitive or complex conversations, in-person or video interpretation can be preferable. Alternatives also come into play for patients who are hard of hearing, have speech difficulties, or can’t physically hold a phone.
In the future, perhaps technology will move translation services from a bedside landline to an app or an algorithm. But, until then, the phone lines are proving critical to better health outcomes for diverse populations.
Karliner compares the initiative to efforts to make hand washing and sanitizing second nature. That’s the goal with professional interpretation, too. “It’s not fancy technology,” she said. “[But] you have to make it easy to do.”Tik Root is a freelance writer.