2016 hin recruitment fair panel discussion june 11, 2016 - quality assurance in interpretation
TRANSCRIPT
2016 Recruitment FairQuality Assurance in Interpretation
June 11, 2016
Presenters:Lola Bendana: Director of Multi-Languages CorporationLiz Essary: Certified Language InterpreterMichelle Westin: Senior Analyst, Planning, Quality and Risk - Black Creek Community Health Centre
#HINRecruit2016
Multi-Languages CorporationLola Bendana
www.multi-languages.comTel: 416-296-0842
Quality Assurance Interpretation
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Topics
o What exactly is Quality Assurance?
o Why is QA in Interpretation Important?
o Benefitso Riskso Interpreter’s Credentials and
QAo Ethics and QA
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What exactly is Quality Assurance?“The overall process used to create the
deliverables”There are 3 elements to consider for Quality Assurance: o Provider: physical or legal person
providing the service. Interpreter Service Provider - Interpreter
o Process: steps used to provide the service
o Product: Interpretation output
The assessment method is different for each element and depends on the desired outcome
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Why is QA in Interpretation Important?
Research indicates that language barriers affect health outcomes for patients that could lead to:
• Misdiagnosis• Delayed diagnosis• Wrong referrals• Wrong treatment
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• Language barriers may result in failure to protect patient confidentiality, to obtain consent, or properly comprehend the nature of the ailment.
• Trust in the health care relationship relies on effective communication
Why is QA in Interpretation Important?
• Informed Consent is predicated on the assumption that there has been effective communication of complex information
• Poor communication due to language barriers can leave organizations open to legal challenges.
Why is QA in Interpretation Important?
Benefits of Quality Assurance• Providers
• Increased patient compliance• Less risk of malpractice• Fewer medical errors• Less conservative treatment• Decreased frustration
Administrators• Decreased liability • Increased efficiency• Increased patient safety
Health system • More appropriate use of services (↓ ER visits)• Improved health outcomes• Increased likelihood of preventative screening measures
(Bowen 2001)
Benefits of Quality Assurance
RisksLanguage barriers impacts patient – provider outcomes in many ways:
• Risk of medical errors• Misdiagnosis or inappropriate treatment• Poor patient comprehension• More medical test and ED visits • Lower patient satisfaction• Lower compliance to treatment
Bilingual Staff: “ad hoc” Interpreter
Utilization of untrained staff as ad hoc interpreters may result in:
• Distortions in information obtained in the clinical interview • Errors that are more likely to have clinical consequences
than errors made by dedicated professional interpreters• Possibility of substantial costs associated with pulling staff
from primary duties
* Dower C, Health Care Interpreters in California. UCSF Center for the Health Professions. 2003* Flores G, Barton Laws M, Mayo SJ et al, Errors in Medical Interpretation and Potential Consequences in Pediatric Encounters. Pediatrics. 2003
The Cost of Language Barriers
Potential Costs:
• Increased and inefficient resource utilization
• Opportunity costs• Societal costs• Malpractice risk
Increased and Inefficient Resource Utilization
• Language barriers between physicians and patients accounted for increased diagnostic testing and length of stay in emergency departments (ED)
• Encounters in which a language barrier was present had significantly higher test costs
• Unnecessary medical tests
Increased and Inefficient Resource Utilization
• Direct relationship between language barriers and the length of hospital stay
• Repeat appointments
• Poor compliance with follow-ups
• No shows
Opportunity Costs
• The cost of lost staff productivity is in many cases twice the cost needed to employ professional interpreters
Societal Costs
• Language barriers have been linked to numerous disparities in health and health care
• These disparities are linked to increased morbidity, mortality, and loss of productivity
Malpractice• Misinterpretation of a single Spanish word led
to a $71 million dollar malpractice settlement associated with a potentially preventable case of quadriplegia.8
• Intoxicado was misunderstood in this case to mean "intoxicated" instead of its intended meaning of "feeling sick to the stomach."
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Interpreting skillsInterpreting constituent tasks:• Active listening• Note taking• Memory retention • Transposition and verbalization• Language Register /Low context / High
context
The Effort Model
Source: Daniel Gile
Comprehension RetrievalVerbalization
ProductionTransposition
Memory
The Effort ModelProcessing capacity
Stress
Strong Accent
Dense Speech
Technical Terms
Noisy room
Poor Audio Feed
Hot Booth
Difficulty UnderstandingBad phone signal
Speed
Lack of background information
Volume
EnvironmentConfused role
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What do we look for when hiring interpreters?
Mandatory Requirements: College Certificate or University degree in one of your
language combinations Language interpreting test CILISAT / ILSAT / CTTIC / Interpretation Training (minimum 100 hours), ideally LITP
(180 hours) 5 years of part time or 3 years full time documented
experience Abide by the National Standard Guide for Community
Interpreting Services (NSGCIS) Medical Terminology training if working in the healthcare
sector
Additional Credentials (an asset): OCCI Accredited Community Interpreter (ACI)
Credential (it will be mandatory in the near future, this is the program we support and promote)
Participation in professional development activities Membership with the Association of Professional Language
Interpreters APLI
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Professional Interpreter’s Code of Ethics• Accuracy and Completeness
• Confidentiality: non disclosure of information, professional secrecy except when required by law or to prevent an act of violence such as suicide
• Impartiality and Conflict of interest
• Respect for all parties / integrity
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Professional Interpreter’s Code of Ethics• Maintenance of role boundaries / limitation
of practice: Competence, knowledge and acceptance of limitation of his/her abilities in regards to language and specialty
• Accountability
• Professionalism
• Professional Development
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Quality Assurance in Interpretation: An Organizational Perspective
Michelle WestinSenior Analyst, Planning, Quality and RiskBlack Creek Community Health [email protected]
Organization
Health Care Provider
Client
• Infrastructure preparation and coordination
• Financial considerations• Risk management framework• Sustainability planning• Integration into service delivery model
• Training in order to work with interpreters
• Understanding of how and when to use a professional interpreter
• “Working with Your Professional Interpreter Guide” – HIN
• Individual advocacy for use of interpretation services
Considerations for using Professional Interpretation Services
Role of Community Health Centres (CHCs)
• Community Health Centres (CHCs) are structured and designed to eliminate system-wide barriers to health, and:
• Ensure equitable access to health-care; • Strengthen the role of the individual an community in
health and health care delivery;• Encourage linkages among health services and with
social and other community services; • Provide comprehensive primary care services,
promote efficient use of health care providers and health resources
• Promote health and prevent illness
Quality Assurance: Organizations
• Create infrastructure for interpretation services within organization (booking processes, staff training, provision of equipment/technology for various modalities)
• Integrate professional interpretation services as part of service delivery model: use of interpretation throughout organization (appointments, groups, consultations)
• Risk Management: Use of professional interpretation helps mitigate risk, by reducing chance of miscommunication, ensuring confidentiality and enhancing therapeutic relationship
• Review policies and procedures in order to identify (e.g., consent forms/declarations, procedures for disposing of notes onsite, invoice and billing information protects client information)
• Collection and analysis of use of interpretation to identify trends, predict usage, and as a tool for planning and advocacy
• Monitor issues and evaluate Quality (how was the client experience? What was the level of provider satisfaction?)
• Communication with language interpretation company crucial in identifying successes and learnings and reporting back of how issues are addressed.
• How do we reduce risk? Use professional, qualitified interpretation services.
• Access to appropriate and timely language interpretation enhances client experience, therapeutic relationships and ultimately improves health.
Quality Assurance: Organizations
• Collection and analysis of use of interpretation to identify trends, predict usage, and as a tool for planning and advocacy.
• Monitor issues and evaluate Quality (how was the client experience? What was the level of provider satisfaction?)
• Communication with language interpretation company crucial in identifying successes and learnings and reporting back of how issues are addressed.
• How do we reduce risk? Use professional, qualified interpretation services.
• Access to appropriate and timely language interpretation enhances client experience, therapeutic relationships and ultimately improves health.
Quality Assurance: Health Care Providers
• Prepare and train health care providers to work with professional interpreters
• Resources: training should be provided by interpretation services company
• Understanding of why, how and when to work with a professional interpreter
• Documentation: appropriate documentation of use of interpreter services within client chart (e.g., interpreter ref#, language, modality)
• Feedback and evaluation mechanisms about services in place for follow-up
Quality Assurance: Clients
• “Working with your Professional Interpreter Guide”: available in 13 languages and identifies:
• The role and value of professional interpreter services,• The standards abide by professional medical
interpreters,• Types of interpretation services available,• Ways to work with an interpreter, and• How a LEP client can access interpreter services• Promote advocating for access to professional
interpreter