A comparison of interpretation services for healthcare providers

Language barriers shouldn’t prevent people accessing healthcare, but sadly they do. 

We live in increasingly culturally and linguistically diverse societies. This requires healthcare organisations to provide professional interpretation services for patients with a language barrier to reduce healthcare inequalities. 

In English-speaking countries such as the UK, USA, Canada and Australia, poor English proficiency hinders an individual’s ability to interact with healthcare professionals, limiting their access to health services. 

The  negative effects of language barriers in healthcare  are well known. Studies have shown that patients facing language barriers are more likely to have a worse experience including slower diagnosis, and poor communication for surgical procedures and at discharge which inevitably lead to hospital readmissions and an increase in costs. 

Healthcare organisations rely on a number of interpretation options to provide safe care for patients. Often, the type used is dependent on what is most easily accessible to clinicians. 

Why are interpreting and translation services in healthcare needed?

General Medical Council guidance states that all possible efforts must be made to ensure effective communication with patients. This includes arrangements to meet patients’ communication needs in languages other than English. 

Whilst not being able to speak English is not a ‘protected characteristic’ defined under the Equality Act 2010, section 13G of the National Health Service Act 2006 (“NHS Act”) states that NHS England, ‘in the exercise of its functions, must have regard to the need to reduce inequalities between patients with respect to: 

• Their ability to access health services; and 
• The outcomes achieved for them by the provision of health services. 

In the United States of America, the Equal Health Care for All Act establishes a definition for inequitable healthcare to ensure patients receive the same high quality healthcare services, regardless of race, national origin, sexual orientation, gender identity, disability, age, or religion 

Not being able to communicate well with health professionals can impact on health outcomes, increase the frequency of missed appointments, reduce the effectiveness of consultations and worsen the patient experience. 

Mismanaged language barriers can exacerbate issues of poor communication and can lead to reduced quality of care for patients. 

A person with good conversational fluency in English may not be able to understand, discuss or read health-related information proficiently in English. In the USA, it is estimated that  85% of the population lack proficient health literacy  and 30% of hospital liabilities arise from miscommunication. 

What is the difference between interpretation and translation?

Frequently used interchangeably, translating and interpreting are two very different activities. 

Interpreting is the conversion of one spoken language into another in real-time. Language translation is the conversion of one written language into another. 

What are the advantages of using an interpreting service in healthcare?

Working with language interpreters and translators to reduce communication barriers between practitioner and patient has been shown to improve safety with respect to diagnosis and prescription. 

In  one study from 2016, patients who have limited English proficiency were 24% more likely to return to the emergency department within 72 hours. 

Using an interpretation service has the following benefits: 

• Improves accessibility 
• Enables the explanation of complex terminologies 
• Improves patient experience and satisfaction 
• Decreases readmissions 
• Reduces the risk of misunderstanding and misdiagnosis and inadequately informed consent 
• Increases the likelihood of treatment plans being followed 
• Enhances operational efficiency, helping with patient flow 

There are several different models of interpretation used in healthcare settings. These are: 

Professional (face-to-face) interpretation 

The use of interpreters in hospital and general practitioner settings varies significantly. For example, professional interpreters are not always available, or on hand when they are most needed which means the type of interpretation method often varies. 

A skilled interpreter doesn’t just convey the meaning of one language into another – they recognise the need to also be culturally correct and sensitive. 

Often there are small cultural nuances that only a native speaker or someone exceptionally fluent in a language can identify. While small, these nuances make all the difference in how the interpretation is delivered, and can avoid costly and embarrassing misunderstandings. 

Use of professional interpreters is associated with  improved clinical care, and professional interpreters appear to raise the quality of clinical care for limited English proficiency patients, to approaching or equal that for patients without language barriers. 

After  evaluating 4,146 hospital stays in an American emergency room, a study concluded that drawing on the services of a professional interpreter resulted in shorter hospital stays, reduced administration of unnecessary medication, and appropriate treatment. 

However, there are barriers to using professional face-to-face interpreters, largely associated with availability, time constraints and cost. All too often we hear the familiar story of interpreters not being available when they are most needed. 

Telephone or video-based interpretation 

Telephone or video-based interpreters for healthcare enable a remote interpreting service. Using this model of interpretation  has been shown to reduce organisational barriers to use, however it is a costly service for healthcare providers, and isn’t always effective. 

Due to the range of languages to be covered,  telephone and video interpretation can help healthcare organisations face up to the demands  for trained interpreters required on short notice and in remote healthcare sites. 

Commenting on video-based interpretation, users recognise the rapid availability, data protection compliance, ability to see the interpreter despite physical distance, absence of potential external influence resulting from personal relationships, legal certainty, and absence of the requirement for personal presence, as key benefits in the use of the new technology. 

Our research has shown that every call made to telephone or video-based interpretation services from the NHS incur a minimum cost of as much as £80. When multiplied by the number of patients facing language barriers at each hospital, the cost to the NHS easily runs into the tens of millions of pounds. 

Friends, family or other healthcare staff as (lay) interpreters 

Due to the time and availability barriers presented by face-to-face interpretation services, and the set-up time and cost associated with telephone and video interpreters, healthcare professionals often have to find work-arounds to ensure they can achieve even the most rudimentary of communication with patients. 

The  most common sources of adverse events for foreign language patients  is the use of unqualified language mediators. Despite this, lay interpreters such as friends or family members, or non-clinical hospital employees, are often asked to interpret, especially in emergency situations. This carries risks, including confidentiality, misunderstandings with possibly severe medical consequences, and an unnecessary emotional burden on the ad-hoc interpreter. 

When  nursing staff with proficiency in a second language are asked to provide interpretation  it also takes them away from other duties, increases workload and hinders efficiency and patient flow. 

When the interpreter is a patient’s loved one, they are more likely to reflect the patient agenda and overtly omit pre-judged information. 

CardMedic – an always and instantly available inclusive communication tool for reducing language barriers in healthcare 

The CardMedic app provides instant access to a library of over 1,000 pre-written scripts in nearly 50 languages, covering common patient-clinician conversations in over 80 topics, from allergies, to ventilators. Every script has been written and checked by an experienced healthcare or allied healthcare professional to ensure it is safe and compliant. 

Accessing the content takes seconds. No long set-up times or waiting for an interpreter to arrive and with a large library of scripts, you can start using it right now. Just download it from your app store, or  create an account  on our website for free. What’s more, CardMedic’s fixed cost unlimited use model means it costs just a fraction of face-to-face or remote telephone and video-based interpreters.

Download on Apple

Download on Android

Whilst CardMedic is not a direct replacement for face-to-face professional interpreters, we know there are huge gaps in service provision, particularly out of hours, or in urgent and emergent situations.  Patients may also be reluctant to request or accept professional interpreting due to fear of costs, inconvenience, cultural barriers, or concerns about confidentiality. That’s when CardMedic becomes an essential solution to bridge those gaps, overcome communication barriers, improve patient safety and enhance patient experience and engagement. If you would like to access the full library of content on CardMedic, please drop us a note to arrange a free demo and chat further! 

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CardMedic in action 

Interested to know more about how CardMedic is helping healthcare organisations reduce health inequalities and provide more accessible healthcare for all? Read our case studies. 

The Christie NHS Foundation Trust

Nor-Lea Hospital District