By Matt Ginsberg-Jaeckle, MA, CHI, Associate Director of Global Patient Services
Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago)
Previously, I addressed the singular role of the interpreter — the only type of healthcare professional that is part of every conversation for patients with Limited English Proficiency (LEP). For these patients, the entirety of their care is mediated through the voices of interpreters.
Traditionally, the role of the interpreter emphasizes an ideal of interpreter invisibility, and this framework of invisibility is part of the reason the work of interpreters often goes unnoticed. In the world of Workers’ Compensation, we call this essential function support, i.e., providing critical, two-way communication that takes place from the time of the injury through recovery.
A substantial body of literature emphasizes the importance of patient-provider relationship, rapport and trust for obtaining good treatment outcomes. Establishing trusting relationships between people who come from different cultural backgrounds and speak different languages involves much more than just transferring meaning back and forth between the world of a provider and that of a patient.
Every Interaction Counts!
The success of cross-cultural communication is not just the responsibility of the interpreter, however. In fact, much of the advice I give providers on how best to work with interpreters can help improve our relationships with patients and each other, regardless of language:
- Look at and speak directly to the patient, not the interpreter.
- Speak in complete sentences, avoiding jargon, acronyms and excessive clauses.
- Be yourself — Although jokes and quips can be challenging to interpret, so much of who we are comes across in the nuance of our communication. Accordingly, don’t shy away from these forms of connection merely because a patient doesn’t share your language. Turn the humor of what gets “lost in translation” into an opportunity to laugh and break down barriers.
- Expect everything to be interpreted, i.e., don’t engage in side conversations without expecting your patient to be party to them. Conversely, if your patient engages in side conversations, create an expectation that you are party to their side conversations, too. Transparency is fundamental for building trust.
- Ask questions and encourage patients to speak for themselves. There is no better way to figure out what you don’t understand than to ask. Don’t expect the interpreter to be a “cultural expert” because culture is dynamic and open to a variety of meaning across region and generation and from individual to individual. Interpreters should help identify misunderstanding and can suggest possible explanations and alternative ways of expressing the point. Misunderstandings are actually a gift because they can guide you in understanding patients in their own words. Interpretations are never a replacement for a patient’s voice.
Even with a well-trained professional interpreter and a well-prepared provider, however, opportunities for misunderstanding in healthcare abound — some with clinical consequence. As an industry, healthcare needs to invest more in research and training to better understand best practices in healthcare interpreting.
If interpreters are visible collaborators in healthcare encounters, we need to ask what that visibility can and should look like and what its impact is. I recently lead a grant-funded study exploring the impact of interpreting on the accuracy of assessments by speech therapists of patients with a particular communication disorder.
We found that when interpreters were trained in specific ways to be visible in supporting speech therapists’ goals, errors were dramatically reduced. Unfortunately, there are few such studies focused on specific domains of healthcare interpreting that can shed light on what practices best support patient and clinician aims and overall best outcomes.
Although we clamor for evidence-based practice in every other area of medicine, the simplistic understanding of interpreters as invisible language conduits has limited the extent to which the same investment and rigor have been applied to healthcare interpreting. Without a better understanding of the process and impact of interpreting on outcome, how can we really know whether the injured workers who speak a language other than English are getting the best possible care? After all, interpreters are the only healthcare professionals involved in every realm of that care.
About Matt Ginsberg-Jaeckle
Matt Ginsberg-Jaeckle, MA, CHI is the Associate Director of Global Patient Services at the Shirley Ryan AbilityLab, where he has worked for over a decade first as a Spanish interpreter and now as an administrator and leader. The Global Patient Services department helps facilitate access to rehabilitation for hundreds of patients from dozens of countries around the world every year and also coordinates care for patients coming from other states, for injured workers, and for active duty service members. Matt received his MA in Translation & Interpreting Studies from the University of Illinois’s Center for Translation Studies in 2015 and his BA from the University of Chicago in Latin American History in 2005. Matt has also trained hundreds of Chicago healthcare interpreters for both local language access agencies and community colleges over the last decade. He recently completed a project he designed and obtained funding for via a Shirley Ryan AbilityLab collaboration with the Coleman Foundation to better understand and improve the services received by patients with communication disorders who have Limited English Proficiency and access speech therapy through an interpreter. That project, “Measuring and Enhancing the Reliability of Interpreter-Mediated Aphasia Assessments” was the first study of its kind to not just understand the impact of interpreting on the assessment of patients with aphasia but implement and measure the effect of an intervention to shift the role of the interpreter and improve the reliability of those assessments.
About Shirley Ryan AbilityLab
Shirley Ryan AbilityLab, formerly the Rehabilitation Institute of Chicago (RIC), is the global leader in physical medicine and rehabilitation for adults and children with the most severe, complex conditions — from traumatic brain and spinal cord injury to stroke, amputation and cancer-related impairment. The organization expands and accelerates leadership in the field that began at RIC in 1953. The quality of its care and research has led to the designation of “No. 1 Rehabilitation Hospital in America” by U.S. News & World Report every year since 1991. Upon opening in March 2017, the $550 million, 1.2-million-square-foot Shirley Ryan AbilityLab became the first-ever “translational” research hospital in which clinicians, scientists, innovators and technologists work together in the same space, surrounding patients, discovering new approaches and applying (or “translating”) research real time. This unique model enables patients to have 24/7 access to the brightest minds, the latest research and the best opportunity for recovery. Shirley Ryan AbilityLab is a 501 (c)(3) nonprofit organization. For more information, go to www.sralab.org.