2016 hin recruitment fair panel discussion june 11, 2016 - quality assurance in interpretation

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

http://www.multi-languages.com/

3Multi-Languages Corporation

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


What exactly is Quality Assurance?


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


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


• 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


• 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.


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


Risks When Lack 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."


Interpreter’s Credentials and QA


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


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


Ethics and QA


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


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

Photo by GotCredit - Creative Commons Attribution License https://www.flickr.com/photos/30576334@N05 Created with Haiku Deck

Photo by ResoluteSupportMedia - Creative Commons Attribution License https://www.flickr.com/photos/29456680@N06 Created with Haiku Deck

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

Thank You to our Sponsors:

A Special Thank you to our Videographer Orestes Robledo

Thank You to our Exhibitors!

OCCI Ontario Council on Community Interpreting

Join us for our Annual General Meeting

FALL 2016

Stay tuned for more information

@HinInfo

2016 hin recruitment fair panel discussion june 11, 2016 - quality assurance in interpretation

Healthcare