Applications of policy and the advancement of patients’ health outcomes through interpreting services: data and viewpoints from a major public healthcare provider

Abstract

This paper has policy as its starting point, relating both to society in general and to healthcare in particular. In Australia, both social and health policy coincide in their advocacy for language (interpreting) services, with the optimisation of healthcare outcomes for patients a desirable outcome of both. This paper relates these macro-level directives to the development of a hospital-wide Cultural Responsiveness Plan that represents policy guidelines at a lower level, and the way that this plan was applied and operationalised at a major public health facility, Northern Health in Melbourne, servicing up to 1 million people. Through the re-establishment of language services, a policy of transcultural training for all new and existing staff, and hospital-wide dissemination of information relating to communicating with limited English proficiency (LEP) patients, a 317% increase is recorded in the requests for interpreters at patient occasions of service (OOS) over an 8-year period. This increase is largely met by the further employment of in-house interpreters, whose cost per OOS drops in proportion to the greater efficiencies that are derived from in-house staff. The augmentation of interpreting services correlates with a 28% decrease in average LEP patient length of stay in hospital, with a decrease in the difference of re-admission rates amongst this group compared to those speaking English. This paper uses demographic data to quantify the likely percentage of LEP patients at Northern Health and matches these against the augmented level of service to show how far this is from a comprehensive or universal level of service which is usually one of the stated aims of macro- and local-level policy. Statistical data gathered longitudinally are presented alongside excerpts taken from interviews with three groups of informants: in-house interpreters, hospital managers outside language services, external language services stakeholders.