Reducing the Use of Ad Hoc Interpreters at a Safety-Net Health Care System

Area of Science:

• Healthcare Quality Improvement
• Patient Safety
• Health Communication

Background:

• Effective communication is vital for patients with limited English proficiency (LEP) to receive safe, high-quality healthcare.
• Using family or friends as ad hoc interpreters for LEP patients poses risks to communication accuracy, patient safety, care quality, and privacy.

Purpose of the Study:

• To describe a quality improvement (QI) initiative aimed at reducing the use of informal interpreters (family/friends) for LEP patients.
• To identify strategies and factors contributing to successful reductions in ad hoc interpreter use within a healthcare system.

Main Methods:

• A centralized QI team monitored interpreter utilization data across multiple clinics.
• Implemented systemwide campaigns, policy changes, operational improvements, and site-specific outreach.
• Supported individual clinics in identifying and testing improvement strategies.

Main Results:

• The number of clinics with high (>10%) use of family/friends as interpreters decreased from 16 to 11 between 2012 and 2018.
• Two clinics demonstrated striking and sustained improvement, attributed to leadership champions, consistent messaging, and workflows promoting professional interpreters.
• Improvement trends varied across sites, indicating the need for tailored approaches.

Conclusions:

• Reducing ad hoc interpreter use in large healthcare organizations requires sustained effort, strong institutional policies, and site-specific outreach.
• Leadership champions and collaborative partnerships are critical for successful implementation.
• CHA's experience offers valuable strategies for other institutions aiming to enhance care for LEP patients.