Tuesday – Afternoon Plenary

Rachel Solomon presented on  Having Interpreting Recognized as an Essential Healthcare Service
Rachel Solomon works with the Toronto LHIN, a regional district in Ontario charged with managing and planning for health care.  She shared about provision of interpreting services in the Toronto area.  One facet that she brought froward as a critical thing to consider is that as a population ages, it will require more need for interpreting services as studies have shown that seniors who are impacted by dementia may lose the ability to speak a second language.
More than 170 languages and dialects are spoken in Toronto, so even though Canada has two official languages, there is still a dramatic need for people who do not speak those two languages.
A good quote to help people realize the importance of having effective interpretation for doctors to be able to effectively treat their patients.

“It is more important to know ‘what sort of patient has a disease than to know what sort of disease a patient has.”  ~ Sir William Osler (via Barbara Starfield, The Hidden Inequity in Health Care)

The LHIN has collected studies that have showed that patients who receive care in their own language have better outcomes ~ both in terms of health and in terms of lower costs.  For example, there were less return visits to the Emergency department and shorter stays in hospital.
There was significant inequities in how things were working throughout the LHIN and so they decided to provide Bulk Services through a coordinated approach called Language Services Toronto.  The provide phone interpretations for many things, but need to look at when particular modes are appropriate.  Whether certain situations would be better to have face-to-face or video interpreters.  Her presentation focused more specifically on spoken languages, but their services includes signed language interpreters as well.
Panel:  Interpreting as an Essential Healthcare Service: Milestones Achieved and Challenges on the Road Ahead
Afternoon Panel ~ Tuesday

  • Lluís Baixauli Olmos, University of Louisville, talking about the experience of interpreters in health care in Spain
    • Challenges
      • Financial challenges
      • A short history of immigration
      • Professional associations are not united which makes it more challenging to implement strategies
      • Legal framework is absent in frame to require interpreters.  This is related to the short history of immigration
    • Breakthroughs
      • Development of a number of programs focused on healthcare interpreting
      • Have high production of research because of the academic programs
      • The research had really led interpreters to start the process of professionalization, but that has essentially stopped due to the financial constraints
      • HC as a public service
      • Waiting for the ISO standards that may serve as a tipping point for bench marking quality
    • Lessons to be Learned
      • Important to convince institutions and policy makers that interpreting needs to be supported and not simply dependent on the surplus of the financial situation – so when the economy goes bad.
      • Need to balance the training provided with the demand in the market
    • Strategies to be Used
      • Important to spread awareness and information about interpreting profession
      • Important to develop good relationship with neighboring professions (and other interpreting organizations)
      • Should there be a collaboration mirrored on EULITA (European Legal Interpreter Association) to develop EUMITA (a European Medical Interpreter Association)?
      • Also a need to make people who make decisions about how cost effective providing interpreting services can be.
  • Axelle Janczur, from Access Alliance Multicultural Health and Community Services
    and Remote Interpretation Ontario

    • Her experience comes out of working with newcomer languages
    • Canada is a large country geographically and diversity is concentrated in urban areas
      • Increasingly, diversity is a positive force for change
      • Focus on equity and access for all people
    • Healthcare Interpreters Network
      • Laid a foundation for the change in society to promote equity and access
      • Developed core testing and training resources
      • Developed a national guideline for standards for healthcare interpreting
    • Some are the challenges is
      • interpreting is still divided into silos
      • Don’t have a critical mass yet
      • Interpreters need to organize and take control of regulation and certification process
      • Interpretation is often seen as survival jobs for people who have been displaced from other countries
      • ATIO has jurisdiction to certify and need to work on that
      • Need to have partnership of equals with community and conference interpreters
  • Cindy Roat, Center for Diversity & Health Equity, Seattle Children’s Hospital
    • We are about the process of system change – not just providing access in specific situations
    • Need to not only focus on isolated projects, but also see that we need to change how our society deals with cultural and linguistic differences
    • In her experience, a shift of thinking occurred from “why do we have to provide interpreters?” to “How do we provide language services in the most efficient way?”
    • Three ideas to share:
      • Look at how are decisions made
        • Who makes them and on the basis of what?
        • May come through legislation or regulations
        • Research also has an impact, particularly grant-funded pilot programs
        • Changes can come in the “norms” of practice  in neighboring hospitals
      • What are the levers that you can use
        • Legal system was the first lever in the US through the Office of Civil Rights
        • Used census and demographic data ~ push to include about how well do you speak English as well as using birth rates and demographic trends
        • Research done through Office of Community Health and the Joint Commission which accredits hospitals
        • Public opinion also an important lever (getting sympathetic stories in the media)
        • Competition between hospitals
        • Standards within a profession – many hospitals were resistant to outsiders saying language access is needed, but it got within medical circles advocating for language access.
        • The point is that you need to approach it from a variety of ways to make change happen.
        • Know your audience
          • When talking with doctors, know your research.
          • With administrators, focus on liability, finances, patient throughput, re-admission rates.
          • When talking with community, right to language access and to better care.
        • Arguments change over time
          • Used to be access to care, now health care disparities
          • Make sure the language used is relevant in advocating for change.