Testing a New Model of Health Care Interpreter

Inova Health System Site Profile

Field of Work: Helping health care organizations meet the challenge of providing language services and signage to Latinos

Problem Synopsis: According to the U.S. Census Bureau's 2000 census, more than 28 million Latinos in the United States over the age of 5 spoke Spanish at home. Among those, almost 9 million said they spoke English "not well" or "not at all," according to the census. Latinos have become the largest and fastest-growing minority group in the United States. In the early 2000s, some 20,000 Latino patients were being admitted every year to Inova Fairfax Hospital and Inova Alexandria Hospital, two hospitals within the Inova Health System. Many were young and spoke little or no English.

Synopsis of the Work: Hablamos Juntos: Improving Patient-Provider Communication for Latinos (October 2001 through June 2006) focused on developing affordable models of innovative language services in Spanish and easy-to-understand signage to post within health facilities. RWJF funded 10 demonstration projects, including Inova Health System, located in communities with high numbers of Latinos in 10 different states.

Key Responsibilities: Inova's patient navigators were stationed in the emergency room and obstetrics units of the two hospitals. Their primary role was to serve as medical interpreters. As observers, trouble-shooters and advocates, they helped to make the system work for Spanish-speaking patients.

Recruitment and Training: Patient navigators had to have a high school diploma, 40 hours of interpreter training and two years experience as a health care interpreter.

An Art and a Science: Project staff described medical interpretation as both an art and a science. A hospital newsletter article, "Un Dia Tipico" ("A Typical Day"), quotes a staff member: "These professionals are well-versed in medical terminology in both languages, sensitive to cultural differences and aware of the nuances of dialects…. A good interpreter is present but invisible, standing back so the patient and the providers can make eye contact."

Interpreters emphasize that they repeat everything the patients and providers say, without editing, additions or deletions. They always speak in the first person, saying, for example "I have a pain in my stomach," and not "she has a pain in her stomach."

After the demonstration project ended, Inova Health System incorporated the costs of the patient navigators into ongoing operations. By April 2007, seven patient navigators were providing interpretation for some 2,500 encounters each month; the project director was recruiting two more patient navigators.

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