Long unpredictable interpreter wait times led clinicians to get by with hand gestures broken Spanish and phone apps

Description #

In semistructured interviews, postpartum clinicians described long and unpredictable interpreter wait times — driven by interpreter understaffing — as the primary barrier to interpreter use, which in a time-pressured, efficiency-centered workflow led them to "get by" with their own limited Spanish, hand gestures, ad hoc interpreters, and smartphone translation apps rather than wait. This is a provider-reported mechanism linking interpreter availability to non-use of concordant care.

"They did not call upon interpreters, whom they characterized as understaffed and overburdened, for every encounter because that could be 'frustrating' (H024) for the interpreter and a 'waste' of their time (H025)." (Jensen, 2023, p. 432)

"Clinicians therefore use 'whatever small amount of language skills we might have' (H012) for timely patient engagement." (Jensen, 2023, p. 432)

"Many clinicians cited workflow barriers and stress as the reason for 'getting by' in 'Spanglish and with hand gestures' (H007)." (Jensen, 2023, p. 432)

Methods Context #

What? #ⓘ

The observable: clinicians' self-reported reasons and described behaviors (workarounds) when interpreters were not readily available — a qualitative account of how wait times and staffing translate into non-use of concordant communication.

"Time management was the primary barrier to interpretation service use, in a context of clinician-focused practice centered around efficiency. In-person interpretation services were particularly challenging because of long and unpredictable wait times for access due to interpreter understaffing." (Jensen, 2023, p. 432)

How? #ⓘ

Semistructured telephone interviews (audio-recorded, professionally transcribed) about facilitators and barriers to interpreter use; transcripts inductively/narratively coded by three authors, with codes synthesized into themes by discussion to axial saturation.

"Responses were then read through in their entirety, with memos and inductive narrative coding conducted by three authors (a nurse and two nonclinicians). Discussion occurred among all authors for synthesis of codes into categories for reflection and development into themes." (Jensen, 2023, p. 434)

Who? #ⓘ

14 inpatient health care team members who practiced on the postpartum unit and requested interpreter services (5 RNs, 3 certified nurse-midwives, 2 NPs, 1 maternal–fetal medicine physician, 1 pediatrician, 1 IBCLC, 1 health unit coordinator), interviewed June–Dec 2020 at the same tertiary academic medical center.

"The health care team members interviewed included five inpatient registered nurses, three certified nurse-midwives, two nurse practitioners, one maternal-fetal medicine physician, one pediatrician, one international board-certified lactation consultant, and one health unit coordinator." (Jensen, 2023, p. 434)

Other Notes #

A registered nurse described "playing charades all day" and using an interpreter only when "doing a consent" because calling one "disrupts the flow of everything" (H012, p. 432) — making explicit the time-effort tradeoff at the core of this mechanism.

Caveats #

• Single-site small sample limited to Spanish-speaking postpartum patients limits generalizability The study drew small samples (50 couplets in the chart review; 14 clinicians interviewed) from a single tertiary academic medical center and restricted attention to Spanish-speaking patients. These descriptive proportions and themes therefore characterize one unit's local practice and may not generalize to other sites, other languages, or other care settings.