Embedding interpreters in inpatient care teams expanded their role to proactive care coordination and problem-solving

Description #

Observation and interview data indicated that when diversity (interpreter) staff were reallocated to inpatient units and integrated into clinical care teams, their role expanded beyond on-demand interpreting into proactive care coordination: they took ownership of patients' care, anticipated needs, proactively addressed discharge translation, and suggested communication strategies. A charge nurse linked the new dedicated-interpreter staffing model to more reliable communication on her unit, and observers noted LCSs prompting physicians with missing discharge information. This describes a mechanism by which the staffing/role redesign improves care-team communication.

"The only time I find that sometimes there's not the clear communication is if for some reason the interpreter is not there or available. Then I feel like that's when stuff gets lost in translation, but it's not that common [because] we have our own interpreter for the fourth floor." (charge nurse, in Marshall, 2016, p. 471)

"In meetings with diversity staff, they described an increased awareness and ability to identify patient need, proactively solve problems for patients, proactively address issues related to discharge translation, suggest innovative approaches to communication, and contribute in planning ways to better address language and culture barriers." (Marshall, 2016, p. 471)

"For example, LCSs were frequently observed approaching physicians and other members of the team to suggest how to meet a need, such as providing abbreviations or missing information in discharge instruction transitions." (Marshall, 2016, p. 471)

Methods Context #

What? #ⓘ

The observable: staff/provider descriptions and observed behaviors of integrated interpreters' expanded care-coordination role and its perceived effect on communication, captured qualitatively.

"By working on the inpatient units and integrating into the clinical care teams, diversity staff started to be held accountable and to take ownership over the care of the families in their departments." (Marshall, 2016, p. 471)

How? #ⓘ

Postintervention systematic observation (20 sessions of interdisciplinary rounds, Jan–Apr 2013, ≥2 per unit; monthly walking rounds Jul 2013–Jun 2016) plus one-on-one interviews (mid-Oct 2013–mid-Feb 2014) with staff and providers; six inpatient diversity staff were embedded in physician workrooms then care-team workstations.

"Six diversity staff were reallocated to inpatient areas with historically limited or no coverage. These staff were paired with a clinical care coordinator and integrated into the patient care processes." (Marshall, 2016, p. 469)

Who? #ⓘ

49 staff and providers interviewed across six inpatient units/teams at Children's Hospital Los Angeles — physicians (attendings, hospitalists, fellows, residents), nurses, and ancillary care staff (therapists, social workers, interpreters, dieticians, etc.).

"Interviews were conducted with 49 staff and providers from across the six inpatient units/teams, including physicians (attendings, hospitalists, fellows, and residents), nurses ... and ancillary care staff." (Marshall, 2016, p. 470)

Other Notes #

This is a qualitative, perceived/observed mechanism linking dedicated unit-based interpreter staffing to better care-team communication and care coordination — complementing the quantitative complaint and satisfaction findings. Observations and interviews were conducted by hospital insiders (the administrator [L.M.] and a research assistant), raising potential for favorable framing (see caveat).

Caveats #

• Postintervention observations and interviews at CHLA were conducted by hospital insiders involved in the intervention The qualitative evidence on interpreters' expanded care-coordination role comes from postintervention observations conducted by the program administrator who led the restructuring [L.M.] and from interviews by a research assistant, with no preintervention qualitative baseline and no independent or blinded analysis reported. Insider-conducted, postintervention-only qualitative data are prone to favorable framing and confirmation bias, so the described role expansion and communication improvements should be read as supportive illustration rather than independently validated outcomes.