The other side of “getting by”: A case study of interpreting provision decision-making and consequences for patients

Rates of provision of professional interpreting services to patients have been shown to be low in hospital emergency departments and wards. This study aimed to elicit the reasons for the context and consequences of non-provision of professional interpreting at an adult hospital and identify strategies to increase provision. This was a qualitative case study of multiple perspectives (including patients, family members, interpreters, clinical and administrative hospital staff) using in-depth interviews, participant-observation, focus group discussions, staff survey and medical record review. The data were analysed using thematic, content and systems thinking analysis to develop a theoretical framework for providers’ decision-making processes and contextual constraints. The patient and family perspectives showed that ad hoc communication negatively affected their hospital experience and patient-centred care, and highlighted errors in communication largely unknown to treating staff. Key reasons shown for low rates of professional interpreter engagement by staff were: (1) a lack of familiarity and clarity of the process of engaging interpreters combined with inadequate infrastructure, (2) low levels of trust in and confidence in working with professional interpreters and (3) little knowledge of the evidence-base (including cost-benefit) or negative consequences resulting from “getting by”. The study shows that influencing norms through (a) clarifying the pathway from identification of need to engagement of interpreters, (b) provision of clinical staff training on the evidence base and role of interpreter (c) influencing training and professionalism of interpreting are important for improving professional interpreting provision rates in a hospital setting.