Meeting demand: A multi-method approach to optimizing hospital language interpreter staffing

Abstract

Objective: The objective of this paper is to highlight a study on optimizing the full-time equivalent (FTE) for Spanish and Mandarin interpreters at Christiana Care Health System. In this study, there were multiple challenges that needed to be addressed, and a multi-method approach was taken. Methods: These methods include: (1) time-motion study to quantify interpreter workflow and variability of duration of time needed for each task; (2) an integer program to optimize the number of interpreters needed per hour based on historical demand patterns for interpreter services; (3) Discrete-Event Simulation (DES) to examine the use of agency interpreters in order to meet demand; (4) cost modelling to convert FTEs and the use of agency interpreters into overall costs to the hospital; and (5) sensitivity analysis to evaluate alternative number of interpreter FTEs and their corresponding costs to the hospital. Results: Overall cost to the hospital is predicted to decrease with additional FTE interpreters, up to a threshold level above which the cost will start to increase. Through this innovative methodology used in this paper, we predict that hiring 3.5 more FTEs for Spanish interpreters will result in 9.07% of cost savings, and predict that hiring one FTE for Mandarin interpreters will result in 25.87% in cost savings compared to the current expense of providing Mandarin language interpretation. Conclusions: Contrary to intuition, increasing number of FTEs results in cost savings. Besides the financial benefit, hospitals will also be able to ensure the quality of health services that Limited English Proficiency (LEP) patients and families receive.

Beyond English only: Addressing language interpretation in professional psychology training.

“…Over a decade ago in the American Psychologist, Snowden, Masland, and Guerrero (2007) called attention to the federal mandate (Title VI of the Civil Rights Act) for public services to offer language accommodations and also to continued barriers faced by individuals with LEP in mental health settings. Since that time, psychologists have made limited efforts at language accommodations (Durbin et al, 2017; Searight & Armock, 2013), yet medical clinics and hospitals have increasingly provided language accommodations (e.g., Chiam et al, 2017; Hsieh, 2016; Masland et al, 2010). Many medical schools train students to work with interpreters (e.g., Ikram et al, 2015), and over 66% offer training in languages such as Spanish (Morales et al, 2015).…”

“…Since 1978, the U.S. judicial system has mandated language interpretation when necessary for legal proceedings (Mikkelson, 2016). Over time, language training for physicians and language accommodations for patients in medical hospitals have become increasingly prevalent (e.g., Chiam et al, 2017; Hsieh, 2016; Jacobs & Diamond, 2017), but relevant mental health training and services have lagged behind (e.g., Becher & Wieling, 2015). The 1993 guidelines from the American Psychological Association (APA) instructed psychologists to provide services in the language requested by the client, with interpreter facilitation as needed.…”

Language Co-Construction and Collaboration in Interpreter-Mediated Primary Care Encounters With Hispanic Adults

“…However, the addition of another participant adds complexity to the patient–provider interaction. Prior research has examined multiple components of interpreter-mediated health care encounters, ranging from utilization of interpreter services (Chiam et al, 2017; Karliner, Pérez-Stable, & Gregorich, 2017) to interpretation accuracy (Cortabarria, 2015; Nápoles, Santoyo-Olsson, Karliner, Gregorich, & Pérez-Stable, 2015); ethical conflicts (Hordyk, Macdonald, & Brassard, 2017), and patient satisfaction (Dunlap et al, 2015). The primary data sources in these studies included postencounter surveys and interviews with patients, language interpreters, and providers.…”