“The talking bit of medicine, that’s the most important bit”: doctors and Aboriginal interpreters collaborate to transform culturally competent hospital care

Abstract

Background In hospitals globally, patient centred communication is difficult to practice, and interpreters are underused. Low uptake of interpreters is commonly attributed to limited interpreter availability, time constraints and that interpreter-medicated communication in healthcare is an aberration. In Australia’s Northern Territory at Royal Darwin Hospital, it is estimated around 50% of Aboriginal patients would benefit from an interpreter, yet approximately 17% get access. Recognising this contributes to a culturally unsafe system, Royal Darwin Hospital and the NT Aboriginal Interpreter Service embedded interpreters in a renal team during medical ward rounds for 4 weeks in 2019. This paper explores the attitudinal and behavioural changes that occurred amongst non-Indigenous doctors and Aboriginal language interpreters during the pilot. Methods This pilot was part of a larger Participatory Action Research study examining strategies to achieve culturally safe communication at Royal Darwin Hospital. Two Yolŋu and two Tiwi language interpreters were embedded in a team of renal doctors. Data sources included interviews with doctors, interpreters, and an interpreter trainer; reflective journals by doctors; and researcher field notes. Inductive thematic analysis, guided by critical theory, was conducted. Results Before the pilot, frustrated doctors unable to communicate effectively with Aboriginal language speaking patients acknowledged their personal limitations and criticised hospital systems that prioritized perceived efficiency over interpreter access. During the pilot, knowledge of Aboriginal cultures improved and doctors adapted their work routines including lengthening the duration of bed side consults. Furthermore, attitudes towards culturally safe communication in the hospital changed: doctors recognised the limitations of clinically focussed communication and began prioritising patient needs and interpreters who previously felt unwelcome within the hospital reported feeling valued as skilled professionals. Despite these benefits, resistance to interpreter use remained amongst some members of the multi-disciplinary team. Conclusions Embedding Aboriginal interpreters in a hospital renal team which services predominantly Aboriginal peoples resulted in the delivery of culturally competent care. By working with interpreters, non-Indigenous doctors were prompted to reflect on their attitudes which deepened their critical consciousness resulting in behaviour change. Scale up of learnings from this pilot to broader implementation in the health service is the current focus of ongoing implementation research.

Malnutrition, symptom burden and predictive validity of thePatient‐Generated Subjective Global Assessmentin Central Australian haemodialysis patients: A cross sectional study

“…4,5,11,18 The implications of these findings are concerning, as renal dietitian staffing has repeatedly been shown to be insufficient, both in Australia and abroad. [19][20][21][22] Given the level of remoteness, and challenges accessing Indigenous health care interpreters [23][24][25] which are necessary for providing culturally safe care, it is possible that many haemodialysis patients are not receiving dietetic input when most needed.…”

Improving outcomes for hospitalised First Nations peoples though greater cultural safety and better communication: The Communicate Study Partnership study protocol

“…On-site availability will improve visibility and availability of the service. Creation of a cohesive, supported team will help mitigate the intimidating nature of the work environment [5,9].…”

“…The rationale for this project is that First Nations peoples in Northern Territory hospitals lack access to interpreters even though many speak an ancestral language as their rst language and interpreter-mediated communication would bene t both patient and provider [3]; experience racism in health care [4,5]; take their own leave from hospitals in 10-12% of admissions [6] (around 11 times the rate for non-Aboriginal people [7]) and have high mortality [8]. Meanwhile, healthcare providers recognise they lack the skills required to deliver culturally safe care [9] and have requested training to address their limitations [10].…”

“…Low demand for interpreters can be attributed to lack of knowledge about the diversity and prevalence of languages spoken in the Northern Territory, and time constraints in chaotic, busy acute care work environments [3]. We previously identi ed that one contributing factor to the low interpreter supply in healthcare was that hospitals can be alienating places for interpreters, reducing their motivation to accept health interpreting jobs when they could be working in other sectors [5,9]. An interpreter noted that doctors seem "intimidating" and "just like police" [9].…”

“…We previously identi ed that one contributing factor to the low interpreter supply in healthcare was that hospitals can be alienating places for interpreters, reducing their motivation to accept health interpreting jobs when they could be working in other sectors [5,9]. An interpreter noted that doctors seem "intimidating" and "just like police" [9]. Healthcare providers may lack skills in how to work effectively with interpreters [3].…”