Presentation
The Underuse of Medical Interpretation Services: A Human Factors Analysis of Why They Are Not Used Enough and How Their Usage Can Be Increased
SessionMethods & Perspectives (PS8)
Description1. BACKGROUND
Language barriers can lead to health disparities for patients whose preferred language is not English, directly impacting care quality and patient outcomes. While professional medical interpretation services (MIS) have been proven effective in reducing these disparities, their utilization remains low in Canadian hospitals. There has been growing attention to health equity in recent years and a growing body of work has revealed several barriers to the consistent use of MIS. However, previous analyses are limited in several ways: (1) they do not apply human factors expertise or identify systematic factors and the root causes that contribute to the underutilization of MIS; (2) they have predominantly highlighted provider-oriented barriers, citing factors like “time pressure”, “cost-related pressure”, and “limited interpreter availability”; (3) their findings are limited in generalizability or transferability since most studies were conducted in the United States and exclusively focused on Spanish-speaking patients.
Our work addresses these gaps by exploring barriers to MIS utilization in Canada. We applied human factors approach to help identify systematic barriers to the utilization of MIS and recommended system-based interventions to increase MIS use. Notably, this work identified patient-centered barriers (e.g., hearing or vision impairment, and dementia). Furthermore, we investigated multiple languages spoken by the diverse ethnolinguistic population of Toronto.
2. OBJECTIVES
Our study aimed (1) to identify systematic factors contributing to the underutilization of MIS by applying human factors tools and (2) to develop recommendations informed by human factors principles to increase MIS use in the General Internal Medicine ward of St. Michael’s Hospital.
3. METHODS
The research was conducted at the General Internal Medicine ward of St. Michael’s Hospital which serves a diverse ethnolinguistic population in Toronto, Ontario, Canada. The General Internal Medicine ward offers on-demand MIS through both phone and video modes. Data sources included relevant literature, policy documents, a prior survey administered to 17 clinicians, and a contextual inquiry involving a group of 14 interviewees that included nurses, allied health professionals, and interpreters. Data analysis involved the development of process maps and a PETT (People/Environments/Tools/Tasks) scan to identify and categorize barriers.
4. RESULTS
By applying process maps and a PETT scan for data analysis, we identified multiple system-related barriers contributing to the underutilization of MIS. Process maps revealed challenges at three key steps for MIS use in the phone mode and at five key steps for MIS use in the video mode. The challenging steps for MIS users were: (1) finding a manual, (2) requesting technical support, (3) finding a tablet, (4) finding a Wi-Fi connection, and (5) finding a convenient location to set up the tablet.
A total of 19 barriers were identified across four PETT scan categories. Some of these barriers are listed as below:
• People: some patients preferred ad-hoc interpreters (e.g., family members) or faced cognitive challenges (e.g., dementia) and sensory issues (e.g., hearing or vision impairment), making MIS usage difficult.
• Environments: many users expressed skepticism about the video MIS due to frequent connectivity issues, causing potential users to perceive it as unreliable or "not working."
• Tools: the single-screen design of the video MIS hampers usability as users need to rotate the screen when speaking.
• Tasks: the phone MIS requires setting up an access code prior to usage, leading to accessibility challenges.
5. CONCLUSIONS
We found 19 system-related barriers contributing to MIS underutilization, including people, environment, tool, and task factors. This finding suggests the potential for improvement across all four aspects of the PETT scan. Furthermore, the identified barriers demonstrate multiple systematic barriers even within these four PETT scan categories. Notably, even within the people factor, identified barriers encompass both provider-oriented and patient-centered challenges, indicating that addressing individual barriers in isolation from others may not be sufficient for improving MIS utilization. Thus, comprehensive enhancements across multiple systematic layers are necessary for achieving desired outcomes.
In response to these findings, we developed 14 practical recommendations informed by human factors to address these barriers systematically. These recommendations were formulated from the findings generated from the contextual inquiry, suggestions from relevant stakeholders (nurses, allied health professionals, and interpreters), and prior research. To systematically gauge the potential impact of the developed recommendations, our team reviewed and classified them by the Hierarchy of Intervention Effectiveness (developed by Vaida and The Institute for Safe Medication Practices in 1999).
6. SIGNIFICANCE
The study carries practical significance as it suggests actionable and feasible recommendations to increase MIS usage. Informed by human factors, the findings of this work shed light on key systematic factors contributing to the underutilization of MIS. Furthermore, this work identified patient-centered barriers (e.g., hearing or vision impairment, and dementia) that were not uncovered in the previous literature review. Lastly, the study’s transferability is particularly robust because of its investigation of multiple languages spoken by a diverse ethnolinguistic population.
7. LIMITATIONS & FUTURE DIRECTIONS
The project’s scope did not include the implementation phase, primarily due to time constraints. However, it would be highly useful to implement the recommended interventions and closely measure their effectiveness in practice. This follow-up phase will validate the ability of these recommendations to improve MIS utilization.
Language barriers can lead to health disparities for patients whose preferred language is not English, directly impacting care quality and patient outcomes. While professional medical interpretation services (MIS) have been proven effective in reducing these disparities, their utilization remains low in Canadian hospitals. There has been growing attention to health equity in recent years and a growing body of work has revealed several barriers to the consistent use of MIS. However, previous analyses are limited in several ways: (1) they do not apply human factors expertise or identify systematic factors and the root causes that contribute to the underutilization of MIS; (2) they have predominantly highlighted provider-oriented barriers, citing factors like “time pressure”, “cost-related pressure”, and “limited interpreter availability”; (3) their findings are limited in generalizability or transferability since most studies were conducted in the United States and exclusively focused on Spanish-speaking patients.
Our work addresses these gaps by exploring barriers to MIS utilization in Canada. We applied human factors approach to help identify systematic barriers to the utilization of MIS and recommended system-based interventions to increase MIS use. Notably, this work identified patient-centered barriers (e.g., hearing or vision impairment, and dementia). Furthermore, we investigated multiple languages spoken by the diverse ethnolinguistic population of Toronto.
2. OBJECTIVES
Our study aimed (1) to identify systematic factors contributing to the underutilization of MIS by applying human factors tools and (2) to develop recommendations informed by human factors principles to increase MIS use in the General Internal Medicine ward of St. Michael’s Hospital.
3. METHODS
The research was conducted at the General Internal Medicine ward of St. Michael’s Hospital which serves a diverse ethnolinguistic population in Toronto, Ontario, Canada. The General Internal Medicine ward offers on-demand MIS through both phone and video modes. Data sources included relevant literature, policy documents, a prior survey administered to 17 clinicians, and a contextual inquiry involving a group of 14 interviewees that included nurses, allied health professionals, and interpreters. Data analysis involved the development of process maps and a PETT (People/Environments/Tools/Tasks) scan to identify and categorize barriers.
4. RESULTS
By applying process maps and a PETT scan for data analysis, we identified multiple system-related barriers contributing to the underutilization of MIS. Process maps revealed challenges at three key steps for MIS use in the phone mode and at five key steps for MIS use in the video mode. The challenging steps for MIS users were: (1) finding a manual, (2) requesting technical support, (3) finding a tablet, (4) finding a Wi-Fi connection, and (5) finding a convenient location to set up the tablet.
A total of 19 barriers were identified across four PETT scan categories. Some of these barriers are listed as below:
• People: some patients preferred ad-hoc interpreters (e.g., family members) or faced cognitive challenges (e.g., dementia) and sensory issues (e.g., hearing or vision impairment), making MIS usage difficult.
• Environments: many users expressed skepticism about the video MIS due to frequent connectivity issues, causing potential users to perceive it as unreliable or "not working."
• Tools: the single-screen design of the video MIS hampers usability as users need to rotate the screen when speaking.
• Tasks: the phone MIS requires setting up an access code prior to usage, leading to accessibility challenges.
5. CONCLUSIONS
We found 19 system-related barriers contributing to MIS underutilization, including people, environment, tool, and task factors. This finding suggests the potential for improvement across all four aspects of the PETT scan. Furthermore, the identified barriers demonstrate multiple systematic barriers even within these four PETT scan categories. Notably, even within the people factor, identified barriers encompass both provider-oriented and patient-centered challenges, indicating that addressing individual barriers in isolation from others may not be sufficient for improving MIS utilization. Thus, comprehensive enhancements across multiple systematic layers are necessary for achieving desired outcomes.
In response to these findings, we developed 14 practical recommendations informed by human factors to address these barriers systematically. These recommendations were formulated from the findings generated from the contextual inquiry, suggestions from relevant stakeholders (nurses, allied health professionals, and interpreters), and prior research. To systematically gauge the potential impact of the developed recommendations, our team reviewed and classified them by the Hierarchy of Intervention Effectiveness (developed by Vaida and The Institute for Safe Medication Practices in 1999).
6. SIGNIFICANCE
The study carries practical significance as it suggests actionable and feasible recommendations to increase MIS usage. Informed by human factors, the findings of this work shed light on key systematic factors contributing to the underutilization of MIS. Furthermore, this work identified patient-centered barriers (e.g., hearing or vision impairment, and dementia) that were not uncovered in the previous literature review. Lastly, the study’s transferability is particularly robust because of its investigation of multiple languages spoken by a diverse ethnolinguistic population.
7. LIMITATIONS & FUTURE DIRECTIONS
The project’s scope did not include the implementation phase, primarily due to time constraints. However, it would be highly useful to implement the recommended interventions and closely measure their effectiveness in practice. This follow-up phase will validate the ability of these recommendations to improve MIS utilization.
Event Type
Oral Presentations
TimeWednesday, March 278:30am - 8:52am CDT
LocationSalon A-3
Patient Safety Research and Initiatives