Reducing the Use of Ad Hoc Interpreters at a Safety-Net Health Care System

Background: Providing effective communication assistance is critical to ensuring that patients with limited English proficiency (LEP) receive safe and high-quality health care services. Health care providers often use ad hoc interpreters such as patients' family members or friends to communicate with LEP patients; however, this practice presents risks to communication accuracy, patient safety, quality of care, and privacy. Methods: Cambridge Health Alliance (CHA) undertook a quality improvement (QI) initiative to reduce the use of patients' family members and friends as interpreters during clinical encounters. A centralized QI team monitored data across clinics and implemented several improvement activities, including systemwide informational campaigns and policy changes, operational improvements within interpreter services, and site-specific outreach. In addition, individual clinics identified and tested improvement strategies with support from the QI team. Results: The number of clinics with high (>10%) utilization of family/friends as interpreters decreased from 16 to 11 between 2012 and 2018. Trends over time varied across sites, and two clinics had particularly striking and sustained improvement. At these clinics, there were several factors that facilitated improvement, including having trusted leadership champions, using clear and consistent messaging reinforcing CHA's policy, and implementing workflows promoting use of professional interpreters. Conclusion: Changing practice to reduce the use of ad hoc interpreters in a large multisite organization is challenging and takes sustained and prolonged effort. Strong institutional policies and site-specific outreach can help stimulate change, and partnership with leadership champions is critical to success. CHA's experience provides strategies and lessons that can be leveraged by other institutions seeking to improve care for LEP patients.