SummaryThrough its participation in the Health Care Interpreter Network, Contra Costa Health Services provides video and telephonic interpretation services in a broad array of languages to diverse patient populations at its clinics, regional hospital, and other points of patient contact, including its county-owned health plan's 24-hour advice nurse line. A cooperative of California hospitals and providers, the network allows Contra Costa providers to access trained interpreters from other cooperative members and other sources through an automated video/voice call center. Hospital and clinic staff access the system using telephonic and videoconferencing devices located throughout their facilities. Network participation has improved access to interpretation services, with both patients and staff generally accepting the idea of not having an interpreter on site.Suggestive: The evidence consists primarily of post-implementation feedback received during interviews with 84 Contra Costa patients with limited English proficiency (mostly Spanish speakers) and with 72 staff members in a variety of positions at Contra Costa's health centers and hospital.
Developing OrganizationsContra Costa Health Services
Date First Implemented2005
Vulnerable Populations > Non-english speaking/limited english proficiency
Problem AddressedA shortage of interpreters trained to work in medical settings makes it difficult for individuals with limited English proficiency, especially new immigrants, to access quality health care and to interact effectively with English-speaking providers.
- Inadequate supply of trained interpreters: A shortage of interpreters trained to work in medical settings often makes it difficult to provide quality interpretation services to patients. This shortage is especially problematic for many publicly funded health care organizations that are required by law to ensure that patients have access to linguistic and culturally appropriate, quality care.
- Poor quality interactions with health care providers reduce access to quality care: Patients with limited English proficiency receive less health education, experience poorer doctor–patient interactions, and report lower satisfaction with health care services than do patients who speak English fluently.1 Providers report that language barriers compromise patients' understanding of their disease and treatment advice, increase the risk of complications, and make it harder for patients to explain symptoms.2
Description of the Innovative ActivityThrough its participation in the Health Care Interpreter Network, Contra Costa Health Services provides video and telephonic interpretation services in a broad array of languages to diverse patient populations at its clinics, regional hospital, and other points of patient contact, including its county-owned health plan's 24-hour advice nurse line. A cooperative of California hospitals and providers, this network allows Contra Costa providers to access trained interpreters from other cooperative members and other sources through an automated video/voice call center. Hospital and clinic staff access the system using telephonic and videoconferencing devices located throughout their facilities. Currently, the Health Care Interpreter Network has approximately 75 interpreters on line. Languages provided by member hospitals include Spanish, Cantonese, Mandarin, Vietnamese, Lao, Mien, Cambodian, Hmong, Korean, Russian, Farsi, Armenian and Mixteco. Key elements of how the program works at Contra Costa include the following:
- Publicizing interpreter services: Signs at key entry points in each participating Contra Costa facility—including the main lobby, emergency department (ED), and reception areas—inform patients and families about the availability of interpreter services. Each sign lists numerous languages to which individuals can point to indicate their preferred language, including American Sign Language for hearing-impaired patients.
- Identifying preferred language and other needs: If an individual cannot read, staff engage him/her in an effort to determine the appropriate language, accessing an interpreter from the network call center for help, as needed. Once they identify the preferred language, staff enter it on the patient's registration forms. If the provider has a need for an unusual language, an appointment can be made within a 2-week window to assure that the interpreter will be available to take the call. Providers also can make special requests, such as an interpreter of a particular gender or with specialized training (e.g., in mental health services). In emergency situations, they can designate a call as a priority and receive immediate assistance. (When calling the network, providers are immediately routed to a medical interpreter trained in all aspects of health care interpreting, including mental health and palliative care.)
- Setting up device: Portable and stationary video conferencing and telephonic devices are available throughout each facility. Upon notification from reception, registration, or ED staff, a nurse or designated staff member sets up the appropriate device for the patient and provider.
- Initiating interpreter services: Providers access video- or telephone-based services by pushing a button—either a tethered remote on a video conferencing device or a special button on telephonic devices. For all languages, pushing this button connects the provider to an interpreter via video or phone. If an interpreter is not available or the language requested is not available on the network, the call is automatically routed to the member's contracted telephone-based service.
- Providing services: For video services, providers position the clinical video unit so that the patient and provider can be seen by the interpreter. For telephonic-based services, patients and providers listen to the interpreter on a speaker phone or a hand-held, dual headset phone. If the patient is not with the provider, interpretation services are provided via a three-way call by phone.
Context of the InnovationContra Costa county has approximately 1 million residents representing many ethnicities, with the largest numbers including people of Latin American and Asian descent. Contra Costa Health Services is a comprehensive county health system that includes a 164-bed medical center and 9 health centers. As an original partner in the planning and development of the Health Care Interpreter Network, Contra Costa Health Services, along with the other two original partners, San Joaquin and San Mateo Counties, formed a temporary governance structure to oversee the network. The network began after the U.S. Department of Commerce Technology Opportunities Program and several California-based organizations, most notably the California Healthcare Foundation, provided grants to help fund its development. It was then decided by the original partners to create a nonprofit organization (HCIN.org) to offer the system to California-eligible health care organizations. In August 2005, several clinics within the Contra Costa system, along with San Joaquin General Hospital and San Mateo Medical Center, participated in a pilot study to test the network's services. Based on its success, nine Contra Costa clinics and its regional hospital now participate.
ResultsThe program improved access to interpretation services, with both patients and staff generally accepting the idea of receiving "remote" services from offsite interpreters.
Suggestive: The evidence consists primarily of post-implementation feedback received during interviews with 84 Contra Costa patients with limited English proficiency (mostly Spanish speakers) and with 72 staff members in a variety of positions at Contra Costa's health centers and hospital.
- Improved access: Survey-based feedback from providers and patients suggest that participation in the Health Care Interpreter Network has improved the ability of Contra Costa Health Services to provide prompt interpretation services to the vast majority of patients with limited English proficiency. Data from across the whole network also suggest the program has enhanced access to interpretation services, as the system routes approximately 18,000 video conference and phone calls each month, with requests usually answered in less than 1 minute. The typical interpreter at participating sites now helps 25 to 30 patients a day, up from 8 to 12 before the network was established.
- Acceptable to patients: More than three-fourths of surveyed patients at Contra Costa agreed that using an offsite interpreter was an acceptable way to provide such services, including 23 percent who strongly agreed with the approach.
- Supported by staff: The vast majority of Contra Costa staff rated the interpretation services highly, including 33 percent rating them "excellent" and 54 percent "good."
Planning and Development ProcessKey elements included the following:
- Assigning responsibility for system implementation: Contra Costa Health Services assigned a corporate staff member to oversee implementation throughout the system. This individual facilitated contact between network representatives and key staff at the clinics and hospital.
- Obtaining buy-in and training interpreters: Senior Contra Costa and network interpreter staff spent focused time explaining the network's services and benefits to inperson interpreters in the Contra Costa system. They emphasized that the video and audio interpretation services would allow them to help twice as many patients each day. Interpreters participated in approximately 40 hours of training that addressed equipment use, effective interpreting through video and telephone, and session documentation.
- Installing system: Working with senior staff, Health Care Interpreter Network representatives developed a plan for each facility that identified the type of equipment required (e.g., video, telephonic, permanent, and/or mobile) and where it should be located. In addition to installing video and phone ports throughout each facility, they established secure areas in which interpreters could engage in private conversations in accordance with Health Insurance Portability and Accountability Act regulations.
- Training hospital staff: Administrative and medical staff participated in training sessions on the mechanics of the equipment and how to use the service with patients. Registration and other staff who work at entry points received training first, followed by nurses and other providers.
- Developing administrative procedures: With guidance from network staff, Contra Costa billing departments instituted procedures for monitoring and paying expenses associated with the new system.
- Publicizing system: With guidance from the network, Contra Costa communications staff developed signs and other materials to publicize and explain the system to patients.
- Evaluating program effectiveness: Senior staff allocated resources to conduct patient and staff surveys related to the program, with a focus on gauging the effectiveness of staff training and equipment maintenance, the need for system expansion, and overall satisfaction with the program.
Resources Used and Skills Needed
- Staffing: Contra Costa Health Services dedicates one full-time manager to the program. All other staff within the clinics and hospital participate as part of their regular duties. The Health Care Interpreter Network provided training to Contra Costa staff as part of program startup, and the program manager provides ongoing training and support.
- Costs: Total program costs are roughly $250,000 annually, which includes $183,500 for calls rolled over to the contracted vendor. An annual Health Care Interpreter Network cost of approximately $66,500 reflects a cost offset that results when Contra Costa interpreters handle calls from network partners.
Funding SourcesContra Costa Health Services
As noted, the U.S. Department of Commerce Technology Opportunities Program and several California-based organizations provided grants to help fund the network's development.
Getting Started with This Innovation
- Assess adequacy of current services: Although many factors affect health outcomes, providers need to recognize the importance of cultural and linguistic competence in ensuring access to quality care. In assessing current services, would-be adopters should examine the number of languages spoken by their patient population, the availability of interpreters in these languages trained to work in medical environments, and the costs associated with providing inperson interpretation services.
- Obtain program support and buy-in: In addition to senior leadership support, would-be adopters need to secure buy-in from existing inperson interpreters who will need to adapt their skills to the new system.
- Designate network manager: Depending on the size of the facility, a full- or part-time manager will be needed to oversee program operations. This individual should be made responsible for onsite program management and for maintaining relationships with network personnel, training staff, and evaluating system effectiveness.
Sustaining This Innovation
- Provide ongoing training: Ongoing program success requires periodic training of administrative, medical, and interpreter staff as part of regular staff development programs.
- Evaluate patient and staff satisfaction: To maintain quality services, conduct regular surveys of patients, physicians, and other staff on the system's effectiveness. This information can help to identify needs related to training, equipment, and system maintenance and expansion (see below for more information).
- Regularly maintain, review equipment: To ensure that equipment remains operational and accessible, make frontline and technical staff responsible for ongoing maintenance and for periodic operational reviews to determine the need for equipment changes.
Contact the InnovatorSally McFalone
Linguistic Access Services Manager
Contra Costa Health Services, Public Health
597 Center Ave. Ste. 275
Martinez, CA 94553
Phone: (925) 313-6242
Fax: (925) 313-6550
6400 Hollis St., Suite 9
Emeryville, CA 94608
Phone: (510) 658-2831
Fax: (510) 764-2415
Innovator DisclosuresMs. McFalone reported having no financial interests or business/professional affiliations relevant to the work described in the profile other than the funders listed in the Funding Sources section. Mr. Puglisi reported receiving travel support from Kaiser Community Benefit. The Health Care Interpreter Network received grant or contract funds from the California HealthCare Foundation and Kaiser Community Benefit.
References/Related ArticlesTo learn more about Health Care Interpreter Network, go to http://www.HCIN.org.
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Original publication: September 28, 2011.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: October 23, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.
Date verified by innovator: September 19, 2012.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.