Name | The Communicate Study: A health systems intervention to improve uptake of Aboriginal interpreters at a tertiary referral hospital. |
Why | An estimated 50% of hospital separations of Aboriginal people at Royal Darwin Hospital are for Aboriginal language speakers who would benefit from the use of an interpreter, but few get access. Ineffective communication about health matters including diagnosis, treatment and prognosis is associated with poor health outcomes, while interpreter use can improve outcomes. Systems changes are needed to support greater uptake of interpreters. High quality inter-cultural communication is one component of culturally safe care. |
What | Employment of a hospital-based Aboriginal Interpreter Coordinator | ‘Working with Interpreter’ training sessions: | Clinical championing of interpreter use |
| An Aboriginal Interpreter Coordinator was employed to address barriers to interpreter use. The individual appointed to the role remained in the role for the whole study period with no staff turnover. They had prior training as an Aboriginal Health Practitioner and work experience as an Aboriginal Liaison Officer. Aims of the role as originally conceived were to: • Provide a central point of contact for health care providers to make bookings. • Coordinate the efficient use of on-site interpreters (i.e. pro-actively seeking clients who need a same-language interpreter and informing the medical team that they are on site). • Ensure the rostered interpreter is used effectively. | These comprised 60 minute hospital-based training sessions provided by the Aboriginal Interpreter Service for all new interns during their orientation days, and for doctors in specific divisions (Emergency department; Surgical division), addressing: an introduction to how different languages work; overview of Aboriginal languages spoken in the Northern Territory; why context is important in communication; how to avoid common areas of miscommunication; how to communicate in plain English; how to work with an interpreter effectively; practical tips for booking and using Aboriginal interpreters. | Medical officers working in the hospital volunteered as ‘clinical champions’, ensuring use of interpreters in their clinical role and advocating use to colleagues. ‘Champions’ met regularly with the study team to discuss barriers and facilitators, and ways to advocate for and promote the use of interpreters in their daily work. |
Materials | The Aboriginal Interpreter Coordinator was introduced at a Hospital Grand Rounds session, was a visible presence on wards, and sent regular emails to all clinical staff relating to Aboriginal interpreter matters, such as whether there was a rostered interpreter onsite and what language(s) they spoke. | Training materials included documents containing contact details for the Interpreter Service and showing language names mapped to Aboriginal communities and districts of the Northern Territory. | Champions helped to make sure posters and fliers about the NT Aboriginal Interpreter Service were visible on hospital noticeboards, and to place bookings forms in prominent places on the different wards. |
Who provided | Aboriginal Interpreter Coordinator employed by the hospital. Also, Interpreters employed by the NT Aboriginal Interpreter Service. | Training was provided by staff from the NT Aboriginal Interpreter Service, with coordination provided by a clinical champion and a Menzies School of Health Research project officer. | Champions were volunteer healthcare providers employed by the hospital. |
How | The Aboriginal Interpreter Coordinator: • Did ward rounds of the hospital to identify language needs and coordinate interpreter bookings was an obvious presence on wards. • Provided in-services on a regular basis to healthcare providers especially nurses and allied health practitioners, promoting interpreter use • Provided mentoring and support for onsite interpreters, especially the rostered interpreter | ‘Working with Interpreter’ training sessions were provided at the hospital in a meeting room easily accessible to the target healthcare provider group during lunch break or during a standing timeslot for training. | Clinical championing of interpreter use was embedded into practice by champions pro-actively identifying language needs and booking interpreters where needed for Aboriginal patients under their care, and promoting interpreter use in informal discussions with colleagues. Regular meetings with Aboriginal Interpreter Coordinator, researchers and clinical champions were held to troubleshoot barriers to using interpreters. |
Where | Royal Darwin Hospital, Northern Territory, Australia. This is a 360-bed public tertiary referral hospital and the largest hospital in the Northern Territory. |
When | April 2018-March 2019 | One-off training sessions were held on September 2018, October 2018, January 2019 | April 2018-March 2019 |
How much | One full time Aboriginal Interpreter Coordinator role was filled for the 12-month intervention period | The three training sessions were attended by 83 healthcare providers (82 doctors and 1 nurse). | The clinical champions participated for the 12-month intervention period. |
Tailoring | Not applicable (one participating site only) |
Modifi-cations | Roles of the Aboriginal Interpreter Coordinator evolved and ultimately focused chiefly on: • Advocacy: Advocating for the cultural and language needs of patients to improve communication and achieve culture change. • Mentoring and support for interpreters when on site: ensuring that interpreters, especially new staff, can be supported to feel confident in the challenging and potentially alienating healthcare environment. • Education for healthcare providers: on when and how to use an Aboriginal interpreter. | No modifications from original plan | No modifications from original plan |
How well (reach) | The Aboriginal Interpreter Coordinator was active across all wards of the hospital. On the basis of the summary above, reach was judged as being good. | While the training was well received and of importance to ensure that healthcare provider expectations of and interactions with Aboriginal interpreters are appropriate, only a small proportion of total healthcare providers attended the working with interpreter training sessions. Reach was therefore judged as being limited. | Clinical championing provides a sustainable, no-cost strategy for modelling behaviour associated with improving quality of care. However as only three clinical champions were involved in the study and had junior roles in the medical hierarchy, reach was judged to be limited. |