“It’s the difference between life and death”: The views of professional medical interpreters on their role in the delivery of safe care to patients with limited English proficiency

Background: Patients with limited English proficiency (LEP) experience poorer quality care and more adverse events in hospital. Consequently, there is interest in understanding the role of professional medical interpreters in efforts to improve patient safety. Objective: To describe the views of professional medical interpreters on their role in the delivery of safe patient care. Design: Qualitative analysis of in-depth semi-structured interviews. Participants: 15 professional medical interpreters affiliated with the Healthcare Interpretation Network in Toronto, Canada. Approach: Participants’ views on their role in patient safety were analyzed and organized into themes. Key results: Professional medical interpreters described being uniquely situated to identify and prevent adverse events involving patients with LEP by: 1) facilitating communication and enhancing patients’ comprehension, 2) giving voice to patients, and 3) speaking up about safety concerns. Participants described a tension between ‘speaking up’ and interpreters’ ethical imperative to remain impartial. Interpreters also highlighted several challenges, including 4) medical hierarchy and healthcare providers’ limited knowledge of the role of interpreters. These challenges introduced safety issues if providers asked interpreters to act outside of their scope of practice. Conclusions: Our study found that professional medical interpreters view their work as integral to the delivery of safe care to patients with LEP. In order to effectively engage in patient safety efforts together, interpreters and providers require a mutual understanding of their roles. Team hierarchy and limited provider knowledge of the role of interpreters can introduce safety concerns. In addition, interpreters describe a tension between “speaking up” about patient safety and the need for interpreters to remain impartial when facilitating communication. Healthcare institutions, providers, and interpreters must engage in discussion on how to best to “speak up” and integrate interpreters into safety efforts. Importantly, the benefits of partnering with interpreters can only be realized when providers consistently use their services.