*Great honour. My 7 images were used for the world leading sociolinguistics team, "Language on the Move."
Hospital corridor, by Sadami Konchi ©
In this episode of the Language on the Move Podcast, Brynn Quick speaks with Erin Mulpur about how hospitals can provide linguistic minority patients with access to interpreting services.
Erin holds a Master of Public Health and is the System Director at Houston Methodist Global Health Care Services in Houston, Texas, United States.
The conversation addresses the potential barriers to both communication and healthcare that linguistic minority patients may face in hospitals, as well as Erin’s 2021 paper Reducing Barriers to Language Assistance During a Pandemic which details Houston Methodist Hospital’s innovative use of a particular language assistance technology during the first waves of Covid-19.
This episode is a natural extension of Distinguished Professor Ingrid Piller’s chat with Dr Jim Hlavac, so be sure to listen to both episodes!
Enjoy the show!
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Artwork
The artwork in this post is from Sadami Konchi’s hospital collection. To learn more about Sadami Konchi’s art visit her website or follow her on Instagram.
Surgery, by Sadami Konchi ©
Reference
Mulpur, E., & Turner, T. (2021). Reducing Barriers to Language Assistance During a Pandemic. Journal of Immigrant and Minority Health, 23(5), 1126-1128. https://doi.org/10.1007/s10903-021-01251-2
Episode Transcript
Brynn: Welcome to the Language on the Move Podcast, a channel on the New Books Network. My name is Brynn Quick, and I’m a PhD candidate in Linguistics at Macquarie University in Sydney, Australia.
My guest today is Erin Mulpur. Erin holds a Master of Public Health and is the System Director at Houston Methodist Global Health Care Services in Houston Texas, United States. Today we are going to talk in general about her work with hospital patients from non English-speaking backgrounds, and in particular about the 2021 paper that she co-authored with Travis Turner entitled “Reducing Barriers to Language Assistance During a Pandemic”.
Welcome to the show, Erin. It’s lovely to have you.
Erin: Thank you so much, Brynn. I am delighted to be here today.
Brynn: So, can you start us off by telling us a bit about yourself? How did you become interested in working with hospital patients from non-English speaking backgrounds, and what kind of work do you do now?
Erin: Absolutely. So, I originally grew up in Montana, a state in the US, and I actually grew up on an Indian reservation. It was the Flathead Indian reservation, so the Salish and Kootenai tribes both lived on that reservation. At a young age, I had a deep, deep desire, instilled by my family, to be respectful of all cultures, and also a deep understanding that language is such a vital part to people’s culture. It’s their voice, it’s how they articulate themselves in the world, and when there isn’t a shared language, then it’s really difficult to connect.
Nurse, by Sadami Konchi ©
And so, at a young age that is definitely something that was a part of my life. Moving on, I went to graduate school and, you know, went to undergrad and then to graduate school, and ended up getting my Masters in Public Health after spending some time in Uganda working for a government-run hospital in Iganga District. And again, this focus on wanting to deeply understand other cultures, be respectful of other cultures, and understanding that language is such a vital part of that – it really led me into this role at Houston Methodist, where I am now.
So, what I do at Houston Methodist, I’ve been here for about 10 years, and I oversee our Special Constituent Management Program and also our Global Patient Services Program. So, what that means is that we have patients who travel from over 70 countries from around the world, speak multiple different languages, and they are facilitated by an amazing team here at Houston Methodist that I have the privilege to work with every day. And my staff come from over 30 countries from around the world. They speak so many different languages, and it’s this beautiful, diverse scenery where we have the ability to take care of patients from different backgrounds, different cultures here at out hospital because they travel to Houston for care.
And we also oversee our Domestic Language Program. So, when you think about it from a healthcare perspective, when a physician walks into a room and he notices that a patient does not speak English, he or she is not thinking, “Is this patient traveling internationally, or is this patient a local patient from our community?”. So, our team, my team, has the privilege to take care of both of those patient populations here at this hospital.
And for those who may not know as much about Houston, TX, we are the fastest-growing diverse city in the United States. So, over 40% of people over the age of 5 speak another language than English in our city, and so when you think about that, over 140 languages are spoken in our city. And when we just looked at our data last year, over 70 languages are spoken just by patients at our hospital. So, it’s so, so important to think about language assistance and think about making sure that patients understand the care that they’re receiving, and that is what I’m doing today.
Treatment room, by Sadami Konchi ©
Brynn: That is fascinating, and what an amazing opportunity to do that kind of work. That’s incredible. So, can you tell us what are some common barriers that patients face if they don’t have a high level of English proficiency and seek treatment at an English-dominant hospital? And this could apply at Houston, but it could also apply to where I’m coming from in Sydney, Australia.
Erin: Absolutely. Absolutely, Brynn. I would say that everything can be a barrier, honestly. When you think about patients navigating a website to a hospital – is the website available in multiple languages? If the patient is calling the call centre to schedule an appointment, is that call centre offering language assistance? Are there options to push for Spanish or Arabic or Vietnamese? What is that infrastructure around language assistance? So, I can say that everything is a barrier if it’s not thought about and intentional to make sure that you’re opening access to everyone, not just English-speaking patients.
And that’s what we see here at Houston Methodist, and that’s why we have created content that’s in multiple languages. That’s why we have our phone system that can be in multiple languages. We have so much infrastructure and technology because we know that if you don’t create that, then patients don’t have a voice.
Brynn: Absolutely, and I absolutely agree. And that brings us to your paper, “Reducing Barriers to Language Assistance During a Pandemic”. This is a fascinating paper, and if anyone has the chance to read it, I would highly recommend. So, can you tell us a bit about something called the Vocera Smartbadge? What is that, and how was your hospital already using it before the Covid-19 pandemic struck?
Erin: Absolutely, so our nurses, prior to Covid, had what is referred to as a Vocera Smartbadge. The way that I would articulate that is that it’s like a smart walkie-talkie where you can dial in, you have the ability to ask the device to call other departments and other services, and so it was really leveraged and utilised amongst the clinical team for patient care. So, if the nurse was in a room, needed another nurse, she could push the button and she could say, “Dial this nurse in this other room”, and so it had that technology and was utilised in that way prior to Covid. It was really helpful because it allowed a hands-free way to care for patients, but also have the ability to connect with other people on the care team.
Brynn: And I think for those of us who’ve been in hospitals before, we’ve seen this happen with handheld phones. We’ve seen nurses be in hospital rooms and call each other on handheld phones, so from my understanding, the Vocera Smartbadge is really kind of that same idea, but, like you said, hands-free, and it’s more voice command, voice-activated.
Treatment, by Sadami Konchi ©
Erin: Absolutely, so it can attach to the lapel or a jacket, and you don’t have to dial anything, you can push a button and you can ask the Vocera device to call into a directory that has already been created.
Brynn: Exactly, and so your hospital, during Covid-19, was able to use the Vocera Smartbadge in a really novel way to provide language services to patients during the pandemic. Can you tell us how that happened and what you observed?
Erin: Absolutely, so unfortunately, with the Covid pandemic, here in the US and in many other countries, we had a limited supply of personal protective equipment. So, I currently have staff who provide in-person interpretation. So, you think about any time an in-person, someone needs to go into the room and provide in-person interpretation, they would have to don and doff gowns. So, with the limited supply of PPE, really the goal was to just use PPE for people who were physically clinically caring for the patient to keep them safe. So, it was really a difficult time to think about, “How are we going to provide language assistance and still keep with that value of ours and making sure that our patients understand the care they are receiving, but not have enough PPE for our in-person interpreters?”
So, what we ended up doing is we ended up integrating our technology around language assistance. Over the phone interpretation was then embedded within that Vocera device to where a nurse who was in PPE, speaking with a patient who was limited English proficient, would have the ability to dial in an over-the-phone interpreter and that patient would still be able to hear, from the nurse’s chest, to that patient to be able to understand the care that they’re receiving, and receive care in the language that is needed to them. That was something that we were able to do. We were able to stand that up fairly quickly because we already had the Vocera device in action and already utilised across our system. It made it really, really easy for us to be able to do it once we were able to accomplish that.
What we found during some of the waves during the Covid pandemic, a few of the surges of patients, there was a large Latino population that ended up receiving care at our hospital that were Spanish speaking. So, it came right in the nick of time, I would say, for us to be able to have that in-person, that interpretation provided by the nurse between the patient and the nurse.
Brynn: And that’s so important because, part of the research that I’ve been doing has been looking into the disparities, the health disparities between majority language speakers and linguistic minorities. We know that there was a larger Covid-19 mortality amongst linguistic minority patients. So, the fact that you were able to integrate this technology could have made the difference, literally, between life and death for patients. So, that is fantastic that that was able to happen.
Patient, by Sadami Konchi ©
You mentioned this, this is something that I found really interesting in your paper, was that concept of the voice coming from the person’s chest because the Vocera Smartbadge was located on the chest, so it was almost like that interpreting voice was coming from the healthcare provider which, as we know, can sometimes be something that is tricky to deal with. When there is this, especially over the phone interpreting, or video interpreting, is this idea of distance between the person who is trying to receive the healthcare and then the healthcare provider. So, the fact that it was literally coming from the healthcare provider’s chest, I think, made it that much more valuable.
Erin: Absolutely, no you’re absolutely right, Brynn. When talking with patients and, you know, hearing their experience with that, they understood the limited amount of PPE, and they also understood and felt that that connection with the nurse and having that voice be so close to the person’s heart, it allowed it to be more intimate than it otherwise has been in the past with some of the technology that has been created around language assistance.
Brynn: Absolutely, thank you. Sort of shifting gears a little bit, what do you feel is something that people, generally monolingual English-speaking or Americans or, even in my case, monolingual English-speaking Australians, I know I don’t sound Australian, I’m originally American, obviously. What do you think is something that those people get wrong when they think of people from non-English speaking backgrounds who seek treatment in predominantly English-speaking hospitals?
Erin: That’s a great question, Brynn, and I would have to say that there’s a tremendous amount of unconscious bias that can occur in a healthcare setting, and even outside of a healthcare setting. It persists in the world that we live in, and so that unconscious bias can impact the provider, it can impact the patient, and so what I would say is – have no assumptions. Be curious. Always be willing to learn something new.
So, as an example, in the role I’m in, I work with patients who are coming from the Middle East, and there are Muslim men who come to our hospital for care, and I know that I’m not to extend my hand. It’s a sign of respect in US culture to extend your hand and to shake someone else’s hand, but in other cultures it’s not necessarily seen as respectful. So, that is something that I have had to learn and implement into my life and my routine. That’s the piece around monolingual cultures, I think it’s important to draw no assumptions. To be curious, and to be open to learning. And, when you’re open to learning, you’re also open to making mistakes. Once you’ve made a mistake because, maybe you find out that you have unconscious bias that you’re not aware of, change. Adapt. Evolve. Learn. Continue to grow. Be curious about other cultures.
Brynn: Absolutely, I couldn’t agree more. In your opinion, what can hospitals do to ensure that linguistic minority patients can access care in a language they can understand?
Patient, by Sadami Konchi ©
Erin: I would say, Brynn, that depending on where these hospitals are located – I know that not all hospitals are looking at this data. Maybe some hospitals don’t even have data to look at. So, you know, in our system, we have an electronic medical health records system, and we utilise EPIC. We’re able to see, based on how that patient is flagged within EPIC, we’re able to see if they need language assistance or not. So, we’re able to see that data, and we’re able to implement solutions and structure and infrastructure and policies around that.
For other hospitals, maybe there are some hospitals that don’t have that kind of access to data, and so what I loved about your paper, Brynn, is that you’re looking at what is the community? What is the language of the community that you’re serving? If you don’t have the data within your hospital, expand to your population. What languages are spoken in your population? Those people are coming to your hospital for care. So, what language programs and language assistance do you need to set up to make sure that these patients feel seen and valued and heard? That is something that I think is so important.
And if you don’t have that expertise, it’s ok! There are consultants. There are different organisations, I mean we have a consulting arm to our operations as well. We have the ability to come in and advise, but be ok asking for support and expertise outside if you don’t have that infrastructure created, because, ultimately, what will happen in any hospital setting, is if a patient receives care that does not share the language of the provider, and they consent, or they end up having a surgery, and they have some sort of complication that they were not aware of, the legal risks and the lawsuits that come from patients not understanding their care are so grave for organisations. So, first and foremost, providing language assistance is just the right thing to do. It’s just the right thing to do. If that’s not convincing you enough, there are major financial risks if you do not provide language assistance to patients.
Brynn: 100%, absolutely. So, before we wrap up, can you tell us what’s next for you and your work? It sounds like you all are doing some truly amazing work at Houston Methodist, and I would just love to know where you go from here.
Erin: Yes, so as you can hear from my history, I am a bridge-builder. I like to bridge people to have access and resources and understanding. So, I love the idea of building bigger bridges in the future so more people have access to care, more people understand the care that they’re receiving. I also believe that when you look at healthcare right now, it’s being so rapidly disrupted. There’s so much technology that is being pushed into healthcare. You see so much artificial intelligence as well being utilised in healthcare. That is where I see language assistance going next, but it could be leveraged. I do think artificial intelligence will be leveraged in a healthcare setting in the future and even with language assistance in the future.
But artificial intelligence will never take away from human connection. It will never take away from in-person interpretation and from a person being seen, heard and valued by a person who physically is there with them and is able to speak their language. But when you think about the amount of care that patients receive at a hospital – there’s nurses rounding on them, physicians rounding on them, specialists, respiratory therapists, occupational therapists – there’s all sorts of people that are part of the clinical care team that help that patient while they’re here. Being able to allow them access to multimodalities for language assistance just means that that patient is getting as much language assistance as they can while they’re at our hospital. So, I do see the bridge getting bigger and wider in the future, and I see technology being a big part of that. And that is really where we are looking in the future here at Houston Methodist.
Brynn: And I love that idea of, yes, there’s absolutely a place for these technologies that we’re seeing expanding and developing, but that, at the core, we as humans still need other humans. We need that human connection and interaction that human interpreting can provide.
With that said, Erin, thank you so much for speaking with us today. We really appreciate it, and I feel like our listeners have learned a lot. Thank you.
Erin: Wonderful, thank you so much, Brynn, it has been such a pleasure connecting today.
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