Second National Conference on
Quality Health Care for Culturally Diverse Populations:
Strategy and Action for Communities, Providers, and a Changing Health System

I-A2: Using Bilingual Staff To Meet Linguistic Cultural Needs

Overcoming Linguistic Barriers: Using Bilingual Staff to meet Linguistic and Cultural Needs

Health service management in English speaking countries throughout the world has traditionally faced the challenge of language barriers within a sliding scale of implementation strategies. The process of communicating with patients who have limited English proficiency (LEP) progresses arguably from what might be considered and most likely to be documented in the literature as an undesirable and at times harmful practice - the use of family members, to the provision of funded interpreter services. Another dimension has developed within more recent years in Australia with the introduction of ethnospecific health worker positions and programs and bilingual health staff as migrants have their overseas qualifications in health recognized or migrants and their children gain qualifications in the health field and become employed in health services. This has enabled the opportunistic use of bilingual and multilingual staff either as an ad hoc or planned mechanism.

This research project has focussed on formalizing these processes of language use within the health care system to foster effective communication between staff and LEP patients by matching the best communication facilitator with the appropriate context of interaction. The ideal communication facilitator may be any of the above staff - interpreter, bilingual doctor or nurse, or indeed family member. It is therefore no longer a sliding scale of poor versus good practice but a plethora of choice, with informed decision making based on circumstance.

In 1996, these researchers conducted a language audit with all staff working in an area health service in Sydney. The survey found evidence that staff use their language(s) other than English (LOTE) in the work place with 31% of staff being bilingual or multilingual and 37% of these staff using their language skills weekly or more frequently. Situations of language use varied from simple tasks, such as giving direction (13.1%) and simple conversation (17.6%) to more complex tasks, for example taking a medical history (8.7%) and conducting consents (11.9%) (Johnson, Noble, Matthews & Aguilar, 1998). Eighteen focus groups were conducted with both bilingual and monolingual (English speaking) staff within this area health service to further explore how and when language is used and to identify barriers to language use. A Bilingual Health Communication Model was developed to describe the language proficiency, placed on a continuum from social to complex proficiency, and the context of language use, placed on an intersecting social engagement to health and medico-legal information transference continuum, articulated by the staff in these groups. This matrix also provided a sound base from which to understand the discomfort expressed by staff when they felt 'coerced' to work in an interaction that required complex language proficiency when their self assessed language proficiency was in the social range of the continuum (Johnson, Noble, Matthews & Aguilar, 1999). A role and function structure used seven key features to delineate the roles of interpreters and bilingual health staff as misunderstandings of these roles were leading to conflict in the work place (Matthews, Johnson, Noble & Klinken, 2000).

This work has been used to inform policy development on the language use of staffs' LOTE and confirmed the need for a tool to assess bilingual staffs' language proficiency in their LOTE. This assessment process has been completed for the Cantonese and Vietnamese languages and a further 4 languages will be conducted in the near future. Observations of bilingual doctor-patient interactions occurred in an emergency setting, bilingual nurse-patient interactions in a short stay medical ward, and interpreter-health staff-patient interactions in a variety of settings across the health service. This work confirmed the Bilingual Health Communication Model but also importantly illustrated the flexibility of medical staff in moving between medical jargon and everyday language use within an interaction, improving the patient's understanding.

Health services must take on the responsibility of incorporating and supporting a number of formal processes to more effectively communicate with LEP patients. This requires a broader understanding of language and its role in the health care setting. Interpreters, bilingual health staff, bilingual community workers, and family/carers are all part of this systems approach and each will be the better communication facilitator in certain circumstances. It is also imperative that solutions to staff issues are a cornerstone to these strategies.

Clair Matthews, BS, Dip. Nutrition and Diet
Manager, Multicultural Health Service
Liverpool Health Service
P.O. Box 7103
Liverpool, BC NSW 1871
Australia
Phone: + 61 2 9828 6220 ‹‹‹‹‹‹‹‹‹‹‹‹‹
Fax: +61 2 9828 6221
Email: clair.matthews@swsahs.nsw.gov.au

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