Sam Wilson, Chief Technology Officer at language services provider Dals, gives some tips on how to overcome any challenges posed by remote methods of language interpreting
One of the enduring consequences of the pandemic is that many things that used to be done in-person are now carried out virtually, often with time and cost savings.
Healthcare is no exception, and remote medical interpreting (RMI) is now far more common than it was in the pre-Covid world.
Given its increasing prevalence in medical settings, researchers at the University of Surrey carried out a study of interpreters to assess their experiences of RMI.
The resulting research, published late last year, found that most interpreters recognised the benefits, including lifestyle advantages and increased access to services for patients with language needs.
However, many also acknowledged challenges when compared with in-person interpreting.
Many of these challenges were technical in nature, with sound issues, the lack of visual cues compared with in-person interpreting and poor logistics among the concerns frequently raised by those with experience in telephone interpreting (TI) and video interpreting (VI).
I would argue these are hurdles that most healthcare providers could largely overcome with the right infrastructure and planning.
I would also argue they should, because being set up for all modes of interpreting is the best way to ensure all patients with language needs are catered for.
Whether they’ve come in for a planned consultation or have arrived unexpectedly in an emergency, every patient needs to be understood if they are to receive the right care.
Covering the basics
Step one for healthcare providers is to look at their existing setup.
The intricate structures and equipment needed for medical facilities mean standard mobile coverage is usually weak inside buildings.
This can hinder TI, however, the workaround here is to use landlines or mobile networks that offer wi-fi calling,
An institution’s own IT setup can also make things harder than they need to be.
Language services providers typically grant access to their interpreters via apps, but firewalls and other security features built into a hospital’s system often block external apps, or disallow camera access.
They can also sometimes be set to work only for Android or Apple operating systems, which may clash with the interpreting company’s system.
Sam Wilson
Healthcare facilities need to get IT involved at an early stage in any discussions with TI or VI providers to make sure all hardware and software can be adapted so the provider’s apps will work with their systems.
Can you say that again?
In the University of Surrey study, the most commonly reported problems were related to sound.
Approximately 90 per cent of both TI and VI interpreters reported issues with background noise and sound quality.
In particular, devices being used on loudspeaker and poor positioning were cited as barriers to communication and survey respondents said this led to frequent requests for parties to repeat themselves.
There’s no easy fix for such issues in some medical settings – it’s one thing to say RMI works best in a quiet space, but it’s also rather obvious and not simple to action in a frantic emergency department.
There are, however, ways to improve audio even in chaotic settings.
For areas likely to suffer background noise, investing in some high-quality separate speakerphones may improve the situation.
Similarly, having some headsets or devices with noise-cancelling headphones may also help.
The caveat here is that in a medical setting, the sharing of headsets is generally discouraged due to the risk of bacteria being spread and the desire for minimal contact, so another option is for a patient and clinician to use separate devices even when they are in the same location rather than sharing one device on loudspeaker.
Picking up the right cues
Another problem frequently cited in the aforementioned research was a lack of visual cues, especially with TI.
A separate study of Scottish interpreters published by Heriot-Watt University in 2021 noted that telephone interpreters spent a significant amount of time and effort compensating for their inability to see patients.
The good news here is that while VI was used rarely prior to the pandemic, its use has increased in much the same way video calls have in business settings.
Healthcare providers have recognised it has significant time and cost savings when compared with in-person interpreting, given there’s no need to pay for the travel or waiting time of interpreters.
VI provides much better scope for facilitating non-verbal communication between patients and interpreters than TI.
As with in-person interpreting, when an interpreter can see a patient is confused from their facial expression, they may repeat their interpretation using different words or ask the practitioner for more detail without the patient even needing to verbalise an issue.
This helps build rapport and minimises the risk of anything being misunderstood.
However, it’s important to get not just the tech, but also the spatial positioning right.
We did a lot of research on this topic when we were designing our Tablet on Wheels – it’s a portable tablet covered in antibacterial casing that’s designed to be at the correct height for a patient’s head when they are in a hospital bed.
Where practitioners don’t have access to something similar, they should think about how they position devices to ensure maximum visibility for any visual cues.
This means making sure the device allows the interpreter to clearly see the patient’s face to read any expressions and also ensuring they can view any hand signals the patient is making.
In addition, while medical staff should not be expected to be experts in lighting, some understanding of the basics can be helpful.
Ideally, patients should be positioned with the main source of light in front of them rather than behind them.
Overhead lighting may cast shadows and obscure the patient’s facial expressions, but staff can mitigate this issue by making sure the video device sits between the patient and the ceiling light.
While RMI may not be suitable for all medical interactions, it is extremely useful in many scenarios and can help reduce wasted appointments and improve patient outcomes.
But to get the most out of it, all healthcare facilities should aim to get their tech right to make sure it aids, rather than impedes understanding.
