Interpreter and Guest Support Services at Boston Medical Center. Organizational & Operational Aspects

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1 Interpreter and Guest Support Services at Boston Medical Center Organizational & Operational Aspects Oscar Arocha Director Diversité culturelle et médiation interculturelle dans l hôpital Bruxelles, Belgique Mardi 23 mai 2006

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3 BMC Map

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5 Boston Medical Center Mission Statement We will provide consistently excellent and accessible health services to all in need of care regardless of status and ability to pay.

6 BMC - FY 05 Statistics! Teaching Hospital (Boston University)! 623 Beds! 27,616 Discharges /year! 421,828 Outpatient visits! 124,447 Emergency Department visits! 20,832 Ambulatory Surgeries! 5,000 employees! Operating expenses: $686 million / FY 05

7 A World of Changes! World conflicts impact migration/refugee changes! International resettlement agencies! Refugee Immigrant! Immigration in Massachusetts (MassINC( MassINC) shrunk - Immigrants account for 17% state s s labor force (1980= 8.8%) - Brazil, Dominican R., China, India, Vietnam, Russia, Haiti, El Salvador, Colombia - From , 1 in every 5 immigrants was Brazilian (17%) - From , 2004, 172,054 new immigrants came to live in MA Without these immigrants, the population in Massachusetts would d have (Boston & New York) - 1 in 4 new immigrants are LEP.! Majority-Minority Minority States: Texas, California, Hawaii, New Mexico

8 Boston immigration Latin America/ Caribean Other Asia Euro pe Asia Europe Canada Other Canada Latin America Caribbean

9 Place of Origin of Boston Residents (Census 2000) Latin America, 5% Europe, 5% Asia, 6% Other, 1% Africa, 2% Caribbean, 7% U.S., 74%

10 KURDISH 0% ETHIOPIAN 1% Requests per language Fy 05 BOSNIAN 2% ALBANIAN 2% *OTHER 6% RUSSIAN 3% ARABIC 3% POLISH 3% SPANISH 35% CHINESE 3% SOMALI 3% VIETNAMESE 4% PORTUGUESE 6% CAPE VERDEAN 10% HATIAN FRENCH 19%

11 YTD Requests For Translation/Interpreter Services 160, , , ,000 80,000 60,000 40,000 20, , , , ,429 98,200 98, ,928 63,500 37,700 FY97 Fy98 FY99 FY00 FY01 FY 02 FY 03 FY 04 FY 05

12 Interpreter Services Department (ISD)! 24/7! Face to face interpreting! Over the Phone Interpreting (OPI)! Video interpreting! Translations! Communication devices! Provider training / in-services (Eric Hardt)

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14 Picture of the entrance (warfa( warfa)

15 The map wall

16 Susan s s office

17 NP office

18 Interpreter Staff! Native speakers (multilingual)! Healthcare professionals! College educated! Medical interpreter experience required! Members of the MMIA! Mandatory yearly trainings! Cultural educators! Community liaison

19 Delivery of service! Scheduling - Intake - Distribution - Re-distribution - Special requests (OR, family meetings, special procedures, cath.. Lab, discharge teachings)! Walk-ins - Emergencies - Same day outpatient visits - Day surgery! On-call services! Telecom - Spanish, Haitian, Portuguese, French, Vietnamese (Other languages through supervisor) - Weekend shifts line - Direct interpreter voice mail - Telecommunication for the deaf (TDD/TTY)

20 Guest Support Services! Added to ISD in 2003! Culturally competent customer service! Point of entry language assistance! Language identification at the entrance! Interpreter services on demand! Staffing representative of the patient population! Comprehensive reception/information services! Usher volunteer program

21 Receptionist duties chart

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23 Receptionist cyracom pics

24 Challenges to ISD! Increasing demand! BMC culture on ad hoc interpreters! Risk management! Mandates! Funding! Access to ISD! Liabilities

25 FY 05 - Requests for Interpreters (Mon-Fri) 4,500 4,000 3,500 3,000 2,500 2,000 Scheduled Requests Added Appointments Unscheduled Requests 1,500 1, Oct. 04 Nov. 04 Dec. 04 Jan. 05 Feb. 05 Mar. 05 Apr. 05 May. 05 Jun. 05 Jul. 05 Aug. 05 Sep. 05

26 Expanding Through Technology! IT Scheduling Support! IT hardware Support! IntrAnet Support! Telephone paging answering system! Standard text pagers for all interpreters! Dual text paging system for the Deaf! OPI devices (Cyracom( Cyracom/Pacific/Online)! Video interpreting (ISDN/Internet/T1)

27 The front desks

28 Picture of the dispatcher

29 Services for the Deaf

30 Video cart picture

31 In Office Support! Language Line Phone Support walk in patients - in any language Dual handset One button dialing to an Interpreter! Customized In-Language Signage POS signage Name-tags for bilingual staff Web and advertising awareness We speak your language

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33 Cyracom demo picture

34 Evolving Technology! Phraselator (portability)! Converser (desktop)! Medbridge (electronic notebook)! Wireless telecom. devices (blue tooth)! Robotics (Intouch( Health)

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40 Purchase: Robot. $110,000 Control center $ 15,000 (per station) Lease: Robot & Control center. $15,000/month

41 Appropriate technology! Needs assessment! Return on investment! Language volume vs. risk & liabilities! Technical support Departmental support! Deployment protocol staff acceptance! Sustainability! Reliable Technology! Simple technology can also produce unwanted results : Translation software products

42 Spanish-Speaking Speaking market in Miami sold T-shirts commemorating the Pope s s visit: I I saw the Potato

43 Ad for a dentist in Hong Kong: Teeth extracted by the latest methodists

44 Thank you! Questions?