"The talking bit of medicine, that's the most important bit": doctors and Aboriginal interpreters collaborate to transform culturally competent hospital care

Vicki Kerrigan, Stuart Yiwarr McGrath, Sandawana William Majoni, Michelle Walker, Mandy Ahmat, Bilawara Lee, Alan Cass, Marita Hefler, Anna P Ralph, Vicki Kerrigan, Stuart Yiwarr McGrath, Sandawana William Majoni, Michelle Walker, Mandy Ahmat, Bilawara Lee, Alan Cass, Marita Hefler, Anna P Ralph

Abstract

Background: In hospitals globally, patient centred communication is difficult to practice, and interpreters are underused. Low uptake of interpreters is commonly attributed to limited interpreter availability, time constraints and that interpreter-medicated communication in healthcare is an aberration. In Australia's Northern Territory at Royal Darwin Hospital, it is estimated around 50% of Aboriginal patients would benefit from an interpreter, yet approximately 17% get access. Recognising this contributes to a culturally unsafe system, Royal Darwin Hospital and the NT Aboriginal Interpreter Service embedded interpreters in a renal team during medical ward rounds for 4 weeks in 2019. This paper explores the attitudinal and behavioural changes that occurred amongst non-Indigenous doctors and Aboriginal language interpreters during the pilot.

Methods: This pilot was part of a larger Participatory Action Research study examining strategies to achieve culturally safe communication at Royal Darwin Hospital. Two Yolŋu and two Tiwi language interpreters were embedded in a team of renal doctors. Data sources included interviews with doctors, interpreters, and an interpreter trainer; reflective journals by doctors; and researcher field notes. Inductive thematic analysis, guided by critical theory, was conducted.

Results: Before the pilot, frustrated doctors unable to communicate effectively with Aboriginal language speaking patients acknowledged their personal limitations and criticised hospital systems that prioritized perceived efficiency over interpreter access. During the pilot, knowledge of Aboriginal cultures improved and doctors adapted their work routines including lengthening the duration of bed side consults. Furthermore, attitudes towards culturally safe communication in the hospital changed: doctors recognised the limitations of clinically focussed communication and began prioritising patient needs and interpreters who previously felt unwelcome within the hospital reported feeling valued as skilled professionals. Despite these benefits, resistance to interpreter use remained amongst some members of the multi-disciplinary team.

Conclusions: Embedding Aboriginal interpreters in a hospital renal team which services predominantly Aboriginal peoples resulted in the delivery of culturally competent care. By working with interpreters, non-Indigenous doctors were prompted to reflect on their attitudes which deepened their critical consciousness resulting in behaviour change. Scale up of learnings from this pilot to broader implementation in the health service is the current focus of ongoing implementation research.

Keywords: Aboriginal; Communication; Cultural safety; Health; Healthcare communication; Interpreters; Racism.

Conflict of interest statement

At time of writing, Sandawana William Majoni and Anna P Ralph were employed by Top End Health Service. Michelle Walker and Mandy Ahmat were employed by the NT Aboriginal Interpreter Service. Alan Cass was a Board Director for Top End Health Service from 2015 until June 2017. Bilawara Lee was a member of the TEHS Health Advisory Group and a member of the NT Health Ministers Advisory Committee. No competing interests were declared by other authors.

© 2021. The Author(s).

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Source: PubMed

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