ORIGINAL PAPER System-Level Factors Affecting Clinicians’ Perceptions and Use of Interpreter Services in California Public Hospitals Danielle Baurer • Julie C. Yonek • Alan B. Cohen • Joseph D. Restuccia • Romana Hasnain-Wynia Ó Springer Science+Business Media New York 2012 Abstract Professional language interpreters are skilled in the nuances of interpretation and are less likely to make errors of clinical significance but clinicians infrequently use them. We examine system-level factors that may shape cli- nicians’ perceptions and use of professional interpreters. Exploratory qualitative study in 12 California public hospi- tals. We conducted in-person key informant interviews with hospital leadership, clinical staff, and administrative staff. Five emergent themes highlight system-level factors that may influence clinicians’ perceptions and use of professional interpreters in hospitals: (1) organization-wide commitment to improving language access for LEP patients; (2) organi- zational investment in remote interpreter technologies to increase language access; (3)training clinicians on how to access and work with interpreters; (4) hospital supports the training and certification of bilingual staff to serve as inter- preters to expand in-person, on-site, interpreter capacity; and (5)organizational investment in readily accessible tele- phonic interpretation. Multiple system-level factors underlie clinicians’ use of professional interpreters. Interventions that target these factors could improve language services for patients with limited English proficiency. Keywords Language services Á Hospitals Á Clinicians Background The growing cultural and linguistic diversity of the com- munities that hospitals and clinicians serve poses chal- lenges to providing safe, high quality care to all patients. Approximately one in five Americans speak a language other than English at home, and 9 % have limited English proficiency (LEP), meaning that they speak English less than very well [1]. A 2006 national survey found that 80 % of hospitals encountered LEP patients frequently (i.e., daily, weekly, monthly) with 43 % reporting daily and 20 % reporting weekly encounters [2]. These trends have important implications for providing high quality and safe care to LEP patients [3–5]. A landmark report by the Institute of Medicine (IOM) identified health system factors as a source of racial/ethnic disparities in health care and stressed the need for system- level strategies to improve quality and reduce disparities in care [6]. One specific system-level strategy that hospitals and other health providers can adopt to improve quality for LEP patients is to provide access to trained professional interpreters [7, 8]. Karliner et al. [8] define a professional interpreter as one who is paid for and provided by a hos- pital or health system to interpret, as opposed to an ad hoc interpreter, such as family members, friends, or bilingual staff who are not trained to provide interpretation services during a health care encounter and who may not be familiar with medical terminology. Professional interpreters are more likely to have knowl- edge of medical terminology, are skilled in the nuances of interpretation, are less likely to make errors of clinical sig- nificance, and are more accurate and reliable than ad-hoc D. Baurer Á J. C. Yonek Á R. Hasnain-Wynia (&) Center for Healthcare Equity, Institute for Healthcare Studies, Northwestern University, Chicago, IL, USA e-mail: r-hasnainwynia@northwestern.edu A. B. Cohen Health Policy Institute, Boston University, Boston, MA, USA J. D. Restuccia School of Management, Boston University, Boston, MA, USA J. D. Restuccia Center for Organizational Leadership Management Research (COLMR), Boston VA Healthcare System, Boston, MA, USA 123 J Immigrant Minority Health DOI 10.1007/s10903-012-9722-3