title: Using a risk assessment approach to determine which factors influence whether partially bilingual physicians rely on their non-English language skills or call an interpreter.
abstract: BACKGROUND
  Partially bilingual physicians may weigh a number of factors in deciding whether to use their own limited non-English language skills or call an interpreter when caring for patients with limited English proficiency. Yet little is known about this decision process or how it might fail. In a patient safety approach to exploration of this complex, potentially high-stakes decision, key risk factors that may contribute to miscommunication during health care encounters in non-English languages were identified.
  
  
  METHODS
  The Healthcare Failure Mode and Effects Analysis (HFMEA) method was adapted to examine the decision process. An initial set of possible decision factors was presented to a national expert panel of eight physicians, who modified and expanded the list of factors and then rated each according to four scales: Frequency, Importance, Amenability to Intervention, and Detectability. A "5 Whys" approach was used to examine underlying causes of these failure modes and generate potential interventions.
  
  
  RESULTS
  Nine factors were described that could lead physicians to use their own skills rather than an interpreter when that decision might pose unacceptable risk. The highest-priority factor was lack of knowledge regarding the value of using a trained interpreter and how to work with a trained interpreter effectively. For the top failure mode, a sample hypothetical 5 Whys exercise shows how to examine potential underlying causes and produce recommendations.
  
  
  CONCLUSIONS
  A variety of discrete factors can have important effects on physicians' decisions to use their own non-English language skills or an interpreter. Because this decision can affect patient safety, organizations and policy makers should use these factors to guide local efforts to examine these issues and develop quality improvement and safety activities.
authors.affiliation: Institute for Ethics, American Medical Association, Chicago, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Maul
authors.forename: Marsha
authors.initials: M
authors.lastname: Regenstein
authors.forename: Ellie
authors.initials: E
authors.lastname: Andres
authors.forename: Richard
authors.initials: R
authors.lastname: Wright
authors.forename: Matthew K
authors.initials: MK
authors.lastname: Wynia
mesh_terms: D003657:Decision Making; D006801:Humans; D019359:Knowledge; D019303:Multilingualism; D061214:Patient Safety; D010820:Physicians / Q000523:psychology*; D011787:Quality of Health Care; D018570:Risk Assessment; D014175:Translating