A Colorado hospital profits from resolving language barriers

Jen Quevedo, center, serves as a medical interpreter for a patient at Grand River Health in Rifle, Colo. Quevedo now serves as the hospital's language access coordinator. **Ashlie Bramley

/Grand River Health**

Ashlie Bramley

/Grand River Health

RIFLE, Colo. — Maria Olivo started serving as her mom's interpreter when she was about five or six years old, whether they were at a bank or a doctor's office. They lived in Rifle, Colo., a desert town of about 10,000 people, where roughly 36% of people speak Spanish at home. Olivo often felt the weight of that responsibility and worried she would get something wrong.

"I'm pretty sure that a lot of it I messed up," Olivo said last month at Grand River Health, Rifle's 57-bed hospital. "I wasn't sure half of the time, right? I was just a kid."

She did this for 12 years — until she was about 18, "feeling like, 'I hope that was the right word. I hope I relayed back what she needs to do right.'"

Olivo eventually refused to serve as an ad hoc interpreter when her mom needed help communicating at the gynecologist's office.

"You do need to have somebody that knows what they are talking about — that have that terminology, and that they are able to really be your interpreter versus be your daughter," Olivo said.

Olivo is now a quality analyst for Grand River, where she's seen other families go through the same thing. In a series of focus groups in 2023, Hispanic and Latino community members told hospital staff that communication barriers created unnecessary confusion.

Maria Olivo is a quality analyst at Grand River Health and helps manage the hospital's interpreter program. Halle Zander/Aspen Public Radio

Halle Zander/Aspen Public Radio

"There's nobody that can really help me in my language," Olivo said. "Walking in, [they] kind of felt unwelcome just because there wasn't that familiar face."

Poor interpretation can lead to deadly errors and a higher risk of malpractice lawsuits, according to Dr. Glenn Flores, chair of pediatrics at the University of Miami's Miller School of Medicine. He's studied the issue for decades and describes disastrous consequences where small linguistic nuances led to critical errors in care.

Language can be life and death

"We've published a few cases of kids dying who had ad hoc interpreters, like siblings doing the interpretation," Flores said. He added that patients are also less likely to answer truthfully when family members are present, especially when doctors ask about sensitive subjects like drug abuse, domestic violence or sexual assault.

While it's common to see siblings or children fill these ad hoc roles, Flores has seen other facilities rely on untrained staff — even people from a restaurant down the road, in a pinch.

"There's huge variability from hospital to hospital, and it depends on how much they prioritize it, and how much they have in terms of resources to do it," Flores said. "Maybe there's some political overlay on top of that."

But a couple of years ago, Grand River tried something new: in addition to hiring a program coordinator and a full-time medical interpreter, they began offering formal training to qualify their bilingual staff as interpreters. Dozens of employees have since taken the 40- to 60-hour course.

"It actually is embarrassing to me that I used to use family members to help with interpretation in the office," Dr. Kevin Coleman, Grand River's chief medical officer, said.

Dr. Kevin Coleman, chief medical officer at Grand River Health, helped develop the hospital's language access plan. Halle Zander/Aspen Public Radio

Halle Zander/Aspen Public Radio

Leveraging Spanish-speaking staff

A few times a day, the dual-role employees are pulled off their regular jobs — whether receptionists, radiologists or medical assistants — to interpret for Spanish-speaking patients. They also get a small pay bump, depending on how much training they do and whether they become certified. But even with the raises and training expenses, Dr. Coleman says the program still saves the hospital money.

Grand River used to rely on virtual interpretation on phones or tablets to serve most patients with limited English proficiency, but they're using it much less now and paying about a third of the previous cost. The hospital has also seen roughly 50% more Spanish-speaking patients since the program started two years ago.

Dr. Coleman hopes their profits will convince other facilities to improve their services too.

"While there's been an overhead cost, for sure, … it's paid off pretty well," he said.

Grand River's program still has limitations. For languages other than Spanish — and on nights and weekends — the hospital relies on virtual interpreters, who sometimes originate from a different country than the patient and speak a different dialect. Some dual-role employees have also reported feeling overwhelmed by the extra responsibilities. But since the program has grown, Olivo says those concerns have mostly dissipated.

She adds that it's been therapeutic to know that fewer kids in Rifle have to translate for their parents at the hospital, like she had to do for her mom.

"There is a little bit of that healing part of things, of saying, 'Okay, well, this teenager — let her off the hook,'" Olivo said. "'If you want to go hang out — wherever — we will make sure that your mom's taken care of."

Olivo and Dr. Coleman want to see the program continue to expand — hiring dedicated interpreters in departments where it's needed most.