Language barriers threaten patient safety at Iqaluit hospital, says report

A new report on Qikiqtani General Hospital's compliance with Nunavut's Official Languages Act finds that health care staff's inability to communicate with patients in their mother tongue is jeopardizing patient safety.

The report, titled "If You Cannot Communicate With Your Patient, Your Patient Is Not Safe", follows an investigation of Nunavut's only hospital and its ability to provide services to patients who speak Inuktitut or French, and the impact of language barriers on quality of care and access to health care.

"Language barriers are systematically mentioned as a major barrier, if not the most important barrier to health care services," according to the report.

The report outlines three factors influencing the quality of health care: "language barriers, the refusal to see that patient safety is not ensured and the lack of willingness to find solutions."

'Misdiagnoses, medical errors, lengthy delays'

Language barriers have a significant impact on quality of care, access to health care, confidentiality and compliance with a treatment plan, according to the report, which reads that "language barriers may result in misdiagnoses, medical errors, lengthy delays and often improper medication in treating pain."

The report also flags issues associated with using untrained ad hoc interpreters such as family members and friends.

"These untrained interpreters not only run the risk of improperly interpreting key concepts, but they may also distort the message by omission or by direct intervention in the process, thus increasing the risk of a misdiagnosis and inappropriate treatment." The report adds that the use of these ad hoc interpreters also negates a patient's right to confidentiality.

The report also underlines reduced access to mental health services when language barriers exist, saying that nonverbal signals "vary from one culture to another" and that "the quality of verbal communication between patient and provider is a very important factor."

Language barriers can also threaten treatment plans and follow-ups when patients do not understand the instructions given to them, including information about prescriptions.

"At the time of the investigation, all recommendations, instructions, prescriptions and other types of related information, both verbal and written, were available in English only," states the report.

Some recommendations in the report:

• The development of a language plan and objectives by the Department of Health
• Establishing strategies that outline the methods used to eliminate language barriers
• A review of the hiring policies by the Department of Health and the Department of Finance to consider priority hiring to include those with French and English after considering Land Claims Agreement obligations
• Ensuring that all Department of Health staff are aware of language rights and incorporate that understanding in day to day practice
• The active offer of services in desired languages by the Department of Health across all primary care service, including escorts and medevac services
• Implementation of accountability measures within the Department of Health's senior management on language obligations
• Developing a clear goal on the importance of providing equality of primary health care in all official language groups
• Establishment of standards of service regarding interpretation
• The development of competency tools to evaluate language proficiency of medical interpreters
• Giving interpreters a professional status to address pay equity issues and facilitate recruitment and retention
• Language training for employees at the hospital to meet language provision requirements in the primary care sector.

Government implementing recommendations

The Government of Nunavut sent a written response to the Language Commissioner regarding the report on Oct. 9, 2015.

"The Department has put in place measures that we trust will alleviate many of the concerns you have expressed," states the letter from the Department of Health.

The letter also states that the territorial government has begun work to implement some of the recommendations in the report, such as revising the territory's model of care.

According to the letter, the government has also begun development of a language plan and new procedures to deal with access to services in all the official languages at Qikiqtani General Hospital.

The letter also notes that the government is developing a representative workforce, including taking steps to hire more bilingual staff, and enrolling its employees in medical terminology courses delivered by Nunavut Arctic College.

The CBC has requested additional comment form the Government of Nunavut.